Diabetes and Periodontal Disease: a two-way relationship
Diabetes is a disease in which your body either cannot produce insulin or cannot properly use the insulin it produces. Insulin is an important hormone produced by your pancreas.
Insulin's role is to regulate the amount of glucose (sugar) in the blood. Blood sugar must be carefully regulated to ensure that the body functions properly. Too much blood sugar can cause damage to organs, blood vessels, and nerves. Your body also needs insulin to use sugar for energy.
More than eleven million Canadians are living with diabetes or prediabetes. Chances are that diabetes affects you or someone you know.
There are three major types of diabetes. Type 2 diabetes is the most common diagnosis, followed by type 1 diabetes. Gestational diabetes occurs during pregnancy and is usually temporary. In addition, prediabetes is another important diagnosis that indicates an elevated risk of developing diabetes.
Type 1 diabetes is an autoimmune disease and is also known as insulin-dependent diabetes. Those with type 1 diabetes are not able to produce insulin on their own (and cannot regulate their blood sugar) because their body is attacking the pancreas. An estimated 10 percent of people living with diabetes have type 1, insulin-dependent diabetes.
Type 1 diabetes generally develops in childhood or adolescence but can also develop in adulthood. People with type 1 have to inject insulin or use an insulin pump to ensure their bodies have the right amount of insulin.
Type 2 diabetes is when people cannot properly use the insulin made by their bodies, or their bodies are not able to produce enough insulin. Roughly 90 percent of people living with diabetes have type 2 diabetes.
Type 2 diabetes is commonly developed in adulthood, although it can also occur in childhood. Type 2 diabetes can sometimes be managed with healthy eating and regular exercise alone but may also require medications or insulin therapy.
Gestational diabetes can occur during pregnancy and is a temporary form of diabetes. Between 3 and 20 percent of pregnant women develop gestational diabetes, depending on their risk factors. A diagnosis of gestational diabetes may increase the risk of developing diabetes later in life for both mother and child.
Prediabetes is a condition where blood sugar levels are higher than normal but are not yet high enough to be diagnosed as type 2 diabetes. Although not everyone with prediabetes will develop type 2 diabetes, many people will.
It is important to know if you have prediabetes, because research has shown that some long-term complications associated with diabetes—such as heart disease—may begin during prediabetes.
The complications of diabetes are related to long-term elevation of blood glucose concentrations (hyperglycemia). Hyperglycemia produces inflammatory mediators in the body. This can cause blood vessel changes. The thickened blood vessels can reduce the flow of nutrients and removal of wastes from body tissues. This reduced blood flow can weaken the gums and bone. This puts them at greater risk for infection.
Long-term complications may occur in both type 1 and type 2 diabetes. Complications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease, retinopathy, nephropathy, and neuropathy. Retinopathy may lead to blindness, whereas progressive renal disease can lead to kidney failure. Peripheral neuropathy may lead to loss of limbs and dysesthesias (burning sensations). In terms of oral manifestations, the patient may experience delayed wound healing and xerostomia, as well as an increased susceptibility to periodontal disease.
Periodontitis has been referred to as the sixth complication of diabetes. Diabetes that is not controlled well leads to higher blood sugar (glucose) levels in the saliva. This promotes the growth of bacteria that can cause gum disease. On the other hand, infections from untreated periodontal disease can cause the blood sugar to rise and make it harder to control diabetes. The level of periodontal health in diabetic patients with good or moderate control of their condition are similar to that in nondiabetic patients. Those with poor control have more attachment loss and are more likely to exhibit recurrent disease.
Prevention and control of periodontal disease must be considered an integral part of diabetes control. The principles of treatment of periodontitis in diabetic patients are the same as those for nondiabetic patients and are consistent with our approach to all high-risk patients who already have periodontal disease. Major efforts should be directed at preventing periodontitis in patients who are at risk of diabetes. Diabetic patients with poor metabolic control should be seen more frequently, especially if periodontal disease is already present. Patients with well-controlled diabetes who have good oral hygiene and who are on a regular periodontal maintenance schedule have the same risk of severe periodontitis as nondiabetic patients.
People with type I and type 2 diabetes appear equally susceptible to periodontal disease and tooth loss. Other factors are involved in the high prevalence of periodontal diseases in association with diabetes. For both type 1 and type 2 diabetes, there does not appear to be any correlation between the prevalence or the severity of periodontal disease and the duration of diabetes.
Another factor, smoking, is harmful to oral health even for people without diabetes. But a person with diabetes who smokes is at a much greater risk for gum disease than a person who does not have diabetes. A recent study found that smoking increases the risk of periodontal disease by nearly 10 times in diabetic patients. According to these results, the management of diabetic patients should include strong recommendations to quit smoking.
Talk to a doctor and a dental professional about dietary and oral hygiene recommendations. Smoking cessation programs can be offered as well. By maintaining the teeth and gums and controlling blood sugar levels, patients will be able to better manage the risks associated with both conditions.