Diabetes is one of the most common metabolic diseases of the 21st century. Diabetes is also considered to be the 7th leading cause of death in the United States. In 2015, 23.1 million adults in the United States have been diagnosed with Diabetes, and researchers found another 7.2 million of adults who were living their lives with undiagnosed Diabetes posing serious, life-threatening risks.

On the other hand, we have periodontitis, also known as gum disease and Periodontal disease, is a common and serious gum infection that affects the soft tissue and destroys the bone that supports the teeth. As a result, teeth become loose and fall out eventually. While poor oral care habits significantly increase the risk of periodontitis many other factors play a role. One of these factors is diabetes. In fact, periodontitis and diabetes have a complicated two-way relationship. Today we are here to discuss the link between these two serious and potentially life-threatening diseases.

Prevalence of periodontitis

According to the National Institute of Dental and Craniofacial Research, about 8.5% of adults ages 20 to 64 have periodontal disease. Higher risk of developing periodontitis is observed in older adults, Hispanic and African-American adults, people with lower income, people with bad oral health habits, current smokers, and among persons with lower education. The same report states that 5.08% of adults from the 20-64 age group have moderate to severe periodontal disease[i].

Figures show that 17.20% of seniors age 65 and over have periodontal disease. In addition, 10.58% of people from the same age group have moderate to severe periodontitis. It is important to mention that although very common, the prevalence of the periodontal disease has decreased since the early 1970s[ii]. We would like to think that the improved education about the risks of smoking, bad oral health habits, unhealthy diet and so much more has a certain role in it.

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Are diabetes and periodontitis really connected?

As mentioned above, diabetes and periodontal disease have a complex and a bit of controversial two-way relationship. Diabetes is a disease that occurs when blood glucose is too high. At the same time, the body doesn’t produce sufficient levels of insulin which helps glucose from food get into cells that use it for energy. Diabetes can harm a patient’s eyes, kidneys, nerves, heart, and other parts of the body including the mouth.

People with diabetes are at a higher risk of developing periodontal disease than the healthy population. In fact, the risk of periodontitis increases by threefold in diabetic individuals compared to their non-diabetic counterparts[iii]. Not only does diabetes increase periodontal disease risk, but the latter could have a negative effect on glycemic control thereby increasing blood sugar levels. Severe periodontitis was identified as a risk factor for compromised diabetes management in one study[iv]. But that is not all – not only is diabetes increases the risk for Periodontal disease, but Periodontal disease as well is listed among the biggest risk factors for developing diabetes as well. This is the reason why we refer to the link between Diabetes and periodontitis as a complicated two-way relationship. And because the existence of such relationship is quite interesting, many research paper and studies investigating both sides have been published until now with more to be expected as well!

What is behind this relationship?

You’re probably wondering about the connection between these two conditions. The reality is that more research is needed to uncover all the underlying mechanisms, but current evidence reveals that inflammation plays a massive role.

Periodontitis is a chronic inflammatory disease wherein inflammation is stimulated by the long-term presence of the subgingival biofilm (dental plaque). If we know anything about diabetes is that diabetes, as well, is linked to the presence of inflammatory markers. At the same time, both type 1 and type 2 diabetes are also associated with higher levels of systemic markers of inflammation. Studies also show that diabetes can heighten inflammation in periodontal tissues[v], thus explaining why diabetic persons are more likely to suffer from gum disease.

Diabetes is known cause several different medical issues and increases the risk for many others including problems linked to your kidneys, nerves, eyes and yes, even your mouth. Thickening of blood vessels, a common diabetes-related complication, can lead to periodontal disease because blood vessels deliver oxygen and nourishment to body tissues including your mouth. Diabetes slows the flow of nutrients to your gums, and it also impairs removal of wastes. Through all of these actions, diabetes influences your oral health and increases the risk of periodontitis, eventually resulting in the development of the symptoms of periodontitis.

There are many studies that serve as a proof for the existence of this two-way relationship explaining everything that we need to know and understand about the potential dangers that this relationship brings. We would like to mention a study [vi]published in the Journal of Indian Society & Periodontology as one of the many available scientific researchers that unravel the mysteries that are hidden behind this complicated two-way relationship between diabetes and periodontitis. This study answers the commonly asked questions such as is diabetes a true risk factor for periodontitis and does periodontitis causes difficulties in the metabolic control of diabetes.

