Uncontrolled periodontal (gum) disease and diabetes – a collective health risk?

Dr Johan Hartshorne B.Sc., B.Ch.D., M.Ch.D., M.P.A., Ph.D. (Stell), FFPH.RCP (UK),
Dental practitioner, Intercare Medical & Dental Centre, Tyger Valley, & Visiting Professor, Department of Periodontics and Oral Medicine, University of Pretoria.

Uncontrolled diabetes and periodontal (gum) disease are a primary cause of disability and important predictors of increased health costs, serious complications and poor quality of health. Both conditions are very common and are go largely unnoticed by a large sector of the population. Diabetes affects an estimated 8-10% of the South African population.

What is the link between periodontal (gum) disease and diabetes?

Both are chronic conditions shares the same preventable biological risk factors (such as high blood pressure, high blood cholesterol, overweight, depression and psychological stress) and common lifestyle factors (such poor oral hygiene, an unhealthy diet, physical inactivity, smoking and alcohol consumption). These common risk factors influence the initiation, progression and severity of both conditions. More importantly, they have a mutual relationship, affecting each other negatively.

Harmful outcomes of uncontrolled diabetes, such as increased risks of heart disease, stroke and early mortality, are more likely in the presence of periodontitis. For example, severe periodontitis is associated with a threefold increase in the incidence of end-stage renal disease in diabetes compared to patients without diabetes. Patients with diabetes are three to four time more likely to have severe periodontal disease, and the severity of periodontitis is associated with poor glycaemic control. If the infection persists, it can spread to the underlying bone, causing destruction of the bone that anchors the teeth, eventually resulting in loss of teeth.

Complicating this situation is the fact that infections don’t resolve as quickly in people with uncontrolled diabetes. This is because uncontrolled diabetes weakens white blood cells, which are the body’s main defense against bacterial infections that can occur in the mouth (and the rest of the body). Besides impairing white blood cells, another complication of diabetes is that it causes blood vessels to thicken, which slows the flow of nutrients to and waste products from body tissues, including the mouth. When this combination of events happens, the body's ability to fight infections is reduced.

Studies have also shown that controlling blood sugar levels lowers the risk of major organ complications of diabetes — such as eye, heart, and nerve damage — thus controlling diabetes will also protect against the development of oral health problems.

Take oral health care and diabetes seriously!

  • Know your risk. If you have periodontal disease, have yourself screened for diabetes.
  • If you have diabetes, keep your blood sugar as close to normal as possible. Periodontal disease can happen more often, be more severe, and take longer to heal.
  • Brush your teeth at least twice a day and floss at least once a day.
  • Schedule regular dental cleanings.
  • Look for early signs of gum disease. Report any warning signs of gum disease to your dentist.
  • Make sure your dentist knows you have diabetes.
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