Diabetes and oral health have a lot to do with each other, both for better and for worse.
Their relationship is two-way, so what affects one will also affect the other. For example, a person with diabetes will have a higher risk of having poorer oral health, specifically a higher risk of periodontitis; on the other hand, a person with periodontitis will have a higher risk of having poorly controlled diabetes. Likewise, improving diabetes control helps prevent worsening of periodontal health, and, in the same way, having good oral health also has a positive impact on diabetes control.
The di@bet.es study has confirmed the close link between periodontitis and diabetes, showing that people with prediabetes or diabetes have a higher prevalence of advanced periodontitis. In addition, it showed that people with advanced periodontitis have a higher risk of developing type 2 diabetes.
Influence of periodontitis
In metabolically healthy individuals without diabetes, their glycosylated hemoglobin is on average 0.3% higher if they have advanced periodontitis. Likewise, there is also strong evidence that supports that patients with periodontitis, especially if it is advanced, have an increased risk of developing diabetes in successive years, in relation to those who do not present periodontitis or have it in an earlier phase. Important studies carried out in the United States, Japan and Taiwan show that a patient with moderate-advanced periodontitis will have a higher risk of developing prediabetes or type 2 diabetes in the future.
In addition, if periodontitis is not treated, this person will have a higher risk of diabetes getting out of control and suffering a greater number of associated complications (retinopathies, cardiovascular diseases, nephropathies,...); Some studies even point out that the percentage of death from any cause is higher in patients with diabetes and periodontitis than in people who have only diabetes. It has been shown that patients with diabetes and untreated moderate-advanced periodontitis have a 5-fold increased risk of diabetes complications, including nephropathies that lead to kidney failure, with the consequent increase in kidney transplants and death.
Impact of diabetes on periodontal health
But it has also been confirmed that diabetes can affect the health of the gums. A person with diabetes is up to three times more likely to develop periodontitis than someone without diabetes.
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This is so because the hyperglycemia that patients with diabetes present is related to an increased risk and severity of periodontitis. The worse glycemic control, the greater predisposition to periodontitis. The increase in inflammatory mediators in patients with diabetes may also influence the greater susceptibility to periodontitis.
The increase in blood sugar causes a series of changes in the gums that facilitate the development of periodontal diseases: 1) the activity of immunocompetents is decreased; 2) the vascularization of the tissues is altered; 3) collagen synthesis is modified. These changes cause a greater susceptibility to the action of bacteria and increase the risk of infections; In addition, the alteration of the vascularization and the synthesis of collagen hinders the healing capacity of the gingiva. All this causes the action of bacteria to be more aggressive in the uncontrolled diabetic patient, producing a loss of bone supporting the teeth.
inflammation, key
It is currently considered that the mechanism that promotes a greater predisposition to diabetes in people with periodontal disease is associated above all with the great inflammatory process derived from the disease, rather than the effect of bacteria itself. And it is that the link that unites diabetes and periodontitis is inflammation: both are chronic inflammatory and non-communicable diseases.
In the case of diabetes, poor glycemic control causes an increase, not only in blood, but also in periodontal tissues, of proinflammatory cytokines and advanced glycation end products (AGE proteins). These stimulate the production of free oxygen radicals by the immune system, as well as a poor inflammatory response, with the destruction of periodontal tissues as a consequence.
Not just periodontitis
But the person with diabetes, especially if it is not controlled, not only has a greater predisposition to suffer from periodontitis and that it evolves more quickly, but also promotes the appearance or aggravates other oral disorders.
The elevation of glucose not only occurs in the blood, but also in the saliva; this increase is related to a greater predisposition to have caries. In addition, people with poorly controlled diabetes have a higher risk of also suffering from other alterations in the oral cavity, such as candidiasis, closely related to high glycosylated hemoglobin, or dry mouth (xerostomia).
And it is that poor control of diabetes supposes, in some way, a deterioration of the health of the mouth, to the point that there may be a greater predisposition, even, to lose teeth; in fact, recent studies indicate that up to 15% of patients with poorly controlled diabetes lose all the teeth in their mouths.
Oral care in people with diabetes
Usually, the diabetes patient is instructed in a series of healthy lifestyle habits (balanced diet, regular exercise, moderate alcohol consumption, not smoking...) to avoid the consequences that accompany poor control of this metabolic disorder. However, oral hygiene advice is not usually incorporated as essential healthy habits in diabetics and is essential.
Undoubtedly, the prevention of periodontitis is the best way to control the negative influence that this infection causes in diabetics. However, it is also known that good treatment and control of periodontal disease in diabetics facilitates control of their blood glucose, thus reducing the risk of derived complications.
Although oral hygiene is always important, if you have an increased risk of diabetes or have been diagnosed with it, it is essential to adopt measures to prevent, control and monitor the health of your teeth and gums. Your dentist can help you, and dental consultation can be essential to prevent or avoid associated complications.
If you have diabetes, you should know that:
- The health of your gums is essential for good control of your diabetes
- In turn, good control of your diabetes is crucial to ensure the success of periodontal treatment.
- Diabetes increases susceptibility to the action of bacteria that are at the origin of periodontal pathologies
- The person with diabetes has 3 times more risk of suffering from gum disease and these can take longer to control, which makes the loss of bone that supports the tooth more likely
- Periodontitis is more severe with poorly controlled diabetes
- An adequate treatment and control of periodontitis in diabetics favors the control of their glycaemia