One of the most interesting relationships in the oral systemic connection is the newly emerging two-way relationship between periodontal disease (periodontitis) and diabetes. For years it’s been apparent that diabetes exacerbates periodontal disease. What’s relatively new is the belief that periodontal disease may have an influence on diabetes.

Diabetes is a metabolic disease characterized by insulin resistance or lack of secretion.  Diabetics suffer from higher than normal blood sugar levels called hyperglycemia.  Over time, this condition can cause permanent damage to the eyes, kidneys, blood vessels and nervous system.
 
As diabetes progresses, so does the likelihood of developing and/or worsening of chronic periodontitis. Researchers are currently studying the possibility that uncontrolled periodontal disease may interfere with glucose regulation in the body.  This makes the diabetic condition worse by interfering with glucose metabolism, which in turn could increase the chance of other serious medical complications.

A growing body of scientific literature suggests a bi-directional relationship. Although the exact nature of this relationship is not clear, both healthcare professionals and patients should be aware of and address this concern.

 
It is not unusual to see very swollen gums, loose and/or shifting teeth and/or a bad taste in the diabetic condition. When gums are inflamed, local inflammatory mediators known as “cytokines” enter the blood stream and cause a negative effect on glucose regulation.  By treating underlying periodontal disease, glucose regulation has a much better chance of returning to a more normal state.   Home care in the diabetic patient should be meticulous to avoid making the situation worse.  Additionally, the diabetic patient should see their hygienist or a periodontist every 3 months for professional maintenance of the more difficult areas of the mouth.
 

Medical management of the diabetic patient by a physician should include asking patients if they have signs of loose or shifting teeth, bleeding gums, chronic bad breath and/or a family history of periodontal disease.  If the answer is “yes”, the patient should be referred to a periodontist or dentist trained in periodontal diagnosis and treatment. Early intervention in a diabetic patient is extremely important for managing both their oral and systemic health.

An estimated 20.8 million individuals in the United States have diabetes. Over six million diabetics are undiagnosed.
 

American Diabetes Association Warning Signs of Diabetes

Type 1 Diabetes: insulin dependent.
- Frequent Urination
- Unusual thirst
- Extreme hunger
- Unusual weight loss
- Extreme fatigue
- Irritability

Type 2 Diabetes: manageable with diet, exercise and medication, if applicable.
- Any of the type 1 symptoms
- Frequent infections
- Blurred vision
- Cuts/bruises that are slow to heal
- Tingling/numbness in the extremities
- Recurring skin, gum or bladder infections
 

Note: Individuals with type 2 diabetes frequently do not have any symptoms.

If you suspect that you or anyone in your care may have diabetes, promptly check it out with a physician.