Dentistry and Diabetes

Periodontal disease and diabetes – are dentists doing enough? With a growing population of diabetics (presently 25 million) and pre-diabetics (60 million), I think we are falling short. Gum disease plays an important role in diabetes. There is significant evidence that periodontal (gum) disease may contribute to higher rates of premature death in diabetics. While many people know about diabetic complications of the eyes, kidneys, nerves, blood vessels, and heart, few know much about the connection between periodontal health and diabetes. This is why we as dentists must step forward and educate our patients about the correlation between gum disease and diabetes.

People with diabetes, particularly those with chronic high blood glucose levels, are more susceptible to bacterial infections everywhere in the body, including in the mouth. In addition to making a person susceptible to infections, high blood glucose levels also inhibit the healing of infections. When an infection in the mouth tissues is not controlled, the teeth can become loose, and chewing can become painful or difficult. An uncontrolled infection can eventually cause tooth loss.

High blood glucose levels can raise the risk of periodontal disease in another way as well: When blood glucose levels are high, the glucose levels in all body fluids, including saliva, become very high. Certain bacteria feed on sugar and grow readily in the mouth, particularly when saliva glucose levels are high. And having higher levels of these bacteria in the mouth increases the risk for both periodontal diseases and dental decay.

One early complication of diabetes – namely, changes in the blood vessel walls – can also increase the risk of developing periodontal diseases. In short, the vessel walls become thicker. Blood is necessary to bring oxygen and nutrients to all body tissues and to remove waste products made by cells in the body tissues. Thicker blood vessel walls slow down these processes and weaken resistance to infection. Without a good blood supply, the periodontal tissues become too weak to fight infections.

There is a whole area of research that correlates periodontal health (gums and bone) to systemic disease. The average person has 1500 billion bacteria in the mouth, comprised of 800 species of microbes living under the gums and along the roots of the teeth. When the microbes increase to proportions of high viral, bacterial and fungal loads they spill into the blood and travel to all parts of the body. In their New York Times best seller “You: The Owners Manual” Michael F. Roizen, M.D. and Mehmet C. Oz, M.D. state that “you need to combat gingivitis and periodontal disease which can cause inflammation in your body and aging of your immune and arterial systems.”

A number of studies show a correlation between periodontal (gum) disease and systemic diseases such as cardiovascular (heart) disease, diabetes, sinus problems and multiple other concerns. So the mouth really is connected to the rest of the body! It has been suggested that all diseases start orally and the challenged immune system shows up as problems in the mouth. Gum disease or periodontal disease is a chronic inflammation and infection of the gums that destroys the supporting bone and tissue around your teeth. It is the major cause of adult tooth loss, bad breath, and affects three out of four people after the age of 35. It provides a direct path for bacteria to enter your blood stream on a daily basis.

Do you know if you are at risk for diabetes? To determine your risk for diabetes, consider being seen by a dentist who is an expert in diabetes and periodontal disease for a periodontal evaluation and diabetic risk assessment. Remember, early treatment is the key to your total health. If you are a diabetic, your treatment team should consist of your primary care doctor, nurse educator, eye doctor, other specialists and your dentist. Communication between these health care professionals is necessary for your total health care. We must build a comprehensive and complete program designed to monitor a healthy outcome for diabetes control and prevention.


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team. Diabetes Forecast, pp. 51-53, April 2008