Detection and prevention of periodontal disease in diabetes

Because the prevalence of both chronic gum disease and diabetes increases with age, establishing a relationship between them in the older age groups in extremely difficult.  However, it is generally accepted that adults whose diabetes is well-controlled do not have more gingivitis or destructive periodontitis that non-diabetics.

Thrush

Diabetics have elevated glucose levels in their saliva when blood glucose is high, and these glucose elevations can influence the bacterial growth in the mouth and the mixture of organisms in the deepest gum pockets around your teeth.

Physiology

In addition to elevated glucose levels, diabetic patients seem to respond to infection differently, reducing the effectiveness of the immune cells that fight infection.

Other factors contributing to gum diseases in diabetics may be vascular changes, including poor circulation in the smallest blood vessels, and altered collagen metabolism.

Dental infections themselves may worsen the diabetic state. As in other infections, dental infections result in hyperglycemic, mobilization of fatty acids, and acidosis. Exacerbation of dental infections may undermine good control that has been achieved in diabetes, and initial control may be difficult or impossible in a newly diagnosed diabetic with active dental infection.

Detections and Monitoring

Dry mouth and thirst are classic symptoms of diabetes, and an increases incidence of thrush is considered a complication of diabetes.

Factors That Link Diabetes to Gum Disease

• Studies show that people with insufficient blood sugar control seem to develop gum disease more frequently and more severely then people who have good management of their diabetes.
• Diabetes slows circulation, which can also make the gum tissues more susceptible to infections.
• Diabetes reduces the body’s resistance to infection which increases the probability of the gums becoming infected.
• High glucose levels in saliva promotes growth of bacteria that cause gum disease.
• People with diabetes who smoke are far more likely to develop gum disease than people who smoke and do not have diabetes.
• Poor oral hygiene is a major factor in gum disease for everyone, but it is even more so for a person with diabetes.

Signs and Symptoms of Gum Disease

• Red and swollen gums
• Gums that tend to bleed easily
• Gums separating from the teeth
• Loose teeth
• Frequent  bad breath
• Change in the way your teeth fit together
• Change in the way partials or dentures fit

Prevention

• Maintain good control of your blood sugar levels.
• Do not smoke.
• Good oral hygiene and regular dental check ups are essential in preventing gum disease.
• Eat a healthy and well balanced diet.

Be sure to tell your dentist and hygienist that you have diabetes so that he / she can detect any signs of early gum disease.

There are two major stages of periodontal disease, gingivitis and periodontitis. Even though people with diabetes tend to develop gum disease more frequently than others, if diagnosed in the early stage (gingivitis), it can be treated and reversed. If treatment is not received, a more serious and advanced stage (periodontitis) may follow which includes bone loss and is not reversible. 

Diabetic patients, with uncontrolled diabetes may exhibit:

• excessive loss of fluids my means of frequent urination
• altered response to infections (like gum disease)
• changes in microscopic blood vessels
• increased sugar concentration in the saliva

The complications of hyperglycemia, leading to increased urination, also result in depleted body fluids and the complaint of dry mouth.  The problems usually escalate when patients try to compensate for the dry mouth by sucking on hard candies. Naturally, this increased sugar furthers the systemic hyperglycemic problems but in addition, the candies increase the likelihood of rapid onset cavities.

Obviously, the key to avoiding this type of scenario is to see a physician annually for thorough physicals and be aware of the signs and symptoms of hyperglycemia.