The link between diabetes and periodontal disease

The link between diabetes and oral health has been scientifically proven by numerous specialist studies, as well as through clinical practice. This article explores the connection between diabetes and periodontitis (a serious gum infection). You will discover how diabetes can increase the risk of gum problems, and how periodontal disease can affect diabetes management. You will also find practical advice on how to prevent and manage both conditions, thereby protecting your oral and general health.

Diabetes is a metabolic condition that prevents the body from maintaining normal blood sugar levels. This happens either because the body does not produce enough insulin, a hormone that helps sugar enter cells to be used as energy, or because the cells do not respond properly to insulin. High blood sugar levels, especially over the long term, can lead to serious health problems.

Globally, 1 in 10 adults has diabetes, and over 90% have type 2 diabetes. According to estimates, approximately 537 million adults aged between 20 and 79 were diagnosed with diabetes in 2021. 

Also in 2021, over 800,000 cases of diabetes were recorded in Romania, according to the National Institute of Public Health.

Diabetes cannot be cured, so this condition requires special care to keep it under control. Managing diabetes can be challenging and may affect one’s emotional well-being, leading to anxiety or depression. For this reason, regular visits to the doctor are necessary to avoid various long-term complications.

There are a number of oral health conditions associated with diabetes. Consequently, people with diabetes may be at increased risk of:

• Tooth decay: Although the link is not direct, certain types of diabetes can influence eating habits and saliva flow, increasing the risk of tooth decay.
• Xerostomia (dry mouth): Diabetes can reduce the amount of saliva, which can lead to discomfort, difficulty speaking and swallowing, and an increased risk of tooth decay.
• Oral mucosal disorders: People with diabetes may be more prone to certain lesions of the oral mucosa, such as lichen planus, recurrent aphthous stomatitis and oral thrush (a fungal infection).
• Periodontal disease: Diabetes and periodontal disease are conditions that influence each other.

High blood sugar levels can also affect blood circulation in the gums, reducing the body’s ability to fight bacteria and heal wounds. This means that dental infections may be harder to treat.

Diabetes and tooth decay

People with diabetes are at increased risk of developing tooth decay, but the situation varies depending on the type of diabetes. For instance, those with type 1 diabetes tend to follow a diet lower in carbohydrates, which reduces the risk of tooth decay. In contrast, type 2 diabetes is often associated with obesity and a higher intake of carbohydrates, which can increase exposure to cariogenic (tooth-decay-causing) foods. 

Xerostomia (dry mouth) and diabetes

Dry mouth is a common problem for people with diabetes. This condition can be caused by various factors, including medicines used to treat diabetes, age or nerve damage (diabetic neuropathy). Furthermore, reduced saliva flow is an additional risk factor for the development of tooth decay.

Oral mucosal conditions in people with diabetes

People with diabetes are more prone to developing certain lesions or conditions of the oral mucosa. These may include lichen planus (an inflammatory condition), recurrent aphthous stomatitis (mouth ulcers) or oral thrush (a fungal infection, also known as ‘thrush’).

Diabetes and periodontal disease are two conditions that dangerously influence one another. If you have diabetes, you are more likely to develop periodontal problems. This is because diabetes can exacerbate the body’s inflammatory response to bacteria in the mouth.

Unlike other oral problems, periodontal disease is considered a serious complication of diabetes. Numerous studies have shown that people with diabetes are at a much higher risk of developing this condition. Furthermore, periodontal disease can negatively affect wound healing following oral surgery. This happens because diabetes can exaggerate the body’s inflammatory response to bacteria in the mouth.

On the other hand, periodontal disease makes it harder to control blood sugar levels and can complicate the management of diabetes. In other words, gum problems can make diabetes harder to keep under control.

At the same time, chronic inflammation of the gums caused by periodontitis can lead to insulin resistance. This means that your body no longer responds as well to insulin, the hormone that helps control blood sugar levels. This resistance can cause fluctuations in blood sugar levels and make diabetes harder to manage. Studies have shown that people with untreated periodontal disease have higher blood sugar levels and are more prone to complications, such as heart disease and kidney problems.

Unfortunately, periodontal disease can have a negative impact not only on blood sugar control but also on other complications of diabetes. The systemic inflammation associated with periodontal disease can exacerbate insulin resistance and increase the risk of:

• Cardiovascular disease (heart disease and stroke)
• Nephropathy (kidney disease)
• Retinopathy (eye disease)

A major study has shown that effective treatment of periodontal disease in patients with diabetes led to significant improvements in blood glucose control. This demonstrates that oral health has a direct impact on glucose metabolism and highlights the importance of an integrated approach to treatment for both conditions.
Therefore, maintaining optimal oral health can play an important role in reducing the risk of long-term complications in people with diabetes.

