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This is part of a fantastic series of articles explaining  the link between oral health and overall health. The article was written for dental professionals but really is great. So, please read through and remember to ask our team for any explanations that you may need.

Dr Brian Johnson

Inflammation – the Link Between gum disease and Diabetes

Type 2 DM is a broad activation of the innate immune response, causing chronic low-grade inflammation throughout the body. Type 2 DM is commonly seen in overweight and obese people who have elevated levels of circulating fatty acids that inhibit glucose uptake, glycogen synthesis and glycolysis. This triggers the innate immune response. Often, insulin resistance is countered by an increase in insulin production. However, in 30 percent of Type 2 DM cases, pancreatic cells are reduced by programmed cell death called apoptosis, leading to inadequate insulin production.

Cytokines are released by white blood cells in the periodontal tissues in response to subgingival bacteria. These cytokines eventually make their way into the blood stream and to distant organs and tissues. Cytokines circulating in the blood stream activate an acute phase response with a cascade of immune responses.

The risk for periodontitis in those with DM is two- to five-times higher compared to those without DM. Changes in the blood vessels in those with DM influence the initiation and progression of gingivitis and periodontitis. Both DM and periodontal disease experience cytokine-induced acute phase immune response reactions. Compromised immune response leads to both progression of periodontal disease and reduced metabolic control in DM.

Some, but not all clinical trials demonstrate improved glycemic control following periodontal therapy. Study outcomes are similar for both oral diabetes drugs and periodontal treatment when measuring glycemic control.

Clinical Implications: Active periodontal therapy, as well as maintenance care is important for both oral health and overall health. Dentists and hygienists provide valuable care for those with both periodontitis and DM.

Tunes, R., Foss-Freitas, M., Nogueira-Filho, G.: Impact of Periodontitis on the Diabetes-Related Inflammatory Status. J Can Dent Assoc 76: 1-7, 2010. Awareness of Diabetes’ Impact on Other Diseases

The incidence of diabetes is on the rise worldwide. Chronic systemic manifestations of diabetes are primarily seen in the vascular system, with specific issues related to the microvasculature including retinopathy, nephropathy and neuropathy. Oral complications of diabetes include gingivitis, periodontitis, xerostomia and consequently, caries. Diabetes is bi-directional, with uncontrolled diabetes leading to periodontitis and severe periodontitis impacting glycemic control.

A researcher at the University of Sharjah in the United Arab Emirates, used a written questionnaire to evaluate the attitudes and awareness of patients with diabetes. The 200 subjects were seeking care at the largest diabetic clinic in Benghazi, Libya. The questions related to oral health and oral care.

The majority of subjects, 71 percent, had Type 2 diabetes, with 18 percent reporting Type 1 and 11 percent unsure which type they had. Subjects ranged in age from 17 to 78 years and had diabetes from one week to 40 years.

Dry mouth was experienced by 84 percent of the group. Smokers accounted for 42 percent of the group. The majority had teeth, but 31 percent were edentulous with only 44 percent of them wearing full dentures. Only 17 percent brushed twice daily and only 12 percent reported daily flossing. The dentist was the primary source of information about oral complications of diabetes and oral care. Those reporting oral infections also had high glycemic control scores. Less than 50 percent were aware that dental diseases are complications of diabetes.

Clinical Implications: Education is needed from both dental and medical professionals addressing the oral complications associated with diabetes and the importance of good oral hygiene and regular dental care.

Eldarrat, A.: Awareness and Attitude of Diabetic Patients about Their Increased Risk for Oral Diseases. Oral Health Prev Dent 9: 235-241, 2011.

  The author is Trisha O’Hehir, RDH, MS who is the Editorial Director at Hygienetown Magazine

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