Diabetes and Periodontal Disease

Diabetes and periodontal disease are two common chronic diseases that are reaching epidemic proportions in America; and in fact current research indicates that the two diseases actually directly influence each other. Periodontal disease effects more than half of all adults; and according to recent statistics released by the American Diabetes Association, 25.8 million children and adults in the United States are diabetic. Another 79 million people are pre-diabetic, meaning that they are at risk for developing this serious disease which can affect many major organs including the heart, blood vessels, nerves, eyes and kidneys. Scientists understand a great deal about both diseases and they are learning more all the time… considering the number of people at risk and the potentially life threatening consequences of developing either of these conditions, isn’t it a good idea to know your risks and to understand how the two diseases are linked?

What is Diabetes?

Diabetes is a complicated disease which involves the inability of the body to make the hormone insulin (Type I) or to use the insulin that it makes (Type II). Insulin is necessary to move glucose, also known as “blood sugar” from the blood stream into the cells, to be used for energy that sustains life. When cells do not receive adequate glucose, the body stops functioning…and if too much glucose accumulates in the blood, a variety of severe health complications can occur. Furthermore, people with diabetes are at higher risk for infections and they tend not to heal as well as people without the disease because their immune systems don’t function as effectively.

Type one diabetics are born with the disease, and are treated with replacement insulin. However, type II diabetes generally develops slowly over time as insulin receptors are damaged or destroyed, thought to result from chronic inflammation. Periodontal disease is jointly caused by the by-products of oral bacteria and the body’s inflammatory response to those bacteria. The common thread appears to be inflammation, but how does the diabetes-periodontal disease relationship work? Researchers have determined that there are several reasons for the association.

• Chronic inflammation occurs in the body for a variety of reasons including untreated periodontal infections and even excessive body fat, and the long standing inflammation causes tissue damage. This process is how the gums and bone surrounding the teeth are destroyed in periodontitis. Similarly, inflammation damages the part of the cell that allows insulin to work (the insulin receptor) making cells “insulin resistant”. As the body’s cells become increasingly resistant to insulin, type II diabetes develops. Untreated, the process continues: damaged tissue itself causes more inflammation, so one disease provokes the other.

• High blood sugar inhibits and slows circulation. The body heals itself of infections by using specialized cells and substances transported in the blood to the site of an infection. Sluggish circulation impairs this natural healing ability, which makes the gum tissues more susceptible to infections and much more difficult to treat.
• High glucose levels in saliva promote growth of bacteria that cause periodontal disease.
• Untreated periodontal disease can actually increase blood sugar and make it more difficult to control; and a study in the Journal of Periodontology found that if Type II diabetes is poorly controlled, patients are more likely to develop periodontal disease.

Many of the risk factors that are associated with Type II diabetes can be minimized through healthy lifestyle changes; and fortunately the same is true of periodontal disease. Good home care practices and regular dental checkups are the keys to good oral health, especially for people diagnosed with or at risk for diabetes. Eliminate tobacco use as well… research has shown that diabetic smokers may be 20 times more likely than diabetic non-smokers to develop periodontal disease! The major risk factors for developing Type II Diabetes include:

• High blood pressure
• High blood triglyceride (fat) levels
• High-fat diet
• High alcohol intake
• Sedentary lifestyle
• Obesity or being overweight

Many people feel overwhelmed by everything they need to learn when they are first diagnosed with diabetes, but they quickly realize that they must take steps to manage their condition every day. Excellent oral care is an essential step in that process, and the good news is that your dental team understands its important role.

Research at Columbia University has demonstrated that dentists can often identify patients with undiagnosed diabetes based on what they observe about the conditions in the mouth during a checkup. So, if you are at risk or suspect you might have the symptoms of either diabetes or periodontal disease, please take the risk seriously and speak to both your dentist and physician … it could save your life. If you have already been diagnosed with either condition then you should know that your dentist is committed to working with you and the rest of your medical team to maintain optimal health and quality of life.

Herbal Supplements: A Wolf in Sheep’s Clothing

    The idea that relatively inexpensive, naturally derived products can be used to prevent disease or improve health and quality of life is intriguing to many people. Alternative medicine including Herbal or botanical supplements have been used for thousands of years and are still popular additions to many a modern, health-conscious person’s daily routine.  But don’t be misled… Your herbal remedy may be a “wolf in sheep’s clothing”. Natural doesn’t mean harmless or effective, and most herbal supplements are not regulated by the Food and Drug Administration. That means it’s up to consumers to do their homework and seek the advice of their doctors … do you know what you are taking?

