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It’s a Two Way Street: Diabetes and Periodontal Disease Update

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Diabetes and Periodontal Disease

It’s a Two Way Street: Diabetes and Periodontal Disease Update

October 16, 2006
By: Jean Johnson for Dental1

We all know life is cyclical in nature, but sometimes in the middle of the forest we forget how ever so subtly individual pieces of the ecosystem interact with one another. We can fall prey to the same myopia when it comes to our bodies – especially when we’re talking about a dental situation on the one hand and a medical condition on the other. Nonetheless, that’s the case when it comes to diabetes and oral health – research confirms there’s an undeniable, clear relationship.

Periodontal disease, or infections of the gums and bone, can be exacerbated by uncontrolled diabetes. On the other hand, diabetics who keep their blood sugar levels within appropriate parameters and practice good oral hygiene are reportedly no more likely to have gum problems than those without diabetes.
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The National Institute of Dental and Craniofacial Research recommend the following home care:
  • Brush twice daily with a soft brush with rounded bristles.

  • Use small circular motions and short back and forth motions, avoiding hard back and forth motions.

  • Use fluoride toothpaste.

  • Brush the tongue frequently.

  • Use plenty of floss – an 18-inch piece is ideal.

  • Floss with a sawing motion and curve the floss around each tooth on the front and back sides..

  • Floss from below the gum up to the top of the tooth.

  • Rinse after flossing.

  • Like anything else, it’s a function of how vigilant and disciplined a person is. How willing they are to accept some short term pain for longer term gains.

    We understand that this isn’t always the easiest thing to do. So for those that might need a little inspiration, we at Dental1 thought a short refresher course was in order. We hope you find some take-home tips below that send you into winter with heightened levels of health and well being.

    The Connection: A Dab of Science

    Because diabetes can thicken blood vessel walls, the systemic disease can impair the extent to which nutrients and waste products are exchanged between tissue cells and the blood. In the case of gums, the result can be weakened tissue that is more susceptible to inflammation and infection than a non-diabetic’s might be. Additionally, people with poorly-controlled diabetes have higher levels of glucose in their mouths that nurture bacteria that can lead to gum disease.

    A number of studies – wrote Deborah C. Mathews, DDS, Dip Perio, MSc, author of an article in the Journal of Canadian Dentistry – “found that diabetes affected all periodontal parameters, including bleeding scores, probing depths [along the gum lines], loss of attachment [gum to bone and teeth], and missing teeth. In fact, one study has shown that diabetic patients are five times more likely to be partially edentulous [missing teeth] than non-diabetic subjects.”

    Mathews added that it seems to make no difference whether a person has juvenile, early onset (Type 1 diabetes) or Type 2 diabetes that generally comes on later in life. “People with Type 1 and Type 2 diabetes seem to be equally susceptible to periodontitis and tooth loss,” she wrote. Also, she observed that “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.” In other words, it makes no difference how long you’ve had diabetes when it comes to susceptibility for periodontitis.

    That said, the studies Mathews surveyed indicated some genetic component in the relationship between diabetes and periodontal disease inasmuch as prevalence was high in aboriginal populations. She also notes that smoking is not a behavior that serves diabetics well at all. “A recent study found that smoking increases the risk of periodontal disease nearly 10 times in diabetic patients,” she wrote, along with the caution that all diabetics need to quit smoking.

    The Connection: Personal Experience

    Said Chris Leonardski of Ashtabula, Ohio, “Now I know why my son lost his teeth so early. He was in dentures by the time he reached his twenties. At the time, we just thought it was one more blow to his already fragile health.

    “He was just like his father before him – both a couple of stubborn Finns if you ever met one. They both had the Type 1 diabetes, you know. My son’s came on when he was a teenager, and you know how kids can be at that age. They don’t listen, and he just didn’t take care of himself like he needed to.

    “He smoked too, so that surely wasn’t in his favor. We did have the big garden for the family, so that helped his diet some. And I always cooked from scratch. But it wasn’t enough.

    “As it turned out, his teeth and I guess the gum disease he probably had were just the beginning of his problems,” said Leonardski. “He finally ended up having both legs amputated below the knee when he was in his forties. That was after his wife divorced him and everything. But he was such a good sport. He moved back home after his dad died and built a greenhouse off the family room for his orchids that he loved to grow. It wasn’t long, though, until it was his turn. He didn’t live to see 50. His body just couldn’t take it any more.”

    Importance of Good Oral Hygiene

    Leonardski adds that she wishes the attention given to oral hygiene these days had been more widespread when she was raising her family in the 1950s. “We meant well, and I know my son tried to take care of his teeth, but there just wasn’t the emphasis on brushing and flossing and all the check-ups with the hygienist the way there is today,” she said. “I have a lot of gripes with the modern world, but how they’ve come along in dentistry with their ideas and education and all – that’s a good thing.”

    Indeed, the University of Virginia Health System literature on diabetes and periodontitis encourages diabetics to pay especially good attention to oral care. “Paired with poor oral hygiene, diabetes can lead to gingivitis, the first stage of periodontal disease, or to periodontitis, severe gum disease.”

    Gingivitis is minor inflammation in which the gums become red, swollen, and tender to the touch. Gums in this condition will bleed easily when a person is brushing and flossing, something Nina Lieblink, Portland, Oregon hygienist says not to ignore. “Bleeding of the gums is just like bleeding on any part of the body. It’s a sign that something’s not right,” Lieblink said. “If your gums are bleeding, see your hygienist so that you can get help before problems escalate.”

    If gingivitis is not nipped in the bud by rigorous, consistent home care, it can develop into periodontitis. This latter condition threatens the integrity of the entire mouth since even in mild forms at early stages, periodontitis erodes bone and tooth structures.

    “Deep cleaning can help remove the plaque and infected tissue in the early stages of the disease, while smoothing the damaged root surfaces of the teeth,” states the University of Virginia Health System. “The gums can then be reattached to the teeth.”

    If you’re shuddering at this point, join the crowd. There’s not much about periodontitis that sounds very fun. And we haven’t even gotten to the infected abscesses that can form around individual teeth and lead to major bone loss in patients with poorly controlled diabetes. Clearly the best bet is to spend the time on a daily basis to keep your gums and teeth healthy and clean.

    Symptoms of Periodontal Disease

    In addition to good home care programs, diabetics can watch for early warning signs of periodontitis. Along with gingivitis, any recession of the gums, or loose or separating teeth should prompt an appointment with the dentist.

    Persistent odorous breath, as well, is an indication of inflammation or infection that needs addressing, as is any visible pus between the teeth and gums. Further, if dentures no longer fit or if a person notices a change in their bite and jaw alignment, it could be a sign of bone deterioration stemming from periodontitis.

    These symptoms are important inasmuch as moderate to advanced periodontitis can progress without obvious warning signs, leaving those with poorly-controlled diabetes highly vulnerable to its adverse effects.

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