Nashville Diabetes Dentist

Your Diabetes Dentist

Dr. Harold Loe at the National Institute of Dental Health has published that periodontal disease is the 6th complication of diabetes. Emerging research is establishing that there is a clinical relevance for the treatment of people with diabetes mellitus and periodontal disease.

It has long been observed that diabetics (especially poorly controlled diabetics) have more gum infections and periodontal disease. Current research is confirming that diabetics are indeed more susceptible to gum disease. But there is more to it than that. There is a classic viscous cycle going on because not only does diabetes create periodontal complications, but having periodontal disease makes diabetes more difficult to control.

New research suggests that the relationship between gum disease and diabetes goes both ways. Periodontal disease can make it more difficult for diabetics to control their blood glucose levels, and people with diabetes tend to have more gum disease. This means that this disease equation is really a double ended arrow, a two way street.

Diabetics have a higher risk for developing infections, including periodontal disease which is a chronic low-grad infection persistent in the mouth. Infections (such as periodontal disease) in diabetics generally impair the ability to process and /or utilize insulin. This can cause blood sugars to be more difficult to manage, and in turn can make the gum infections (or any infection in the body) more severe.

Signs and symptoms of gum disease include:

Gums that bleed
Red, swollen and tender gum tissues
Bad breath
Loose or migrating teeth
Elevated C-reactive protein levels

Because gum disease is more common and more serious in people with diabetes, periodontal disease has now been called an “oral complication” of diabetes. In fact, one in three diabetics have chronic gum disease problems. The evidence clearly shows that gum disease occurs more than twice as much in people with diabetes as for non-diabetics. Because gum disease is an infection, and diabetics generally have problems dealing with infections and wound healing, gum disease represents a significant complication for diabetics. The problem is that physicians often fail to examine the mouths and teeth of their patients, or fail to refer to a dentist for an evaluation. And too often, dentists fail to recognize the important implications and relevance that diabetes and periodontal disease have with each other.

Since periodontal disease is a bacterial infection of the gums and bone around teeth, it automatically increases local inflammatory factors. The inflammation which occurs in the gums allows bacteria and inflammatory by-products to enter the blood stream through small tears in the gums and produce systemic inflammation in the body generally. The greatest danger is the oral bacteria entering your bloodstream through a tear in your gum tissue.

The surface area of the gum tissue surrounding your teeth, is the equivalent of the surface area of the palm of one or even two hands, depending on the severity of the gum disease. If a patient had an equivalent challenge (open wound) anywhere else on the body, it would certainly be a great concern to them!

This “open wound” allows the bacteria to penetrate into the tissues, and eventually, the bloodstream, resulting in a bacteremia. The bacteria can move directly through the arteries to anywhere in the body. This oral bacteria has been found throughout the body, in fetal cord blood, and in atheromatous plaque- the plaque that causes blood flow constriction.

Science has uncovered that as control of diabetes decreases, levels of inflammatory proteins in gum tissue increase. What this means is that poorly controlled diabetics have more harmful proteins (called inflammatory cytokines) in their gum tissues which can cause destructive inflammation of the periodontal gum and bones tissues. This means you are at increased risk to experience bone loss around your teeth and your teeth can eventually become loose. Also, beneficial proteins (such as growth factors) have been found to be at reduced levels in diabetics. This interferes with the body‟s natural healing response to infection, of which gum disease is a classic example.

These findings strongly suggest that poorly controlled diabetics experience a dysregulation or disruption that can contribute to periodontal breakdown and diminished tissue repair capacity. As a consequence, diabetics respond differently to the oral bacterial microfilm that naturally accumulates at the gum line around teeth, compared to non-diabetics. This means that as a diabetic, you tend to manufacture more plaque. If the gums start to hurt or bleed when brushing or flossing, the natural tendency is to brush or floss less thoroughly, or less often, leading to more plaque hardening into calculus buildup.

Effective control of diabetes increases and improves the health of the gum tissues, and improved health of oral tissues improves the ability to control blood sugars and increasing diabetic control. The good news is that when chronic oral infections are treated and when people have good oral health, the management of diabetes markedly improves. This information should give diabetics and the care-takers another reason to smile, because health gums aid in the overall control of diabetes, and vice-versa.

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