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Why Control of Your Diabetes Is Essential to the Health of Your Mouth

Written by Andrew Swiatowicz, D.D.S.. Posted in Family Health.

Diabetes and Healthy teethWhen it comes to diabetes mellitus (DM), patients have enough to worry about. Controlling this disease is essential to maintaining the health of one's blood vessels, eyes, limbs, kidneys and numerous other parts of the body. While most patients who are diagnosed with diabetes are aware of the previously mentioned potential complications, many are surprised to hear that their diabetes can impact their oral health.
Diabetic patients report a variety of oral issues, including xerostomia (dry mouth), oral candidiasis, and poor wound healing following dental surgery. However, what dentists notice the most in their patient with poorly controlled DM is a higher prevalence of periodontitis.

Periodontitis, commonly known as bone and gum disease, is a bacterial inflammatory condition of the mouth that results in the loss of bone and damage to the supporting structures of the teeth. It is the most common chronic bacterial infection in adults, with almost 36 million people affected. Patients with periodontal disease may notice bleeding in their mouth, receding gums, and even looseness of their teeth. While most people have the bacteria in their mouth that can result in periodontitis, healthy individuals have an easier time controlling it.

When a patient suffers from both DM and periodontitis, the diseases play off of, and can worsen each other. Numerous scientific studies have shown DM to be a significant risk factor of periodontitis. Uncontrolled diabetics are 2.5 times more likely to suffer from the disease, and when they do, it is typically more severe. These patients tend to have greater gum pocketing, bone loss and plaque levels. In fact, aggressive periodontitis is recognized as the sixth complication of diabetes (the other five being retinopathy, neuropathy, nephropathy, cardiovascular disease and peripheral vascular disease). On the other hand, periodontitis can have an impact on the patient's ability to control their diabetes.

The mechanisms of how periodontitis and DM interact have been a heavily studied area in the scientific literature for decades. Their findings suggest that the systemic inflammation caused by periodontitis, along with the infectious actions of periodontal bacteria, negatively impact the diabetic condition. Alternatively, DM increases inflammatory signals in the body, decreases certain immune cell function, and alters the way bone cells respond and act in the mouth; all of which can worsen periodontitis.

So, what can be done to control periodontal disease? The first line of defense is proper home care. By removing the bacteria that cause periodontitis and disrupting the plaque they live on, patients can begin to improve their periodontal condition. Proper brushing for two minutes twice a day, flossing everyday (yes, EVERYDAY), and rinsing with anti-bacterial mouth wash can help remove the bacteria responsible for destruction of the bone and gums.
If home care alone is not controlling a patient's periodontal disease, it is important for your dentist to get involved. The first step is to get a full periodontal screening. At this appointment, the dentist measures the depth of the gums, looks for any signs of periodontitis (bleeding, recession, mobility, etc.), and will take radiographs to see where your bone levels are around the teeth. Depending on your diagnosis, it may be recommended that you receive scaling and root planning (a "deep" cleaning), possibly with local antibiotics to help remove the bacteria. Studies show that following scaling and root planning an improvement in glycemic control may occur in diabetic patients. In severe cases, a specialist known as a periodontist may need to get involved. They may suggest surgery or grafting as potential treatment options.

It is important to note that periodontitis and DM are treatable, not curable diseases. Both are chronic conditions. Proper maintenance is essential, and regression to old habits can result in the disease process starting up again.
I encourage all patients to consult their dentist about what their periodontal status is. The link between periodontitis and DM is not the only mouth-body interaction we see. A strong association exists between periodontitis and cardiovascular disease. Other associations have been noted with respiratory disease, cancers, cognitive impairment, and the health of joint replacements. By understanding and controlling your own periodontal condition, you may be helping more than just your mouth.

Bascones-Martinez A, et. al. Diabetes and Periodontal Disease: Review of the Literature. Am J Dent.
Preshaw PM, Bissett SM. Periodontitis: Oral Complications of Diabetes. Endocrinol Metab Clin N
Am. 2013:42;849-867.
Chee B, et. al. Periodontitis and Type II Diabetes: A Two Way Relationship. Int J Evid Based Healthc.
Sgolastra F, et. al. Effectiveness of Periodontal Treatment to Imporve Metabolic Control in Patients with
Chronic Periodontitis and Type 2 Diabetes: A Meta-Analysis off Randomized Clinical Trials. J Periodontol.
Sima C, Glogauer M. Diabetes Mellitus and Periodontal Diseases. Curr Diab Rep. 2013:13;445-452.
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