Diabetics and Periodontal / Gum Health

• Periodontitis is a common chronic inflammatory disease characterized by the destruction of the supporting structures of the teeth. It is highly prevalent.

• Epidemiological data confirm that diabetes is a major risk factor for periodontitis. There is a clear relationship between the degree of hyperglycemia (high blood sugar levels) and the severity of periodontitis. There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycemic control.

• Incidences of macro albuminuria and end-stage renal diseases are increased twofold and threefold, respectively, in diabetic individuals who also have severe periodontitis compared to diabetic individuals without severe periodontitis.

What is periodontitis?

Periodontitis is a broad term and for the purpose of simple definition it is inflammation of the gum and supporting structures (including underlying bone).It takes into account the clinical presentation, age at diagnosis, rate of disease progression, and systemic and local factors that may increase risk.

Periodontitis is a slowly progressing disease but the tissue destruction that occurs is largely irreversible and is divided broadly as:

1.Gingivitis: where the inflammation is confined to the gingiva(gums), and is reversible with good oral hygiene

2. Periodontitis: where the inflammation extends and results in tissue destruction and alveolar bone resorption(that is underlying bone).

3. Periodontal Pockets:Tissue destruction in periodontitis results in the breakdown of the collagen fibers of the periodontal ligament(fibrous  attachment of tooth to bone) resulting in the formation of a periodontal pocket between the gingiva and the tooth.

4. ‘Pockets’ are not evident on simple visual inspection, and assessment using a periodontal probe in dentist’s office is essential. In the early stages, the condition is typically asymptomatic; it is not usually painful, and many patients are unaware until the condition has progressed enough to result in tooth mobility. The pockets deepen as a result of the further destruction of fibers of the periodontal ligament and the resorption of the alveolar bone that occurs parallel with the progressing attachment loss.

5. Advanced periodontitis is characterized by gingival(gum) erythema(redness) and edema(swelling), gingival bleeding, gingival recession, tooth mobility, drifting of teeth, suppuration from periodontal pockets, and tooth loss.

Associations between diabetes and periodontitis

•  Diabetes has been unequivocally confirmed as a major risk factor for periodontitis. The level of glycemic control is of key importance in determining increased risk. The majority of research has focused on type 2 diabetes mellitus as a risk factor for periodontitis, probably because both diseases have historically tended to develop in patients in their 40s and 50s. However, type 1 diabetes mellitus also increases the risk of periodontitis, and all patients with diabetes (including children and young adults) should be considered to be at increased risk of periodontitis..

•  Dentists have long been aware of the importance of a diagnosis of diabetes in their patients, and various oral conditions are associated with diabetes, including xerostomia and candidal infections as well as periodontitis.

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       • People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk.

·     • Research has suggested that the relationship between diabetes and periodontal disease goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.

·      • Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with high blood sugar. This puts people with diabetes at increased risk for diabetic complications.

Clinical signs of periodontitis:

•  Increased redness of the gum tissues along the teeth is a classic sign of gingivitis, a condition that indicates that there is an active inflammatory response to bacterial infection.

• The use of a toothbrush or a toothpick to gently touch the gums of diabetic patients with inflammation will provoke bleeding that will cease within minutes. Dentists always suggest a thorough dental examination if such bleeding is common throughout a patient's mouth.

• The presence of white or gray deposits on teeth suggests that dental treatment may be necessary.

•  Spacing between upper front teeth and mobile teeth are other signs of periodontitis.

Conclusion

Patients with diabetes are usually poorly informed about the relationship between periodontitis and diabetes. Therefore, health care providers of patients with diabetes should be aware of this link and inform their patients about the need for good oral health.

Referral of patients with uncontrolled diabetes for a dental evaluation and periodontal treatment may result in better control of blood glucose levels.

Diabetic patients should therefore get routine dental check updone at least every six months.

Author: Dr Justin Jacob