Diabetes and teeth—what’s the link?

Diabetes is when the body fails to produce adequate amounts of the hormone insulin. Since insulin is necessary for the absorption of glucose (sugar) into muscle, this leaves abnormally high concentrations of sugar in the blood. Careful balance of blood sugar is necessary to prevent the symptoms and complications of diabetes which can be quite serious. These include obesity, heart disease, kidney disease, vision and eye problems, painful sores in the feet and legs, and skin and mouth infections.

Studies have shown that the prevalence of diabetes in Australia is increasing, with one study finding a doubling since 1981. According to a National Health Survey (2007-2008), about 4% of Australians have been diagnosed with diabetes at some time in their lives. This proportion holds true for all states and territories, and is similar for major cities, regional areas, and remote areas.

The prevalence of diabetes increases with age; and men are more likely to be affected.

This has led the authors of the Australian Diabetes, Obesity, and Lifestyle Study to conclude that ‘Australia has a rapidly rising prevalence of diabetes and other tags of abnormal glucose tolerance. The prevalence of abnormal glucose tolerance in Australia is one of the highest yet reported from a developed nation’.

So where does gum disease fit in?

People with diabetes are more likely to have periodontal (gum) disease than those without diabetes. While this may be because diabetics are more susceptible to infections, there’s also been research that finds gum disease could make it harder to control your blood sugar, and that treating it helps improve diabetes symptoms.

More and more, high quality evidence supports the significant relationship between diabetes and gum disease, but researchers still aren’t sure which comes first—does having diseased gums increase the chance of diabetes, or does having diabetes increase the risk of gum disease? Nevertheless, gum disease is now considered the 6th major complication of diabetes.

What we know so far indicates that it may be a feedback loop that works both ways!

In a long-term study conducted at Columbia University in the United States, researchers followed 9,000 people who did not have diabetes. Over the 20-year study period, those individuals who had gum disease were more than twice as likely to develop diabetes as those who did not—even after adjusting for age, smoking, diet, and so on. Extending this idea, it seems that good oral hygiene and dental care to prevent infections and gum disease will also lower the risk of contracting diabetes.

A particularly noteworthy study published in 2010 (Simpson et. al. Cochrane Review) demonstrated a significant improvement in the glycaemic control of diabetics (0.74% reduction) just by getting their teeth cleaned by a hygienist! Having your teeth ‘cleaned’ is not just to make them look good and have them polished—what the dentist/hygienist is actually doing is removing all of the bacteria that has accumulated on the teeth and gums over the 6 month+ period thus eliminating oral inflammation, increasing the function of your immune system, improving glycaemic control and general health. For people with diabetes this means that their risk of other complications reduces dramatically: 8x less chance of kidney failure, 2x less chance of stroke and heart attack, less eye complications, less amputations and less medication.

What it means for you

In practical terms, if you have gum disease, you need to follow a treatment plan that will stabilise and maintain this. Gum disease is not cured—it is managed. If you are a diabetic, you need to take very good care of your health – every aspect. Good control of your blood sugar will make preventing and correcting gum disease and other complications that much easier. Good control of oral hygiene and gum inflammation will improve your glycaemic control and make management of your diabetes easier. If you have been told that you are ‘borderline’ diabetic—you need to have your gums checked. By simply having your teeth scaled  and removing the inflammation in your mouth, you can reduce your blood glucose (HbA1c) by 0.74% – this enough to keep you off medication!

At Bite Dental, we provide a free gum disease risk assessment for people with diabetes. So if you know someone with diabetes who has not had their gums checked yet—(tell them to!) and tell them about our program. At Bite—we know diabetes.

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