It is well described that people with diabetes are more susceptible for development of infection than non-diabetics. It is not widely known that periodontal disease is often considered as a complication of diabetes.
Diabetes is characterized by too much glucose (or sugar) in the blood. Body often lacks enough insulin, a hormone, which regulates body sugar. Uncontrolled diabetes has multiple complication including vision loss (retinopathy), stroke, heart disease, circulation and nerve problem in extremities (peripheral vascular disease and neuropathy).
Periodontal disease (often called periodontitis and gum disease) is a progressive condition that often leads to tooth loss if treatment is not promptly sought. Periodontal disease begins with a bacterial infection in the gingival tissue which surrounds the teeth. As the bacteria colonize, the gum pockets become deeper, the gums recede as tissue is destroyed and the periodontitis eventually attacks the underlying bone tissue.
Experts suggest the relationship between diabetes and periodontal disease can worsen both conditions if either condition is not properly controlled.
Here are ways in which diabetes and periodontal disease are linked:
- Increased blood sugar – Moderate and severe periodontal disease creates a chronic inflammation in the body and release certain chemicals in the body (Cytokines). This makes available Insulin ineffective (also called Insulin resistance) and leads high blood sugar levels. This is why diabetics with periodontitis have difficulty in controlling their blood sugar. In addition, the higher sugar levels found in gum tissue provide a stimulus and nutrition for bacterial growth.
- Blood vessel thickening – Thickening of blood vessels is a complication of diabetes that may increase risk for gum disease. Blood vessels deliver oxygen and nourishment to body tissues, including the mouth, and carry away the tissues’ waste products. Diabetes causes blood vessels to thicken, which slows the flow of nutrients and the removal of harmful wastes. This can weaken the resistance of gum and bone tissue to infection.
- Smoking –The harmful effects of smoking, particularly heart disease and cancer, are well known. Studies show that smoking also increases the chances of developing gum disease. In fact, smokers are five times more likely than nonsmokers to have gum disease. For smokers with diabetes, the risk is even greater. If you are a smoker with diabetes, age 45 or older, you are 20 times more likely than a person without these risk factors to get severe gum disease.
- Poor oral hygiene – It is essential for diabetics to maintain excellent levels of oral health. When daily brushing and flossing does not occur, the harmful oral bacteria can ingest the excess sugar between the teeth and colonize more freely below the gum line. This exacerbates the metabolic problems that diabetes sufferers experience.
Diagnosis and Treatment
It is of paramount importance for people suffering from diabetes to see the dentist at least twice yearly for checkups and professional cleanings. The dentist will use medical history, family history and dental X-rays to assess the risk factors for periodontal disease and determine the exact condition of the gums, teeth and underlying jawbone.
In the early stages, the dentist will use deep cleaning to remove hardened plaque and infected tissue under the gum and smooth the damaged root surfaces of teeth. This allows the gum to re-attach to the teeth. A special mouthrinse or an antibiotic might also be prescribed to help control the infection.
Deep cleaning is successful only if the patient regularly brushes and flosses to keep the plaque from building up again
Gum surgery is needed when periodontitis is very advanced and tissues that hold a tooth in place are destroyed. The dentist or periodontist will clean out the infected area under the gum, then reshape or replace the damaged toothsupporting tissues. These treatments increase the chances of saving the tooth.
If you have questions or concerns about diabetes or periodontal disease, please contact our office.