INS and periodontitis: Currently, it is believed that periodontitis-derived virulence factors can enter the blood circulation through an ulcerated surface in the periodontal pocket48–51 or through saliva to the gastrointestinal tract52 and travel to the pancreas or other insulin-targeting tissues.27–29,53 Of those, β-cells in the pancreas have a high affinity for these virulence factors.27 After long-term stimulation with virulence factors, β-cell status shifts from a compensatory state to a decompensatory state, thereby becoming dysfunctional.