Diabetes and Dentistry

Miranda Schwartz
1 March 1998

No one enjoys going to the dentist, but for people with diabetes, getting that cleaning and check-up are especially important. The link between diabetes and oral health can't be ignored. In fact, dental problems in people with diabetes are so rampant that Mark Finney, DDS, believes oral disease should be referred to as "the sixth 'opathy' of diabetes," deserving of the attention given to retinopathy, neuropathy, nephropathy and the like.

While everyone is prone to periodontitis, or diseases of the tissues surrounding the teeth and gums, people with diabetes often have more severe cases that can both cause and predict additional diabetic complications.

Defining Periodontitis

Periodontitis or periodontal diseases involve inflammation and destruction of the tissues supporting and surrounding the teeth, including the gums and supporting bone. Periodontitis destroys the periodontal ligaments or connective tissue fibers that attach the tooth to the bone causing resorption of the alveolar bone (tooth socket). Consequently, the gums swell, redden, change shape, bleed, teeth loosen and pus forms. With the loss of soft tissue and bony support, deep periodontal pockets may form that foster bacterial growth.

The formation of plaque on the teeth is the first step toward periodontal disease. Plaque, the white sticky substance that collects between teeth, is often the start of periodontitis. Made of microorganisms, dead skin cells and leukocytes (infection fighting white blood cells), it can be removed by brushing and flossing regularly. If it is allowed to build up, it will harden and turn into tartar. Tartar can only be removed with a professional cleaning at the dentist's office. Both plaque and tartar make the gums vulnerable to infection.

If an infection enters the gums it is referred to as gingivitis, the first stage of periodontitis. Bacteria that collect and breed at the gum line and the groove between the gum and the tooth cause the gums to redden, swell and bleed. This response is normal but can also lead to periodontitis. Gums affected by gingivitis often bleed and are sensitive, but not always. Other signs include swollen gums, loose teeth, a bad taste in the mouth and persistent bad breath.

The Relationship to BG Control

BG control and good oral hygiene seems to be the key to avoiding most dental complications. Everyone is at risk of developing periodontal disease, but all people with diabetes, regardless of age or type of diabetes, are more susceptible. There are several reasons for this.

For one, people with diabetes have more sugar in the mouth which provides a more hospitable environment for hostile bacteria. This makes all forms of periodontal disease more likely.

High and fluctuating BGs are also a big factor in the increased risk of periodontal disease. Poor BG control means higher degrees of periodontitis and more vulnerability to complications.

It also makes healing more difficult once an infection sets in. Just like diabetics with poor BG control have a hard time healing wounds and infections on their feet, their bodies have a hard time fighting infections and healing wounds in the mouth.

At the same time, on-going infections may make BG control more difficult. Inflammation and infection affect BG control no matter where they occur. But the mouth is often overlooked as most doctors do not look in the mouth.

Once an infection takes root a vicious cycle ensues making metabolic and infection control a struggle. This cycle can have drastic consequences. If oral infections get out of control they can lead to BG control problems serious enough to land a person with diabetes in the hospital, to say nothing of the damage to the teeth and gums.

Gum infections can also impact insulin needs. Authors of a study cited in September's 1997's Practical Diabetology concluded that when an infection is rampant, patients with diabetes often have increased insulin requirements. If periodontal disease is treated and gingival inflammation is eliminated, these insulin needs often decrease.

Collagen, which is a building block of the tissue that attaches teeth to bones and the surrounding soft tissue, is also affected by diabetes. Diabetes' effect on collagen metabolism, according to Finney, "may make an infection potentially more destructive."