More often than not when it is time to update the health history at the dental office people omit mentioning the supplements and other over-the-counter products that they consume. However, it is important to realize that it doesn’t matter whether the active chemical substances contained in a product occur naturally in a plant or whether they are synthesized in a pharmaceutical laboratory; the effect may be the same.  As a matter of fact, many commonly prescribed medications include ingredients that derived from the very same plants and natural ingredients that are available for purchase over the counter as a supplement. Familiar examples include:

• St. John’s Wort contains ingredients chemically similar to many commonly prescribed SSRI antidepressants like Prozac, Zoloft and Celexa.

• Warfarin (Coumadin) is an anticoagulant or “blood thinner” that contains coumarin, an ingredient found naturally in many plants including sweet clover, licorice, parsley and chamomile.

All drugs (natural or pharmaceutical) that are ingested have what is known as a primary effect (the reason one takes the drug), and a secondary effect (side effect) which can sometimes be harmful. Furthermore, adverse interactions between herbal remedies and prescription medications are common, as are sometimes serious side effects, but we may choose to take these substances anyway when the benefits outweigh the disadvantages.  Vitamins and herbal supplements can cause a variety of effects including bad breath, cardiac and respiratory complications, excessive bleeding, negating or increasing the effects of antibiotics and other types of medications, and more. A few supplements have specific oral effects including these examples:

• Gingko Biloba and several other botanical supplements can cause throat swelling, bleeding of the gums.
• Kava Kava:  can cause muscle spasm of the lips and tongue, may increase the effects of anesthesia during surgery.
• St. Johns Wort:  can cause dry mouth

Botanical supplements frequently do exactly what they are advertised to do, and can be very beneficial; but just as you would not take someone else’s prescription medication, it is important to thoroughly investigate any vitamin or herbal supplement with your health providers before deciding to include it in your health regimen.

Next time you are asked about your medical history at the medical or dental office, remember to list everything you take, including any herbal supplements. The information could be very important when deciding what other medications are prescribed for you, and it may even be a clue to resolving unexplained symptoms!

Tea Time!

Do you have Green tea on your grocery list? If so, you are not alone… it is heavily marketed for its potential health benefits ranging from weight loss to cancer prevention, heart health and more. Recent scientific research supports what Asian medical practitioners have believed for nearly 5000 years: many of the reported general health benefits of tea are genuine, and regular consumption may even improve your oral health!

According to an article that appeared in the Journal of Periodontology, green tea promotes healthy teeth and gums because it contains antioxidants called catechins that interfere with the body’s inflammatory response to the oral bacteria responsible for periodontal disease. Evidence suggests that green tea may have an anti-cavity benefit as well, but interestingly, researchers at the University Of Illinois School Of Dentistry have reported that drinking black tea may also lead to fewer cavities. Black tea seems to inhibit the formation of dental plaque by suppressing the ability of decay-causing bacteria to grow, stick to the teeth and produce the destructive acids that cause decay. This is great news, since about 80% of all the tea consumed in Western countries is the Black Oolong variety.

A few important cautionary notes are in order before incorporating more tea into your diet:

• When sugar is added to the tea, the anti-cavity effect may be lessened or negated – if you must use a sweetener, consider using Xylitol which is a sugar substitute that has its own anti-bacterial effect.

 

• Preparation is important! Releasing the catechins for maximum antioxidant benefit requires that tea be brewed and steeped for 3 to 5 minutes.

 

• Tea stains! Like most pigmented liquids, tea can leave a brown stain behind on your teeth. Rinse with water after drinking tea to keep stain to a minimum, and consider using a whitening toothpaste. Remember that regular professional cleanings and perhaps a simple cosmetic whitening procedure available in the dental office can keep your smile looking its best!

Alternative medicine fads come and go, and it can be a challenge to differentiate between the ones that have some real health benefit from those that have little value or may actually be dangerous. As a general rule, it is a good idea to verify claims about products and practices with reliable sources and research before incorporating any supplement or practice into your diet or self care routine. Your dental team is here to help, and a great resource for all of your oral health questions.

