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Gum Disease and Diabetes

Periodontitis and diabetes are both chronic diseases that modulate each other. That is, they can exacerbate each other, each making the other more severe. Diabetes can have a negative effect on periodontal health and periodontal disease can increase the need for insulin in diabetics.

Periodontal Disease Has a Negative Effect on Diabetic Control

Periodontal disease is an infection that, like any infection, can make it hard to keep blood sugar under control. Increased blood sugar levels can result in an increased risk for diabetic complications such as harm to the eyes, nerves, kidneys, and other important organs. But studies have shown that treatment of periodontal disease can reduce the need for insulin in diabetics. So, by treating and controlling the periodontal infection, a person also is controlling insulin need and diabetes.

Poor Diabetic Control Has a Negative Effect on Periodontal Health

Compared to non-diabetics, people with poorly-controlled diabetes (those with blood glucose levels above normal) are more likely to develop periodontal abscesses and other oral infections. The longer someone has diabetes, the more likely they are to have periodontal disease. And if the person smokes and has poorly-controlled diabetes, the risk of developing periodontal disease is even greater.

Poor diabetic control can affect the gum tissue in two ways. One is the result of the thickening of the blood vessels that occurs with diabetes. This results in a reduction of oxygen and nutrient delivery to the tissues and a diminished ability of the immune system to fight infection, including periodontal disease. The second is because many of the bacteria that cause oral infection thrive on the sugar linked to diabetes (glucose). Poor diabetic control can actually feed the bacteria that cause periodontal disease.

Oral symptoms associated with poor diabetic control include:

• Increased tooth mobility
• Dry mouth that can increase the risk for ulcers, root cavities, and infections
• Infections that take longer to heal and are more severe

These symptoms can all be managed with control of blood glucose and improved periodontal health. If the diabetes is well controlled and blood sugar level is within the normal range, the risk of developing periodontal disease is not greater than in people who don't have diabetes. On the flip side, treating periodontal disease reduces the need for insulin on people that have diabetes.

To prevent complications from periodontal disease and diabetes, it is important to maintain normal blood sugar levels and periodontal health. Follow the diet and medication guidelines supplied by your physician and see your dental care provider routinely for periodontal screenings and professional cleanings. Meticulous plaque control is critical. If you have diabetes, your dentist needs to know what your blood glucose level is before starting any dental surgical procedures, and although abscesses and acute dental infections should be treated as soon as possible, non-emergency dental treatment should be postponed until the blood glucose is well controlled.

By Laura Minsk, DMD

Oral Hygiene, Periodontal Disease And Heart Disease

The well-known risks for heart disease include smoking, obesity, high cholesterol, and high blood pressure. Now evidence suggests that having gum disease puts you at greater risk for cardiovascular (heart) disease.

The bacterial infection that causes periodontal disease also may affect the heart. In fact, all other conditions being equal, people with periodontal disease may have twice the risk of having a fatal heart attack as people that don't have periodontal disease. By taking care of your periodontal health, you can prevent or help control one of the risk factors for heart disease.

Although the exact mechanism of infection has not been determined, it is possible that the bacteria that cause periodontal disease enter the blood stream directly through the gum tissue. This can be precipitated by normal oral activities, such as brushing and chewing, that create tiny injuries in the gum and then release bacteria into the blood stream.

The bacteria can contribute to small blood clots that clog the arteries. There also is the possibility that the inflammation caused by periodontal disease contributes to the build-up of fatty deposits inside the heart arteries and the formation of blood clots. These clots can obstruct the normal blood flow, restricting the amount of nutrients and oxygen to the heart and resulting in a heart attack.

Oral bacteria can also travel to the heart and cause an infection of the lining or valves of the heart called infective endocarditis. People with a history of rheumatic heart disease, mitral valve prolapse with regurgitation, or heart murmur associated with various heart conditions are at greater risk of developing infective endocarditis and may require antibiotic treatment before dental procedures that may induce bleeding.

These procedures include oral surgery, tooth extraction, and routine cleanings. The best way to avoid infective endocarditis is by maintaining good oral health. But if you have any of the conditions that put you at greater risk for infective endocarditis, consult your cardiologist and dentist before starting any dental treatment.

Treatment of periodontal disease may be one of the ways you can help prevent heart disease and a heart attack. With meticulous oral hygiene, daily brushing and flossing, professional cleanings, and periodontal screenings, you may help save your teeth and your life.

By Laura Minsk, DMD