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Diabetes & Periodontal Disease

Two Diseases with a Common Enemy... You!

By Dr. Brian L. Mealey


Taking care of Type 1 and Type 2 Diabetes

Follow these guidelines to keep blood sugar levels under control:

  1. Follow the healthful eating plan that you and your health care provider, dietician or nutritionist have set.
  2. Try to exercise at least 30 minutes each day. Check with your health care provider to see what activities are best for you.
  3. Take your diabetes medicine as recommended by your health care provider. Keep a daily record of the times of day and the amounts and kinds of medicine you take.
  4. Check your blood sugar level regularly, as recommended by your health care provider. Keep your blood sugar levels as close to normal as possible. Let your health care provider know if your readings are too high or low for two or three days.
  5. Do not smoke.
  6. Brush and floss your teeth every day and visit your dentist at least twice a year. Tell your dentist if you have diabetes and see your dentist if you have a problem with your teeth or mouth.
  7. Check your feet each day for cuts, sores, blisters, swelling, redness or sore toenails. Wear shoes that fit well, and dry your feet between the toes after washing. Have your health care provider check your feet at every visit.

Sources: National Diabetes Information Clearinghouse, U.S. Department of Health and Human Services; Lalla and D'ambrosio; National Diabetes Education Program.

Periodontal Disease — More Than A Mouth-Full

While periodontal diseases may be isolated to the mouth, their effects are not: research is beginning to uncover a relationship between periodontal health and general health. Known risk factors for periodontal disease include smoking and diabetes.

Periodontal disease (peri-around, odont-tooth), or gum disease as it is commonly called, is really a group of diseases caused by dental (bacterial) plaque — the biofilm that collects between the teeth and gums in the absence of effective daily oral hygiene. The end results are the same — destruction of the periodontal tissues which include gingivitis (inflammation of the gums) and periodontitis (the loss of bone and the surrounding periodontal structures).

Nearly all people will develop gingivitis in the absence of good oral hygiene; however, only about 10-15% of people go on to develop more advanced periodontal disease with the loss of supporting bone and eventual tooth loss.

The immune system is the body's way of protecting itself against disease. It is made up of a complex recognition and response system to bacteria or other pathogenic (disease-causing) organisms. Generally, once recognized, specific antibodies to organisms will allow a more rapid response in the future. The immune system responds in different ways to different bacteria in dental plaque. This highly complex interaction gives rise to varying patterns of disease, depending upon which bacteria are involved and which components of the immune system are activated.

Diabetes also results in changes in the function of the immune cells responsible for normal inflammatory response and wound healing. Since the immune system may be compromised in diabetes it can also affect the severity of periodontal disease.

But Why?

One of the major body responses mediated by the immune system is inflammation. Inflammation is actually the immune system at work, trying to isolate disease and prevent spread to other parts of the body and repair the effects of disease. Defense cells and their products get rid of pathogenic (disease causing) bacteria and damaged tissues by the repair process that occurs during wound healing. Unfortunately, the body's immune system can be impeded by a number of factors, heredity being one of the most critical. Certain groups of people carry genes that may predispose them to periodontal and other inflammatory disease like diabetes.

Family history of periodontal disease and diabetes may be an important clue to this since we inherit our genes from previous generations. Genetic testing has recently been developed that helps identify such people, but the genetic components of wound healing are complex and not easily identified by simple genetic tests. Another impediment to the immune system is stress, brought on by physical illness or severe emotional distress. Stress can affect the immune system by lowering resistance, which impedes its ability to fight disease.

Chronic or prolonged inflammation, leads to a progressive shift in the type of cells that are present at the site of inflammation and is characterized by simultaneous destruction of tissues alongside attempts at healing. Inflammatory products may play a major role in the mechanisms and complications of diabetes.