Diabetes and Oral Health

Physicians have long observed the relationships between poor oral hygiene and increased rates of disease, particularly heart disease, but now they know that type 2 diabetes complications can also be accelerated by gum disease, especially periodontitis.

Periodontal disease is considered a risk factor for developing type 2 diabetes. Those who already have periodontitis should be concerned about their increased risk of developing serious complications from diabetes, including heart attack, stroke, and kidney disease, among others.

Studies show that when combined with diseases already often seen together, such as type 2 diabetes and hypertension, having severe periodontal disease can increase your chances of having a heart attack. The Journal of the International Academy of Periodontology noted in 2011, “The long-term clustering of risk factors, such as diabetes, dyslipidemia, hypertension, and periodontitis, are associated with the development of [heart attack, a condition referred to as] multiple risk-factor syndrome.” The Journal of Clinical Periodontology in 2010 noted patients “with type 2 diabetes, periodontitis, and gingivitis associated with increased left ventricular mass and increased blood pressure.”

For pregnant females, periodontal disease presents yet another risk, as it is linked with a higher incidence of premature delivery and low birth weight.

Causes

Periodontitis is the most serious form of gingivitis, or gum disease. It begins with bacteria, which multiplies on the surface of the teeth and along the gum lines, forming plaque. Diets rich in sugars and starches, such as those of type 2 diabetics with hyperglycemia, increase the risk of gingivitis, which after years of poor oral hygiene eventually progresses to periodontitis. When a person develops periodontitis, he or she has a higher incidence of cavities. The gums deteriorate. They separate from the teeth forming pockets—spaces where more bacteria can settle, making the disease chronic and severe. If not caught early and treated, chronic periodontitis can lead to infection and disease in the bone, eventually causing teeth to loosen and fall out.  

A 2008 study published by the Journal of the American Medical Association discussed the relationship between type 2 diabetes and periodontitis. “Diabetes appears to have a particularly close relationship with conditions within the [mouth]. This relationship seems to go both ways; diabetes can lead to unwanted changes in the gums and periodontal tissues, and periodontal disease can make it more difficult to control diabetes.” The study concluded that periodontal disease can worsen type 2 diabetes because bacteria released into the bloodstream contributes to inflammation. Severe periodontitis can also keep blood glucose levels high, even if a person is careful about their diet, because of increasing insulin resistance.

Symptoms

A variety of symptoms can signal that gum disease is present, such as sore, swollen, or bleeding gums, especially when you brush your teeth. Other signs and symptoms that your gingivitis may be worsening to periodontal disease include:

  • mouth sores
  • tender gums
  • gums that have pulled away from teeth
  • loose teeth
  • pus around the teeth/gum line
  • bad breath
  • a “bad taste” in your mouth
  • changes in tooth alignment

Prevention

Proper blood glucose control combined with good oral hygiene (daily brushing and flossing) is the easiest way to prevent periodontitis. Daily rinsing with medicated washes is also recommended, some of which are available only by prescription to specifically treat gum disease. If you are diabetic, you should keep regular, twice yearly dental appointments and remind your dentist at each visit that you have diabetes.

If you notice changes in your mouth, like breath odor, sores, bleeding gums, or painful or loose teeth, tell your doctor/dentist immediately. Since some medications can cause dry mouth, which may also contribute to plaque build-up, tell your doctor if you’re experiencing this problem. Finally, if you smoke, you should quit immediately; smoking can worsen gum disease and its associated problems, such as chronic dry mouth, soreness, ulcers, and tooth decay.