Aug 13, 2021 - minute readminutes read

Diabetes and Periodontal Disease

In addition to Heart Disease, Hypertension, and Adverse Pregnancy Outcomes, diabetes is a systemic condition linked with periodontal disease.
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“The connection between oral health and systemic health is bidirectional; systemic illnesses, especially metabolic disorders, affect oral health, and it appears that oral health may affect systemic health.”

(Diabetes Mellitus: Considerations for Dentistry Srividya Kidambi and Shailendra B. Patel J Am Dent Assoc 2008;139;8S-18S)

 

The connection between diabetes and periodontal disease is becoming more understood thanks to advances in clinical research. As a chronic disease, diabetes is common in most populations worldwide, making it a regular occurrence for dentists to have patients with this condition.

Scientific evidence

It is now broadly accepted that people with diabetes require careful management of their oral health, therefore dentists are encouraged to play a more proactive role in identifying the potential risks that these conditions create in individual cases. Some of the latest research has highlighted the following:

  • It was previously thought that diabetic patients tended to have a high incidence and severity of periodontitis. Recent studies show evidence that the opposite is true: a prevalence of diabetes among patients with periodontitis
  • According to the European Federation for Periodontology (EFP), severe periodontitis adversely affects glycemic level (how much a specific food increases blood sugar levels) in both diabetic and pre-diabetic patients
  • Depending on the severity of their periodontal disease, diabetic patients are more likely to have complications with their diabetes
  • Emerging evidence indicates an increased risk for diabetes onset in patients with severe periodontitis

What can dental professionals do?

The European Federation of Periodontology (EFP) has developed guidelines for oral health professionals in the management of periodontal diseases in relation to systemic conditions. Its advice on diabetes and the role of the dentist is summarised here:

  • Dentists can be proactive and play a role in the preventive aspects of diabetes and periodontitis
  • Screen and diagnose for periodontal disease in all diabetes patients as a rule
  • Dentists should assess their patient databases for groups with high diabetes risk in the dental and medical histories
  • Dentists should evaluate patients for signs or symptoms of poorly controlled or undiagnosed diabetes and refer to a physician for formal medical evaluation and diagnosis
  • Patients with type 1, type 2 and gestational diabetes (GDM) should receive a thorough oral examination, which includes a comprehensive periodontal examination. Even if no periodontitis is diagnosed initially, an annual periodontal review is recommended

  • Randomised clinical trials consistently demonstrate that mechanical periodontal therapy associates with approximately a 0.4% reduction in HbA1C (glycated hemoglobin which identifies average plasma glucose concentration) at 3-months, a clinical impact equivalent to adding a second drug to a pharmacological regime for diabetes
  • Long-term assessment and management of oral health care may reflect the management of diabetes in general, and assessment of diabetes control may allow the dental care team to predict the success of oral health care
  • Diabetes patients presenting with any overt signs and symptoms of periodontitis, including loose teeth not associated with trauma – spacing or spreading of the teeth – and/or gingival abscesses or gingival suppuration, require prompt periodontal evaluation

  • Oral health education should be provided by dental professionals to all patients with diabetes
  • Patients with diabetes should be told that periodontal disease risk is increased by poorly controlled diabetes
  • Patients should be advised that if they suffer from periodontal disease, their glycaemic control may be more difficult to manage, and they are at higher risk for diabetic complications such as cardiovascular and kidney disease

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