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.