Gingivitis, Periodontitis and Diabetes

When it comes to diabetes, it is common to focus on the effects on the heart, lungs, kidney and other major organs of the body. As a result, one certain part of the body is sometimes overlooked – the gums. They are overlooked in spite of the fact that there is a close association between type 2 diabetes (T2D) and gum or periodontal disease (PD).[1]

What is Periodontal Disease?

Gum or periodontal disease is divided into 2 basic types: gingivitis and periodontitis – the former is the milder version and the latter is more severe. Gingivitis often progresses into periodontitis if left untreated. PD is best described as a chronic bacterial infection that affects those crucial tissues supporting your teeth – your gums and bones. It is true the disease does affect those individuals who do not have diabetes, but diabetics are especially prone to developing these conditions due to sugar imbalances in the body that promote bacteria growth.

There is another difference between diabetics and non-diabetics. Those who are diabetic are at higher risk of having not just PD but PD in a more aggressive form.[2]  Yet, whether or not you have diabetes, PD has certain features. The most common of these is inflammation. This may be low grade inflammation, but it can lead to extensive damages to gums, bones and teeth in a systemic fashion.

The Relationship between Diabetics and Gum Disease

As noted previously, diabetics are at increased risk of developing bacterial infections and, therefore, gum disease. The disease tends to be more severe for those who have diabetes. A contributing factor to the severity of the problem is poor blood sugar control. Conversely, recent research has indicated that periodontal disease may actually increase the risk of individuals developing diabetes. It is considered a possible contributory factor to poor glycemic control. Factors related to diabetes appearing to contribute to the relationship between PD and diabetes includes the following:

  • Slow circulation of the blood
  • Decreased immune system – the decrease in white blood cells results in a reduced ability to fight off infectious bacteria
  • High glucose levels connected to diabetes are in the blood and saliva. The bacteria leading to PD thrive and multiply on sugar
  • Smoking – this seems to increase the chance a diabetic will get gum disease
  • Xerostomia[3] – this is called dry mouth. It results in diminished saliva production. This, in turn can give rise to increased bacterial growth in the mouth

The Common Signs and Symptoms of Gum Disease

There are certain indications that you may have gum disease. In the early stages of gingivitis they may consist of the following[4]:

  • Red and inflamed gums
  • Build up of plaque
  • Gums that are sensitive to the touch
  • Gums that bleed too easily- particularly after you brush or floss your teeth

As the bacteria invade your mouth and multiply, the symptoms worsen becoming more overt and severe. They can include:

  • Pockets begin to develop between areas of the teeth
  • Gap develops between the teeth and the gums, root tips are exposed
  • Bone loss
  • Loose teeth that will wiggle and eventually fall out due to disease progression
  • Build up of tartar
  • Ongoing issues of bad breath not corrected by using mouth wash products
  • Teeth that do not seem to fit together as well
  • A change in how your dentures or partials fit

These symptoms indicate that gum disease is progressing from gingivitis to periodontitis.

Diagnosing Gum Disease

Only your dentist can diagnose gum disease. A thorough dental examination that includes a visual look at the teeth as well as X-rays and even something known as periodontal charting (measurements that look at the pockets surrounding each tooth as well as other aspects) will provide the dentist with the information on the condition of your teeth, gums and bone.

Treatment for PD

Treatment depends upon the stage of PD. If it is gingivitis, it can be treated with a thorough cleaning of the teeth and the application of proper oral hygiene practices. In other words, you must:

  • Brush your teeth a minimum of twice daily using the right toothpaste and toothbrush[5]
  • Floss your teeth regularly, at least once a day
  • Use a non-alcoholic mouth wash – alcohol can result in dry mouth which can increase the risk of gum disease
  • Rinse your teeth after every meal using water
  • Visit your dentist at least once a year for a check-up
  • Once or twice a year have your dentist or oral hygienist professionally clean your teeth

If, however, you neglect to practice proper oral hygiene and gingivitis becomes periodontitis, you will require more serious measures. These may include:

  • Scaling
  • Root planning
  • Antibiotics
  • Surgical procedures

It is important for the diabetic to undergo treatment for PD. It not only decreases the risks associated with gum disease, but also results, for T2D, in an improvement in glycemic control.[6]

Prevention of Gum Disease

Prevention is always the best route to take. If you want to stop gum disease before it takes hold, you need to put into place a solid program of proper oral hygiene in addition to maintaining your blood glucose at the proper levels. To reinforce this approach you also need to consider the following:

  • If you are smoking – stop now
  • Eat a balanced meal
  • Eat healthy and nutritious food – abandon the over processed, fatty and sugary components of modern diets
  • Do not neglect to inform both your dental hygienist and your dentist that you are diabetic. This will make them aware of the necessity to be more diligent in looking for signs of complications due to diabetes.

Conclusion

Gum disease is a serious problem for many people. However, when you are diabetic, developing gum disease is more likely. Nevertheless, as in non-diabetic individuals, the same preventive measures are effective. It is essential to maintain a regular program of oral hygiene and to keep the blood glucose levels under control.

References

[1] Demmer, RT; Jacobs DR; and Desvarieux, MS (2008). “Periodontal Disease and Incident Type 2 Diabetes.” Diabetes Care, 31(7):1373-1379.

[2] Díaz-Romero, RM; and Ovadía, R (2007). “Diabetes and Periodontal Disease: A Bidirectional Relationship.” Facta Universitatis. 14(1):6-9.

[3] Levin, ME; and Pfeiffer, MA (editors) (2009). The Uncomplicated Guide to Diabetes Complications, 3rd ed. Alexandria, VA: ADA.

[4] Marcovitch, H (2006). Black’s Medical Dictionary 41st edition. Lantham, Maryland: Scarecrow Press.

[5] Rosenthal, S (2005). The Type 2 Diabetes Source Book For Women. New York: McGraw Hill.

[6] Teeuw, WJ; Gerdes, VEA; and Loos, BG (2010). “Effect of Periodontal Treatment on Glycemic Control of Diabetic Patients.” Diabetes Care, 33 (2):421-427.

[7] This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.