Diabetes mellitus is emerging as a global epidemic, the complications of which have a significant impact on the quality of life, longevity and healthcare costs.
It is estimated that 346 million people currently suffer from diabetes worldwide and the World Health Organization (WHO) predicts that this will increase to 439 million or almost 10% of adults, by 2030.
Insulin, produced by the pancreas, is a hormone that allows glucose to move from the bloodstream into the body’s cells where it can be used for energy.
The onset of diabetes is caused by dysfunction or damage to the pancreas leading to increased presence of glucose in the blood circulation, which will give rise to the complications of diabetes.
Inflammatory periodontal (gum) disease is the most common chronic inflammatory condition of adults worldwide.
The destructive form of periodontal disease or severe gum disease is called periodontitis.
It affects approximately 50% of adults and over 60% of over 65-year-olds while severe periodontitis impacts 10–15% of populations.
The primary cause of periodontal disease is bacterial plaque biofilm, which if not removed by maintaining oral hygiene, will accumulate in the gum margins, eventually leading to the destruction of the attachment apparatus of the teeth.
This destruction of the attachment apparatus, namely the gingiva, periodontal ligament, cementum and the supporting alveolar bone, is known as chronic periodontitis.
If periodontitis is not treated, it will eventually lead to tooth loss.
A two-way link
Diabetes that is not well controlled leads to higher blood sugar (glucose) levels in the mouth fluids.
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.
Severe gum disease can negatively affect your blood sugar control and increase your chances of suffering from other common, long-term complications of diabetes.
The inflammation, which occurs in the gums, escapes into the bloodstream and upsets the body’s defense system, which in turn affects blood sugar control.
Diabetes is a systemic contributing factor to gum disease, but does not directly cause gum disease like periodontitis.
However, diabetes can alter the response of the periodontal tissues to bacterial plaque biofilm, speeding up the destruction of the soft and hard tissues of the attachment apparatus of the tooth and delay healing after treatment.
You may have gum disease if you notice:
- Red, bleeding or swollen gums
- Discharge (exudate) from the gums
- Foul taste
- Longer looking teeth
- Loose teeth
- Increasing spaces between your teeth, and
- Calculus (tartar) on your teeth.
Nutrition for bacteria
The increased glucose in the gingival fluid and blood of diabetic patients could change the environment of the oral microflora by inducing qualitative changes in bacteria which contributes to the severity of periodontal disease.
The glucose in the oral tissues and gingival fluid also provides nutrition to oral microorganism leading to an increased rate of multiplication.
This increased presence of the bacteria in the gum tissues will accelerate the destruction of the periodontal tissues.
Take a look at the clinical images below:
Before gum treatment (Image 1): This is the gum appearance of a 52-year-old type 2 diabetic patient.
Her oral hygiene was very poor, leading to gum swelling, soggy appearance of the gums, redness and increased discharge from the gum tissues.
Her blood glucose level was high at that time and she was referred to her medical healthcare provider.
After gum treatment (Image 2): This is the appearance of the gums three months post treatment.
Although her oral hygiene was still not satisfactory, the inflammation of the gums shows some resolution.
The gum has taken a pinkish hue and has a firmer appearance.
Her blood glucose level was under control after seeing her medical healthcare provider.
Image 3 shows the appearance of the gums on the right lower molar in a 57-year-old male patient who is a poorly controlled type 2 diabetic.
There is a periodontal abscess (circled) associated with the molar tooth which requires immediate attention. Periodontal abscesses can occur in patients with poor glycaemic control due to the presence of glucose in the periodontal tissues, which provide nutrition to the bacteria.
Schedule a check-up
Patients who have just been diagnosed with diabetes, whether type 1, type 2 or gestational, should be informed that they are at higher risk of periodontal disease and should get dental a check-up as soon as possible.
Diabetics attending oral health clinics for the first time should:
- schedule their appointment preferably in the mornings;
- take their diabetic medications before their scheduled dental appointment in the correct dosage prescribed by their medical doctors; and
- inform the oral healthcare professional of the medications they are taking.
If you have been told by your dentist that you have gum disease, you should follow up with necessary treatment as advised.
This may require several appointments.
Like diabetes, gum disease is a chronic condition and requires long term maintenance.Oral healthcare in diabetics
Patients with diabetes should also be evaluated for other potential oral complications, including dry mouth, burning mouth and candida infections.
For children and adolescents diagnosed with diabetes, an annual oral screening for early signs of periodontal involvement is recommended starting at the age of six.
If you do not have diabetes, but your dentist identified some risk factors for diabetes including signs of worsening gum disease, it is important to get a medical check-up as advised.
Your medical doctor can order blood tests to see if you have diabetes and can provide proper advice and care based on the results.
Do not forget to inform your dentist about the outcome of your visit to the medical doctor.
The immune response of an individual with diabetes (especially poorly controlled) and periodontal disease will be affected, and it may be more difficult to ward off infections like Covid-19.
It can also take a more severe toll on that individual.
So, keep your mouth and your whole body as healthy as possible with proper oral hygiene, regular oral health and medical care.
Dr Dasan Swaminathan is a professor of periodontology. For more information, email firstname.lastname@example.org. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.