Diabetes and Dental Complications

It has long been known that having diabetes increases the risk of severe periodontal disease.

Poorly controlled type 2 diabetics are more likely to develop periodontal disease than well-controlled diabetics are. Studies conclude that poorly controlled diabetics respond differently to bacterial plaque at the gum line than do well-controlled diabetics and non-diabetics. Also, poorly controlled diabetics have more harmful proteins (cytokines) in their gingival tissue, causing destructive inflammation of the gums.  In turn, beneficial proteins (growth factors) are reduced, interfering with the healing response to infection.

Diabetics tend to lose collagen, a protein that supports gums, skin, tendon cartilage, and bone, in their gum tissue, thus hastening periodontal destruction. Vascular disorders (caused by diabetes), such as reduced circulation in tiny blood vessels in the gums, interfere with nutrition and healing in the gum tissues. Young people with type 1 diabetes, especially those with poor control, are very vulnerable to early-onset periodontal disease as they reach puberty.

Studies on Diabetes and Dental Problems

A study published in the September 2002 issue of Diabetes Research and Clinical Practice looked at 102 patients, average age 65 with type 2 diabetes.

In this Swedish study, the researchers conducted a comprehensive dental examination and then compared these results with the same battery of tests given to a control group without diabetes but otherwise the same in terms of age and gender. The results indicate that diabetic subjects had more pockets between teeth, which indicate moderate to advanced gum disease. They also had deeper pockets. The diabetics had more plaque on their teeth and experienced more bleeding of their gums when being examined. The 22 subjects on insulin had more cavities than those who were controlling diabetes with diet only.

Overall, the diabetic group also had problems with dry mouth and those with poor control had worse problems.

In an article in the Journal of Periodontology, the author Christopher Cutler, DDS, states that "increased serum triglyceride levels in uncontrolled diabetics seem to be related to greater attachment loss and probing depths, which are measures of periodontal disease."

For this reason, the article stresses that diabetics work with their health care team to keep cholesterol levels and triglyceride levels normal. "Reducing ...[these two levels], preferably through diet and exercise, may be the most important changes that diabetics can make to improve their life, as well as their oral health."

How Diabetes Affects Your Teeth and Gums

We all know that these problems can occur to anyone. That's why we all go to our dentist on a regular basis. Plaque builds up on all of our teeth. However, high blood glucose levels help germs to build up on your teeth and gums, making these problems worse so that you could actually loose you teeth.

What does this look like if it's happening to you? The first signs are red, sore, and bleeding gums. This can lead to periodontitis, which is an infection in the gums and the bone that holds the teeth in place. Pockets form between the teeth, which fill with germs and pus. If not treated and the infection gets worse, your gums may pull away from your teeth, making the teeth look very long, and your teeth will loosen.

Sometimes when I write these articles, I think that diabetics are singled out for many diseases, but with gum disease about 85% of all adults develop it. 10% have lost all of their teeth to it. It is difficult to get people to brush and floss as often as they should.

Many people do not go to the dentist when their gums bleed when they brush or floss. This bleeding is not normal. It needs to be addressed. If the plaque is not brushed and flossed away it hardens into tartar and collects under the gum line.

To make matters worse, more plaque forms over the tartar, so you can imagine how the problem can escalate. Although tartar is inert, it harbors surface bacteria and worsens the disease below the gum line. As the process accelerates, more and more tissue becomes diseased and more plaque accumulates. Once the bone begins to be destroyed, you know the rest; the teeth loosen and false teeth are around the corner.

Fighting Periodontal Disease When You Have Diabetes

The prospects for fighting periodontal disease are excellent, as there are many things that someone with diabetes can do to stop the process or correct the disease once it starts. The first goal is easy.

1. Good Blood Glucose Control

The degree to which a person is in control appears to have a direct relationship to the severity of periodontal disease. This is clearly a very good thing to know, especially on those mornings when you think you are running too late to brush and floss. You can run out the door or, like many of us, make an appointment with the periodontist of your choice.

It has been found that in people with good control, gingival tissues usually react in a fairly normal manner. In people with diabetes who have poor blood glucose control, bone loss in periodontal disease is particularly severe.

2. Oral Hygiene

Make sure you schedule regular dental check-ups. For a diabetic this may mean every six months, or if you have periodontal disease more often until you get it under control. According to periodontists we spoke to, check-ups every three months may ensure problems can be arrested with relatively minor procedures. Having had to undergo periodontal surgery, I can tell you to take care of your gums. The alternative is not so good!

Brush and floss the proper way. If you are not sure, the hygienist can help you out. The hygienist is the person who regularly cleans your teeth at the dentist's office. Now that you've read this article, you know that brushing and flossing are important to remove bacteria before it causes damage. If necessary, your dentist may recommend mouthwashes using chemicals that destroy plaque-forming bacteria and neutralize their toxins.

3. Watch for Warning Signs

We've gone over these in the article, but for one more time, let's list these.

  • Bleeding gums while you eat or brush and floss are a warning sign.
  • Abnormal changes in your mouth such as soreness, sores, bright red gums and tenderness.
  • Also look for gums pulling away from your teeth, making your teeth look long.
  • Also see the dentist if you have chronic bad breath or your bite feels different.
  • Run, don't walk, to the dentist if your dentures do not fit well or you experience any of these symptoms, and at the same time throw away any cigarettes you have any in the house. Smoking and diabetes and dental hygiene do not go together.
  • White patches on your gums might mean the presence of thrush, which is a fungal infection requiring treatment.

If you have to visit the dentist or periodontist because of periodontal disease, they will most likely first root plane by using instruments called scalers and curettes. The dentist can probe the periodontal pockets and remove plaque and tartar. Once these are removed, the inflammation of the gums should subside and the gums should re-adhere to the teeth.

If this does not work for you, periodontal surgery may be needed. This occurs if the pockets caused by plaque don't close up following the root planing just described. During the surgery, excess gum tissue may be surgically removed. This way the gingival crevice will be shallow enough to remain free of plaque by brushing and flossing.

Why do diabetics need to care about controlling periodontal disease? First, dental infections may worsen diabetes by causing hyperglycemia, mobilization of fatty acids, and ultimately acidosis. As we know, all of these conditions make it very difficult to control blood glucose levels.

Proper nutrition is essential to good control of diabetes. When gums are tender, a diabetic may opt for foods that are not appropriate for their diet. Dentures are not a good option for those with diabetes, according to the American Dental Association, because of the tendency for gum irritation and the possibility for infection.

To summarize, we hope that reading this article has helped you understand the importance of caring for your teeth, gums, and blood glucose levels. Most people know that when diabetes is poorly controlled, they will eventually have problems with their extremities, particularly toes and feet. But the same type of damage can occur to the salivary glands. Without those protective proteins we spoke of, diabetic people are at a higher risk for dental problems. In people with well-controlled diabetes, there really is no difference in their oral health compared to those without diabetes. But, as we have explained, those with poor blood glucose control or poor oral hygiene run the risk of cavities and periodontal disease.

Updated on: December 6, 2012