DIABETES

Long-term poor glycaemic control in both type 1 and type 2 diabetes can lead to major complications including diabetic nephropathy, retinopathy, coronary heart disease and strokes. But did you know that people with diabetes are also at higher risk of developing oral health problems that can lead to tooth loss? 

 

There appears to be a relationship between levels of periodontal disease and glycaemic levels. *Periodontal disease is a common chronic inflammatory disease characterised by the destruction of the supporting structures of the teeth (the periodontal ligament and alveolar bone). 

 

It is a bi-directional relationship because the inflammation response by the body produced by this inflamed periodontal and gum tissue can also increase the severity of diabetes, worsen cardiovascular outcomes and increase risk of death. The risk of mortality from heart disease and diabetic nephropathy is 3x higher in diabetic people with severe periodontitis, than in diabetic people without severe periodontitis.

 

A meta-analysis reported that treatment of periodontal disease by an oral health expert and improved oral hygiene in people with diabetes resulted in a mean reduction in HbA1c levels of 0.40%.

 

How does diabetes affect oral health:

 

Periodontitis – Periodontitis is a highly prevalent, but largely hidden, chronic inflammatory disease that is often not painful. Diabetes has been unequivocally confirmed as a major risk factor for periodontitis. In cases of diabetes being the risk factor for periodontitis, we see the disease as more severe, extensive and harder to control. The risk of periodontitis is increased by approximately 3x in diabetic individuals compared with non-diabetic individuals. There has also been a lot of emphasis on the ‘two-way’ relationship between diabetes and periodontitis. That is, not only is diabetes a risk factor for periodontitis, but periodontitis could have a negative effect on glycaemic control. The impact of periodontitis on changes in HbA1c was assessed in a prospective 5 year study of 2,973 non-diabetic individuals. 'Those participants with the most advanced periodontitis at baseline demonstrated an approximately fivefold greater increase in HbA1c over the 5 years of the study compared with those with no periodontitis at baseline'.

 

Increased inflammatory markers – Both type 1 and type 2 diabetes mellitus are associated with elevated levels of systemic markers of inflammation in the body. This systemic inflammation associated with periodontal disease may therefore enhance the diabetic state. It also increases the risk of cardiovascular disease and other health conditions. Periodontitis is preventable with the right care and prevention/stabilisation treatment can help to reduce the burden of excessive inflammatory markers in the body caused by the presence of periodontal disease.

 

Increased risk of tooth decay – People with diabetes have increased levels of glucose in their saliva and GCF fluid (the fluid produced under the gum that protects and flushes the gum line). Increasing the levels of glucose in saliva affects the activity of microorganisms, such as Streptococcus Mutans and Lactobacillus, which are the bacteria most responsible for tooth decay. These species feed off glucose and produce acid that breaks down the tooth surface. Giving them a constant supply of glucose in saliva and GCF fluid means they are continuously producing the acid that can cause cavities in teeth. It is important to have frequent dental appointments and appointments with Oral Health Experts to check and treat early, but preventative wise, they can also can place varnishes that help to remineralise and strengthen your enamel against tooth decay.