Enjoy the many benefits of a perfectly brewed glass of ice tea (or a cup) this summer … with all of its many benefits, and we look forward to hearing from you!

Why are my teeth so sensitive… and what can I do about it?

With summer just about in full-swing, it seems appropriate to ask a timely and important question:
Do you have a love-hate relationship with ice cream? Tooth sensitivity affects many people and has a
variety of causes, some are obvious and some are not… but all of them are treatable. Unfortunately,
most people who experience this annoying condition never discuss it with their dentist because they
assume that nothing can be done. Healthy, living teeth have a nerve at their center, and it is normal
for them to respond to dramatic temperature changes, but if you experience extreme or lingering
responses to temperature, touch or sweet foods, help is available!

Tooth enamel, or the white layer that covers the visible part of the tooth is the hardest substance
in the body and it has a protective effect, shielding the softer layers of the tooth from temperature
changes and decay-causing bacteria. Directly underlying the enamel is a layer of dentin, which is
composed of microscopic tubes that lead to the pulp of the tooth where the nerve is housed. It
shouldn’t be very surprising that one would experience discomfort or pain when the protective enamel
is damaged or missing. As a matter of fact, some of the most common causes of tooth sensitivity include
chips, cracks or fractures in the enamel which expose the underlying dentin.

When a tooth seems to respond primarily to sweets, a leaky filling or a cavity may be the culprit…
substances in the mouth may have access to the dentin even though the defect may not be visible to the
eye. Fortunately, your cosmetic dentist can diagnose these problems with an oral examination and an
x-ray; and he can usually repair them with a simple filling or crown. Pain that occurs as in response to
heat, such as when drinking hot coffee or soup is a serious concern often indicating that an infection is
present, in which case your dentist may advise that a root canal is necessary in order to save the tooth.

Hypersensitivity can be particularly severe for almost 90% of people who have exposed roots as a
result of bone loss and gum recession from periodontal disease, or from habitually aggressive tooth
brushing. If you happen to be among the roughly 60% of people who experience an extreme response to
temperature, touch or certain sweet or acidic foods even though there is no apparent disease or defect,
you may be suffering from dentin hypersensitivity, a condition believed to be caused by fluid movement
in the miscroscopic tubes of the dentin layer. There are still a number of things that can be done to
alleviate your discomfort.

Desensitiziong toothpastes contain ingredients such as potassium nitrate, potassium chloride or
potassium citrate which seem to chemically alter the ability of the tooth nerve to sense pain, but
there is some evidence that rinsing the toothpaste out may dilute the effect. Regular applications of a
prescription strength Fluoride at home, and in-office applications of Fluoride varnish reduce sensitivity
over time and is an effective, inexpensive solution for many. It works because fluoride is absorbed into
the tooth, filling in and “sealing” the exposed dentin tubes. Your dentist can also apply one of several
topical medicines to the tooth surfaces for long term temporary relief. Severe abrasion or wear of the

enamel that has caused sensitivity can be easily and permanently repaired with a cosmetically appealing
white filling or bonding agent. You can also minimize or prevent dentin hypersensitivity by making a few
simple changes in your lifestyle and diet:

•

Reduce acid containing foods. Summer is a great time to enjoy fresh fruits and vegetables, but
citrus fruits, strawberries and tomatos are notorious for making sensitivity worse!

•

Avoid or reduce acidic drinks such as wine and soda.

•

Always use a soft tooth brush and make sure to use a safe, American dental Association
recomended technique. Mechanical brushes are excellent but can be very destructive if
misused. Your dental hygienist can answer all your home care questions!

•

Try a desensitizing toothpaste and a fluoride rinse or gel. Several good ones are available over
the counter and if that doesn’t help enough, your dentist can prescribe something stronger.

•

Minimize the use of whitening products until the sensitivity subsides.

•

Skip the polish at your next cleaning appointment! The polishing paste is abrasive and may
temporarily heighten your sensitivity… and Its not the most important part of the cleaning
anyway, especially if your teeth are not stained.

Tooth sensitivity can be significantly reduced and even completely cured or in many cases,
depending upon the cause. Don’t suffer in silence, and don’t miss out on the best treats of summer.
Discuss your sensitivity concerns with your dentist and dental hygienist… and have two scoops next
time!