Connection Between Diabetes and Oral Health

1. What does taking care of your teeth and oral health have to do with your blood sugar?
People with diabetes or higher-than-normal blood glucose levels, may be 2-3 times more likely (compared to a non-diabetic subject,) to develop oral chronic disorders such as periodontitis, bleeding gums, recession of the gums, dry mouth, halitosis, and mucosal ulcers.

Why?

Because diabetic patients are more predisposed as their immune system has a reduced ability to defeat the bacteria that invade the gums. Their immune responses to infections are impaired. As a result, maintaining proper oral health is crucially important for diabetic patients. 

Typically, diabetic patients may suffer from periodontitis. Long-lasting inflamed gums tend to either recede or create deep pockets around teeth. These pockets are full of germs that reinforce the inflammation itself. When a patient suffers from periodontitis, it may involve the loss of bone that supports the tooth. The weakening of the supporting bone tissues causes a decrease in the stability of a tooth leading to its potential loss. 

Lack of treatment and inadequate control of periodontitis are among the most frequent causes that can lead to tooth loss.

But the relationship between oral health and diabetes is twofold. Gum disease can also negatively affect blood glucose control, worsening the diabetic condition due to the release of hyperglycemic hormones that lead to hyperglycemia.

Here a vicious circle is triggered that requires constant and scrupulous monitoring of a diabetic patient’s oral health. 

2. How is oral health related to blood pressure?

According to published studies, people subject to periodontitis are those with the greatest risk of suffering from hypertension. This fact would confirm that excess periodontal bacteria, if not treated on time, can lead to serious systemic inflammation.

3. Can your dental health offer any first signs of diabetes? 
The mouth of a "diabetic person" is more sensitive than that of a healthy patient. It has poor resistance to bacteria, which leads to oral infections, inflammation of the gums, gingivitis or periodontitis over time, and much more serious consequences, such as tooth loss.

The causes are: 

• a lower-than-normal salivary PH level (acidic), which reduces the defense capacity of the tissues causing gingivitis.

• reduced salivary flow with denser saliva, which therefore has less cleaning capacity and exposes the patient to a greater chance of developing tooth decay and gingivitis.

It is estimated that for a "diabetic patient", the risk of contracting periodontitis is 2-3 times greater than for a "non-diabetic patient". Therefore, a dentist should pay attention to the following signs of oral disease as being potentially linked to uncontrolled diabetes:

• red, swollen and bleeding gums, with the formation of bacterial plaque and tartar and the onset of gingivitis
• gingival recession showing the hidden part of the tooth (root); 
• tooth mobility, tooth displacement, and tooth loss, 
• presence of bad breath (halitosis) 
• increased sensitivity to hot and / or cold foods due to the fact that the exposed root is not covered by gums, and the dental root is structurally not protected by the enamel.
• permanent teeth that recede; dental prostheses that do not stay in place; pain upon chewing

• increased exposure to Candida infections
• slower wound healing in the presence of high blood sugar
• frequent infections and ulcers
• onset of "Thrush" caused by fungi growing in the mouth
• burning sensation in the mouth (glossopyrosis)
• benign migratory glossitis (geographic tongue)
• polymicrobial stomatitis

As a reminder, periodontitis is the final stage of gum disease where bacteria attack the tissues that support the teeth, destroying them and causing the loss of dental elements. 

When the periodontium becomes irritated and detached from the tooth, a periodontal pocket is formed where plaque and bacteria can lead to a reduction in the supporting bone and a loss of stability of the teeth.

Gingivitis instead, is the first stage of gum-related diseases, caused by the accumulation of plaque under the gumline. Plaque consists in food residues and sticky bacteria. If not removed, it hardens, becomes tartar, which leads to swollen gums and causes them to bleed.

 4. Are people with diabetes still more likely to experience dental health issues even once their diabetes is properly managed/controlled? 

When glycemic control is good, there will no longer be an alteration in the immune response. The defenses against bacteria in the mouth will increase and there will be less:

• presence of periodontal pockets
• less gingival bleeding 

If the patient has a healthy lifestyle and manages to keep his or her blood glucose levels at normal levels, the chances of developing dental health issues will be meaningfully reduced, if such a regimen is adhered to.

5. Aside from the usual advice of regular brushing/flossing/regular dentist visits and teeth cleanings, how can people with a chronic condition such as diabetes or hypertension proactively prevent dental health issues?

A diabetic patient should (also):

• pay close attention to gingival bleeding, which is more frequent in a diabetic patient
• avoid drinking alcohol and smoking
• undergo at least 3 professional hygiene sessions and check-ups per year, instead of the usual twice yearly
• follow a diet low in simple and complex sugars (a low glycemic diet) 
• dedicate oneself to physical activity 

6. Can proper dental health practices lower your risk of high blood pressure, diabetes, and/or any other cardiovascular health issues in any way? 

An adequate periodontal therapy not only determines the improvement of one’s oral health but contributes to the achievement of better glycemic control. Why? Because gum disease can also negatively affect blood glucose levels, worsening the diabetic condition due to the release of hyperglycemic hormones that lead to hyperglycemia.

Treating periodontitis can help prevent the development of high blood pressure or help control it in people already suffering from it. Gum infecting bacteria can in fact migrate in the bloodstream and induce systemic inflammations that may favor the development of systemic disease such as hypertension.