What many people don’t know is that oral microbiota can have an impact on diabetes to some extent. One study found that recovery of different periodontal pathogens such as Campylobacter rectus, Aggregatibacter actinomycetemcomitans, Eikenella corrodens, Capnocytophaga spp, Prevotella intermedia, and Fusobacterium nucleatum was almost the same in both diabetic and non-diabetic subjects. That said, people with diabetes had a higher concentration of P. gingivalis bacteria[vii].

Management of periodontal disease is associated with improved glycemic control, i.e., it aids management of diabetesviii. The dental team plays a significant role in the management of diabetes among patients with periodontal disease. Plus, diabetes screening tools can be used to identify periodontitis patients who are at a higher risk of diabetes[ix]. Good oral hygiene is important to take part in every single person’s life, however, it is essential for diabetes patients. The patients diagnosed with Diabetes must be educated about the potential risks that their new diagnosis brings upon with periodontitis being one of them. These patients need to understand the importance of good oral hygiene, regular check-ups at the dentist and diabetes management if they are interested in preventing not only periodontitis but also worsening of their diabetes as well.

Conclusion

Periodontal disease and diabetes are both widely prevalent and are connected to one another. They have a two-way relationship, and diabetes increases periodontitis risk and vice versa. Management of periodontitis can improve glycemic control, however, if left untreated, periodontitis is known to cause difficulties in the management of diabetes and pose a life-threatening risk. Also, keeping your diabetes under control could decrease the risk of having to deal with the periodontal disease. But if we learned anything by reading the extensive research that is available on this controversial topic is that prevention is everything and we should do anything that is in our power to prevent both diabetes and periodontitis for as long as possible. And if it does happen for diabetes or periodontitis to be diagnosed, we should do whatever there is to be done in order to prevent these two conditions or any of the potential risks and complications that they bring from ever occurring at the same time.

References

[i] Periodontal disease in adults (age 20 to 64), National Institute of Dental and Craniofacial Research https://www.nidcr.nih.gov/research/data-statistics/periodontal-disease/adults
[ii] Periodontal disease in seniors (age 65 and older), National Institute of Dental and Craniofacial Research https://www.nidcr.nih.gov/research/data-statistics/periodontal-disease/seniors
[iii] Mealey BL, Ocampo GL. Diabetes mellitus and periodontal disease. Periodontology 2000 2007 Jun;44(1):127-53. Doi: 10.1111/j.1600-0757.2006.00193.x https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0757.2006.00193.x
[iv] Taylor GW, Burt BA, Becker MP, et al. Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus. Journal of Periodontology 1996 Oct;67(10 Suppl):1085-93. Doi: 10.1902/jop.1996.67.10s.1085 https://www.ncbi.nlm.nih.gov/pubmed/8910827/
[v] Preshaw PM, Alba AL, Herrera D, et al. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012;55(1):21-31. doi:10.1007/s00125-011-2342-y. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228943/
[vi] Deshpande K, Jain A, Sharma R, Prashar S, Jain R, (2010), Diabetes and periodontitis, Journal of Indian Society & Periodontology 14(4): 207–212
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118068/

[vii] Thorstensson H, Dahlen G, Hugoson A. Some suspected periodontopathogens and serum antibody response in adult long-duration insulin-dependent diabetics. Journal of Clinical Periodontology 1995 Jun;22(6):449-58 https://www.ncbi.nlm.nih.gov/pubmed/7560223/
[viii] Teeuw WJ, Gerdes VE, Loos BG. Effect of periodontal treatment on glycemic control of diabetic patients: a systematic review and meta-analysis. Diabetes Care 2010 Feb;33(2):421-7. Doi: 10.2337/dc09-1378 https://www.ncbi.nlm.nih.gov/pubmed/20103557/
[ix] Casanova L, Hughes FJ, Preshaw PM. Diabetes and periodontal disease: a two-way relationship. British Dental Journal 2014 Oct;217:433-7. Doi: 10.1038/sj.bdj.2014.907 https://www.nature.com/articles/sj.bdj.2014.907

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