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Diabetes & Periodontal Disease

Two Diseases with a Common Enemy... You!

By Dr. Brian L. Mealey


United They Stand

Think of it this way, periodontal disease is a wound which is an open ulcer facing inward toward the body. Therefore, periodontal inflammation is often hidden and cannot be detected except by a dentist. If it was an exposed wound on the surface of your body, it would cover an area from the size of a fist to a forearm. The potential for biofilm (plaque) related bacterial products and promoters of inflammation to reach the bloodstream, is therefore significant. There is a large body of evidence demonstrating elevated “markers” of inflammation in individuals with periodontitis, particularly if it is severe. There is also strong evidence that diabetes is a risk factor for gingivitis and periodontitis and that level of blood glucose “glycemic” control appears to be an important factor.

In general it is thought that the mechanisms explaining the classic blood vessel complications of diabetes also operate in the periodontal tissues, which are also rich in blood vessels, as are the eyes and kidneys. The periodontal tissues are also different because they undergo constant assault from biofilm bacteria. The inflammatory response, so critical to maintaining periodontal health is markedly altered in many people with diabetes.

The presence of periodontal diseases can also have a significant impact on body function in people with diabetes who, for example, are subject to a six fold higher risk for worsening blood sugar control over time than periodontally healthy individuals. Diabetic individuals with periodontal disease have a greater risk for cardiovascular and kidney complications than diabetic patients without periodontal disease. In a large study on mortality in diabetes, in over 600 subjects with type 2 diabetes, the death rate was over 2.3 times higher from heart attacks, and 8.5 times higher from kidney disease in people with severe periodontitis. The presence of periodontal disease is associated with heart attacks, strokes and kidney complications in people with diabetes independent of other risk factors for these conditions, for example smoking.

Divided They Fall

Clinical trials reveal a significant general health benefit from periodontal therapy in many people with diabetes. Several studies have shown improved blood sugar control in diabetic patients with severe periodontal disease after effective plaque control (improved oral hygiene), scaling, root planing (deep cleaning) and antibiotic therapy. The more periodontal inflammation is reduced, the better the improvement in blood glucose control. Further, periodontal treatment that reduces inflammation may restore insulin sensitivity, resulting in improved metabolic control (general body function). Periodontal treatment therefore not only improves conditions locally resulting in improved dental and oral health, but also decreases the substances that promote inflammation and that can cause insulin resistance, thereby positively impacting blood glucose control.

Information you should provide your physician

  • If you have diabetes and you also have periodontal disease, let your physician know as he may want to call your dentist or periodontist if he is having trouble controlling your blood sugar.

Information you should provide your dentist

  • If you have already been diagnosed with periodontal disease, make sure your dentist knows if someone in your family has a history of diabetes.
  • If you are a woman, make sure your dentist knows if you had gestational diabetes during pregnancy as that can be a precursor to diabetes and diabetes can influence your dental health.

Your General and Oral Health in Good Hands

Strong evidence demonstrates that diabetes increases the risk for and severity of inflammatory periodontal diseases. Furthermore, the presence of periodontal disease may adversely affect blood glucose control in people with diabetes and increase their risk for complications. Because periodontal diseases are “silent” and chronic in nature, many patients do not realize they have them. Likewise physicians may not know that their patients have a condition that affects blood sugar control and makes diabetes management more difficult.

Those with diabetes should see their dentist or a periodontist (specialist in the diagnosis/treatment of disorders of the supporting structures of teeth) to be screened for periodontal disease and those with periodontal disease should be screened for diabetes if signs or symptoms are present.

After periodontal therapy, it is customary for dentists or periodontists to re-evaluate the results several weeks later. Many periodontists now request blood sugar testing to determine the systemic effects of treatment in patients who have diabetes.

Recognition of the relationships between oral and general health will challenge physicians and dentists to work together closely in the future when managing patients with diabetes and periodontal disease.