Periodontal Diseaes And Diabetes. What You Need To Know

The relationship between diabetes and gum disease periodontitis) is bi-directional. This means that not only are diabetic patients more prone to periodontitis, but periodontitis can also make it more difficult for diabetics to control their blood sugar level. In the the United States, it has been shown that diabetic patients are up to 4.2 times more likely to develop periodontitis than those without diabetes.

(1) What is periodontitis?

Periodontal disease, more commonly called gum disease, is a chronic (long-standing) bacterial infection of the gums. It is caused by plaque, which is a sticky, colourless or slightly yellow layer that accumulates on teeth. In the early stage of the gum disease called gingivitis, the bacteria in plaque produces toxins (poisons) that leads to red and swollen gums. As the disease progresses to periodontitis, the toxins destroy the bone supporting the teeth. Although there is little pain in the early stages of periodontitis, gum swellings, pain and loosening of teeth may develop later.

(2) How will I know if I have gum disease?

The following are some signs of gum disease:
a) Red and bleeding gums
b) Swollen and receding gums
c) Bad breath
d) Spaces appearing between teeth
e) Loosening and shifting of teeth
f) Vague itchiness or ache in the gums

(3) How does having diabetes affect my gums?

In diabetic patients, the white blood cells (which protect against infection) are defective. The amount of collagen necessary for healthy gums and good healing capacity are also reduced. This is worse in poorly-controlled diabetics. Hence, poorly-controlled diabetics have a poor healing capacity and an increased risk to periodontitis. Periodontitis is also more severe in diabetics with more advanced diabetic complications and in those who have had diabetes for a longer time.
Well- controlled diabetics have a lesser risk to periodontitis compared to poorly-controlled diabetics.

(4) How does diabetes affect the rest of the mouth?

Those with uncontrolled or poor-controlled diabetics may experience a burning sensation in the mouth or tongue due to a reduced salivary flow. There may also be an increased risk to tooth decay and fungal infections.

(5) How is periodontitis treated in a diabetic patient?

The Periodontist (dental surgeon who specializes in gum disease) needs a certain amount of medical information such as the patient’s blood sugar level nad the type of medication he/she is on. Treatment may need to be modified according to the medication the patient is on and how well the diabetes is controlled.

A well-controlled diabetic is usually treated similar to a non-diabetic with periodontal disease unless there are other medical conditions present. Patients are instructed to take their medications as prescribed and eat a normal breakfast. Early morning appointments are preferred as a certain type of hormone that reduces stress is in greater quantities in the morning.

A poorly-controlled diabetic will be treated in collaboration with his/her doctor or endocrinologist. Gum treatment is till encouraged though these patients may not respond as well as well –controlled diabetics. Early studies in the United States suggest that controlling periodontitis in the poorly-controlled diabetics may contribute to better blood sugar control.

In general, gum treatment consists of multiple sessions of deep scaling beneath the gums usually with local anaesthetic. In certain cases, surgical treatment may be recommended. Periodontal treatment may also be combined with treatment fro other dental specialities especially if replacement of lost teeth is required.

(6) What should I do to keep my oral health optimal at all times?

Prevention is always best. Once periodontitis occurs, the amount of bone supporting the teeth that is lost cannot be regained. Periodontal treatment will control the disease and helping the prevention of tooth loss but may not fully correct the receded gums or lessen the looseness of teeth that has already occurred.

Optimal oral health can be achieved via:

Good control of diabetes via medication, diet, exercise as advised by the doctor.

Regular dental check ups that include gum checks and X rays.

Regular periodontal maintenance by a dentist or periodontist for patients who have had gum disease.

Good personal oral hygiene or home care. Efficient tooth brushing and flossing techniques should be learnt from the dentist or periodontist.