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Periodontal disease associated with diabetes

Scientific support: Prof. Dr. Thomas Beikler

Diabetes can also affect dental health The affected regions in the oral cavity are the gums, the periodontium (the supporting structure for the teeth), and the jaw bones. People with diabetes have an elevated risk of gum inflammation and periodontal disease, previously incorrectly referred to as periodontitis. 

Diseases of the periodontium not only negatively affect blood sugar levels but also - especially in people with type 1 diabetes - cause frequent metabolic episodes as a result of insulin deficiency (ketoacidosis). Other complications of diabetes, such as diseases affecting the eyes, kidneys, nerves, and heart, can also occur as a result of periodontal disease. On the other hand, pronounced fluctuations in blood sugar levels can increase the risk of periodontal disease in people with diabetes. Successful treatment of periodontal disease can have a positive effect on diabetes therapy and reduce the HbA1c level.

How does periodontal disease develop?

Periodontal disease is the chronic bacterial inflammation of the periodontium. The disease progresses slowly and gradually leads to bone loss. The affected teeth begin to loosen. If left untreated, it leads to tooth loss. The progression of periodontal disease is usually pain-free and goes unnoticed by the patient. Gum inflammation is the precursor to periodontal disease and can be reversed via adequate dental treatment and good oral hygiene. If left untreated, gum inflammation can lead to periodontal disease.

Good to know:

Gum inflammation is a precursor to periodontal disease.

Gum inflammation and periodontal disease are triggered by certain types of bacteria that stick to the surface of the teeth. When the gum inflammation spreads to the periodontium, the result is bone loss and the development of gingival pockets between the gum and tooth. Pus and fistulas can also develop in the affected area. This causes the teeth to loosen and begin to wobble.

What are the signs of periodontal disease?

Periodontal disease usually develops gradually and without pain, meaning it can progress unnoticed. Most people don’t notice periodontal disease until their teeth become loose. At this stage, it is no longer possible to completely cure the condition. However, the condition can be stabilized in 85 to 90 percent of cases using therapy and regular aftercare.

Gum inflammation develops before the onset of periodontal disease. Signs of gum inflammation are reddened and/or swollen gums and bleeding from the gingival margins. During this stage, the jaw bones are still unaffected and full recovery is possible.

When left untreated, gum inflammation leads to periodontal disease. The following signs may indicate developing or existing periodontal disease:

  • Bad breath
  • Sensitive teeth (sensitivity to hot and cold when eating)
  • Gum regression
  • Swelling or reddening of the gums
  • Bleeding gums
  • Purulent discharge from the gingival pockets
  • Loose or wobbly teeth
  • Tooth migration (displacement of the teeth)

People with diabetes are three times more likely to develop periodontal disease. Approx. 75 percent of all people with diabetes suffer from inflammation of the oral mucosa. And a third of those have severe periodontal disease.

In cases of type 1 diabetes, periodontal disease can develop in early childhood or adolescence, especially when the diabetes is poorly managed and there are frequent episodes of high blood sugar.

    Good to know:

    People with diabetes are three times more likely to develop periodontal disease.

    Numerous risk factors can increase the risk of periodontal disease. A significant influencing factor is the long-term blood sugar value (HbA1c). Several studies have shown that people with type 2 diabetes and a HbA1c level above nine percent (above 74.8 mmol/mol) have a higher risk of periodontal disease than those with a lower long-term blood sugar value.

    Long-term elevated blood sugar levels can damage the blood vessels leading to poor circulation in the oral cavity. This can make the periodontium more susceptible to infection and cause inflammation to heal poorly. Simultaneously, people with poorly managed diabetes often have higher sugar levels in the saliva and dryness of the mouth (xerostomia). This allows bacteria to reproduce faster, triggering gum inflammation or periodontal disease.

    Further risk factors for periodontal disease include:

    • Poor oral hygiene
    • Smoking
    • Stress
    • Being overweight
    • Genetic predisposition

    There are several ways to effectively protect against periodontal disease.

    • Try to keep blood sugar at normal levels from the beginning of the disease and avoid severe blood sugar fluctuations.
    • Regular and thorough dental hygiene is essential. Teeth should be brushed twice daily and the interdental spaces  should be cleaned once daily using dental floss or an interdental brush.
    • When using mouthwash, ensure that it does not contain alcohol.

    Additionally, a dental check-up should be performed by specialist dental professionals at least once annually, along with professional teeth cleaning. Using the periodontal screening index (PSI), a dentist can easily determine whether a patient is suffering from periodontal disease during a check-up.

    A healthy lifestyle also plays a crucial role in preventing periodontal disease:

    • Don't smoke.
    • Avoid alcoholic drinks as much as possible.
    • Try to maintain a healthy weight.

    Periodontal disease is treated by the treating dentist or a specialist in periodontal disease (dental hygienist or dental prophylaxis assistant). Dentists specialized in this field are known as periodontists. The dentist begins by removing plaque with ultrasound or manually using dental hand instruments. In very severe cases, antibiotics are given to treat the inflammation. The teeth that have already lost contact with the jaw bone are removed. In some cases, further surgical interventions are necessary. After the initial therapy, life-long regular check-ups may be necessary several times per year. This is because patients cannot reach and clean the deep gingival pockets using a toothbrush or dental floss. Professional help is needed in these cases.

    Because periodontal disease can influence the entire body, and also diabetes, the treating primary care doctor or diabetologist should definitely be told about the disease. Only then can diabetes therapy be optimally adjusted with regard to accompanying diseases. The dentist should also be informed of the diabetes treatment. Successful periodontal disease therapy can reduce HbA1c levels and preserve the teeth.


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    As of: 31.10.2019