Common risk factors 

Diabetes and periodontal disease share certain risk factors, which further complicates the relationship between the two conditions. These factors are:

Recent research has opened up new avenues for treating the link between diabetes and periodontal disease. There are now more effective treatments, such as non-surgical periodontal therapy (which involves either prophylaxis sessions or subgingival laser decontamination), combined with rigorous oral hygiene at home. There are also clinical trials exploring the use of anti-inflammatory agents and laser therapy to treat periodontal disease in people with diabetes.

In the future, researchers hope to better understand the role of the oral microbiome (the totality of bacteria in the mouth) in the interaction between diabetes and periodontal disease. Work is also underway to develop personalised prevention and treatment strategies based on each patient’s genetic profile.

To manage diabetes and periodontal disease effectively, it is essential to have a coordinated healthcare team comprising:

• Dentist: Plays a crucial role in the early diagnosis of periodontal disease, administering appropriate treatment and educating patients on the importance of oral hygiene.
• Diabetologist: Is responsible for monitoring blood sugar levels and the overall management of diabetes.
• Other specialists: Depending on your needs, other healthcare professionals may also be involved.

Regular communication between these specialists is vital to ensure comprehensive and personalised care.

If you have diabetes, it is important to know that you are at greater risk of developing oral health problems, particularly gingivitis and periodontitis. This risk is higher in type 2 diabetes than in type 1 diabetes. Gum inflammation can affect blood sugar control and exacerbate cardiovascular problems, increasing the risk of serious complications.

Fortunately, there are simple steps you can take to prevent and manage both diabetes and periodontal disease:

Keep your blood sugar under control

Strict control of blood sugar levels is essential to prevent diabetes complications, including dental problems. Well-controlled blood sugar reduces the risk of gum infections and helps wounds heal quickly.

Prioritise visits to the dentist

People with diabetes should visit the dentist at least twice a year for check-ups and professional cleanings. These visits allow for the early detection of problems and the removal of tartar, reducing the risk of periodontal disease.

Also, when you have diabetes, it is important for your dentist and diabetes specialist to work together to ensure safe and effective treatment of dental problems.

Pay attention to oral hygiene and give up smoking

Brush your teeth at least twice a day and use dental floss or interdental brushes to clean between your teeth. This helps prevent the build-up of bacterial plaque, the main cause of periodontitis.

Smoking is a major risk factor for both diabetes and periodontal disease. Quitting smoking can improve your oral and general health and help maintain better blood sugar control.

Blood sugar control before dental treatment

The main goal of diabetes treatment is to keep blood sugar levels as close to normal as possible. An important test is the glycated haemoglobin (HbA1c) test, which shows the average blood sugar level over the last two to three months. Before certain dental procedures, your dentist may request your HbA1c level to ensure that your diabetes is well controlled.

The timing of dental treatment is important, especially if you take insulin. Dental procedures should preferably be scheduled in the morning, when blood sugar levels are more stable. If you take insulin, the appointment should be scheduled so that it does not coincide with the peak of the insulin’s action, to avoid the risk of hypoglycaemia (low blood sugar).

It is also important that the dentist uses local anaesthetics with caution, as some substances in the anaesthetic can affect blood sugar levels.

The most common complication that can occur at the dentist’s surgery in a patient with diabetes is hypoglycaemia. If the dentist suspects you are having a hypoglycaemic episode, they will stop treatment immediately and give you a source of sugar (e.g. glucose tablets, glucose gel, sugar, sweets, juice or soft drinks).

Following certain dental treatments, the dentist may recommend taking antibiotics or using special mouthwashes with antimicrobial effects to prevent infections and aid healing.

Diabetes is a complex condition, and as a patient, you need to be aware of the impact it can have on your oral health. It is also important that your dentist is informed about your condition so that they can provide you with the best possible care.

Studies have shown that regular visits to the dentist for professional clean-ups have a positive effect on the oral and general health of people with diabetes.

“If you have diabetes, it is crucial to pay special attention to your oral health. Remember that regular visits to the dentist and rigorous oral hygiene can make a significant difference in preventing complications and maintaining a good quality of life. Work closely with your healthcare team to manage both your diabetes and your oral health, and you’ll be one step closer to a healthier life.” – Dr Diana Beleni (ex-Guțiu), Specialist in Periodontology.

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