Diabetes and Periodontal Disease

Diabetes affects around 20 million people in the US and about 35 to 40 percent of these people don’t know they have the disease. Statistically, greater than nine percent of Americans have type 2 diabetes and the incidence of diabetes is increasing as the population ages.

Type 1 diabetics lack insulin that is normally produced by the pancreas because of an autoimmune disease, while type 2 diabetics make enough insulin but suffer from insulin sensitivity that negatively impacts blood sugar levels.

Both types of diabetics have an increased risk of periodontal disease.  There is a vicious cycle going on with this because periodontal disease causes the blood glucose levels to rise and this, in turn, worsens the periodontal disease and increases the chances of having complications of diabetes.

Diabetics likely have an increase in periodontal disease when compared to non-diabetics because diabetic people are more prone to getting infections.  Periodontal disease is nothing more than an infection of the mouth and is considered a complication of type 1 and type 2 diabetes.  People who do not have good control over their diabetes have an even greater chance of having periodontal disease.
As mentioned, it is a vicious cycle. The higher the blood sugar, the greater is the chances of having periodontal disease, while having periodontal disease causes higher blood sugar levels.  Severe periodontal disease is especially associated with high blood glucose levels and this increases the chances of having other complications of diabetes, including kidney disease, blindness, amputations, nerve damage, and heart disease.

Type 2 diabetics make up almost 90 percent of diabetics.  As mentioned, there is insulin produced by people with type 2 diabetes but, because of insulin resistance, they have elevated blood sugars.  The amount of insulin produced by type 2 diabetics eventually diminishes, putting them at a greater risk of complications of diabetes, including periodontal disease.

More than 200 articles have been written in English over the past half century.  It is difficult to interpret the relationship between diabetes and periodontal disease because each study uses a different classification for diabetes and uses different ways to describe the degree of periodontal disease the participants have.

Additionally, researchers need to be careful when comparing the results of the various studies done on diabetics with periodontal disease because many of the studies have been done without using control subjects and often the studies used very small numbers of participants.  Taken together, however, it appears that diabetes causes increased rates of gingivitis and periodontitis when compared to non-diabetics.

Gingivitis and Diabetes

In one study done on diabetics with gingivitis done more than thirty years ago, the presence of gingivitis and inflammation of the gingival tissues was higher in patients who had type 1 diabetes when compared to patients who did not have diabetes but had the same amount of plaque on their teeth. The researchers noted an increase in the amount of gingival bleeding in those participants who had poor glucose control compared to those participants who had good control over their blood glucose levels.

People with type 2 diabetes also seem to have a greater chance of having gingival inflammation when compared to people who didn’t have diabetes.  The worse the control over blood sugar values there was, the greater was the incidence of gingivitis in diabetic patients.

Children with type 1 diabetes also see to have more gingival bleeding at the time of their diagnosis.  When the children were given insulin to control their blood sugars, the incidence of gingival bleeding decreased.

A more recent study followed type 1 diabetics over a period of time to see if they had an increased incidence of gingivitis.  The study found that adults with type 1 diabetes had more cases of severe gingivitis when compared to people who did not have diabetes, even though the amount and type of plaque in the mouths of all subjects were about the same. This suggested that diabetic patients suffer from gingivitis because they are more prone to inflammation of the gingival tissue when compared to non-diabetics.

Periodontitis and Diabetes

Most research indicates that diabetics have a greater than average chance of developing periodontitis.  In one study, type 1 diabetics had a 5 times increase in the amount of periodontitis.  A recent study showed that loss of attachment of the teeth was more extensive in children with type 1 diabetes when compared to children who did not have diabetes.

In addition, epidemiologic studies on periodontitis and diabetes showed an increase in tooth loss and loss of bone around the teeth in adults with diabetes when compared to adults who did not have diabetes.  In fact, participants who had type 2 diabetes had three times the increase of having periodontitis when compared to adults who didn’t have diabetes, even if they had good oral hygiene.

Diabetics also seem to have an increased chance of having ongoing periodontal disease that ultimately destroys alveolar bone and loosens teeth.  In one study done over a two-year period of time, there was a four times increase in progressive bone loss around the teeth in adults with type 2 diabetes compared to non-diabetics.

Just as is seen in gingivitis, the chances of having periodontitis may be increased in those diabetic patients who have poor control over their diabetes when compared to diabetics who had good control over their diabetes.  This means that there is something about having increased glucose levels that contributes to getting periodontitis.

A very large study involving thousands of people (The Third National Health and Nutrition Examination Survey), it was found that adults who did not have their diabetes in good control had three times the incidence of periodontitis when compared to people who didn’t have diabetes. Those subjects who had diabetes but had good control over their diabetes had normal rates of periodontitis.

The Take Away Message

As it seems that diabetics have an increased chance of having both gingivitis and periodontitis, it is a good idea to have your blood sugar levels in the best possible control and to have regular dental visits at least every six months in order to have the plaque removed and the teeth inspected for the presence of loosening of the teeth, loss of bone around the teeth, and evidence for increased inflammation of the gingival tissue.

References:

• Periodontal Disease and Diabetes. http://www.ada.org/~/media/ADA/Member%20Center/FIles/Perio_diabetes.pdf?la=en
• Diabetes and Periodontal Disease. https://www.perio.org/consumer/diabetes.htm