Periodontitis May Indicate Type 2 Diabetes

Severe gum disease, which is known as periodontitis, is often an early indicator of type 2 diabetes.

According to the latest data, diabetes affects approximately 422 million people worldwide, and this number is expected to increase.

In the United States, 29 million people live with the disease. Of these, over 8 million people have it but have not been diagnosed, according to the Centers for Disease Control and Prevention (CDC).

The CDC also estimates that 37 percent of American adults over the age of 20 have prediabetes.

New research - published in the journal BMJ Open Diabetes Research & Care - suggests severe gum disease, or periodontitis, might be an early sign of diabetes.

The authors also suggest a simple finger stick diabetes screening procedure could be carried out in the dental office to avoid the adverse effects of leaving diabetes untreated.

Researchers from the University of Amsterdam in The Netherlands assessed a total of 313 participants from a dental clinic at the university.

Of these, 126 patients had mild-to-moderate gum disease, 78 patients had severe periodontitis, and 198 individuals did not have signs of gum disease.

Participants with periodontitis had a higher body mass index (BMI) than the rest, with an average BMI of 27. However, other diabetes risk factors - such as high blood pressure or high cholesterol - were similar across all three groups.

The researchers analyzed higher glycated hemoglobin (HbA1c) values in dry blood spots, and evaluated the differences in mean HbA1c values, as well as the prevalence of diabetes and prediabetes between the two groups.

HbA1c values measure the average level of blood sugar in the last 2-3 months. The dry blood spots were obtained by sampling participants' blood using a finger pin-prick test.

Prediabetes is commonly considered to range between an HbA1C value of 39-47 millimoles per mol (mmol/mol).

The analysis revealed that those with the most severe form of periodontitis also had the highest HbA1c values.

The average HbA1c values for the severe gum disease group were 45 mmol/mol, compared with 43 mmol/mol in those with mild-to-moderate gum disease and 39 mmol/mol among those without gum disease.

Additionally, the researchers found a high percentage of people with suspected diabetes and prediabetes among participants with mild-to-moderate as well as severe gum disease.

In the severe gum disease group, 23 percent of study participants were suspected of diabetes, whereas 14 percent of the mild-to-moderate gum disease participants had suspected diabetes. In the severe gum disease group, 47 percent had prediabetes, and 46 percent of those in the mild-to-moderate group had prediabetes.

By comparison, 37 percent of those with no gum disease had prediabetes, and 10 percent had suspected diabetes.

Additionally, the researchers found previously undiagnosed cases of diabetes across the three groups: 8.5 percent of those with no gum disease and a little under 10 percent of those with mild-to-moderate gum disease had not been previously diagnosed with the disease until the study.

As much as 18 percent of those with severe gum disease had not been diagnosed with diabetes.

The study is observational, so it cannot explain a causal link between gum disease and diabetes. However, the authors suggest that screening patients with severe periodontitis for diabetes as part of dental medical practices might be an effective way of avoiding complications of the disease.

Periodontal Disease – Part 3

Follow your dentist's recommended schedule for regular checkups. If you notice any symptoms of periodontitis, make an appointment with your dentist as soon as possible.

Here's some information to help you get ready for your appointment and know what to expect from your dentist. Your dentist may ask you questions about your symptoms, such as:

• When did you first start experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How often do you brush your teeth?
• Do you use dental floss? How often?
• Do you see a dentist regularly?
• What medical conditions do you have?
• What medications do you take?
• Do you use tobacco products?

Depending on the extent of your periodontitis, your dentist may refer you to a specialist in the treatment of periodontal disease (periodontist).

Diagnosis of periodontitis is generally simple. Diagnosis is based on your description of symptoms and an exam of your mouth. Your dentist will look for plaque and tartar buildup and check for easy bleeding. To determine how severe your periodontitis is, your dentist may:

• Use a dental instrument to measure the pocket depth of the groove between your gums and your teeth. Your dentist or a dental hygienist inserts a metal probe beside your tooth beneath your gum line, usually at several sites throughout your mouth. In a healthy mouth, the pocket depth is usually between 1 and 3 millimeters (mm). Pockets deeper than 5 mm may indicate periodontitis.
• Take dental X-rays to check for bone loss in areas where your dentist observes deeper pocket depths.

If periodontitis isn't advanced, treatment may involve less invasive procedures, including:

• Scaling. Scaling removes tartar and bacteria from your tooth surfaces and beneath your gums. It may be performed using instruments or an ultrasonic device.
• Root planing. Root planing smoothes the root surfaces, discouraging further buildup of tartar and bacterial endotoxin.
• Antibiotics. Your periodontist or dentist may recommend using topical or oral antibiotics to help control bacterial infection. Topical antibiotics can include antibiotic mouth rinses or insertion of gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning. However, oral antibiotics may be necessary completely to eliminate infection-causing bacteria.

If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene. In that case, periodontitis treatment may require dental surgery, such as:

• Flap surgery (pocket reduction surgery). In this procedure, your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and root planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. After you heal, it's easier to clean these areas and maintain healthy gum tissue.
• Soft tissue grafts. When you lose gum tissue to periodontal disease, your gum line recedes. You may need to have some of the damaged soft tissue reinforced. This is usually done by removing a small amount of tissue from the roof of your mouth (palate) or another donor source and attaching it to the affected site. This procedure can help reduce further gum recession, cover exposed roots, and give your teeth a more pleasing appearance.
• Bone grafting. This procedure is performed when periodontitis has destroyed the bone surrounding your tooth root. The graft may be composed of small fragments of your own bone, or the bone may be synthetic or donated. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.
• Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.
• Enamel matrix derivative application. Another technique involves applying a special gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue.

Try these measures to reduce or prevent periodontitis:

• Get regular professional dental cleanings, on a schedule recommended by your dentist.
• Use a soft toothbrush and replace it at least every three to four months.
• Consider using an electric toothbrush, which may be more effective at removing plaque and tartar.
• Brush your teeth twice a day or, better yet, after every meal or snack.
• Floss daily.
• Use a mouth rinse to help reduce plaque between your teeth.
• Supplement brushing and flossing with an interdental cleaner, such as a dental pick, interdental brush or dental stick specially designed to clean between your teeth.

Care of your teeth is important!

Periodontal Disease – Part 2

Periodontitis is the last topic in periodontal disease. Periodontitis is a serious gum infection (I will not cover this under infections) that damages the soft tissue and destroys the bone that supports your teeth. Periodontitis can cause tooth loss or worse, an increased risk of heart attack or stroke and other serious health problems.

Periodontitis is usually the result of poor oral hygiene. Brushing at least twice a day, flossing daily, and getting regular dental checkups can greatly reduce your chance of developing periodontitis. It is also preventable by using the above oral hygiene.

Signs and symptoms of periodontitis can include:

• Swollen gums
• Bright red or purplish gums
• Gums that feel tender when touched
• Gums that pull away from your teeth (recede), making your teeth look longer than normal
• New spaces developing between your teeth
• Pus between your teeth and gums
• Bad breath
• Bad taste in your mouth
• Loose teeth
• A change in the way your teeth fit together when you bite

There are different types, or classes, of periodontitis. Chronic periodontitis is the most common class, affecting mostly adults, though children can be affected, too. Aggressive periodontitis usually begins in childhood or early adulthood and affects only a small number of people.

Factors that can increase your risk of periodontitis include:

• Gingivitis
• Heredity
• Poor oral health habits
• Tobacco use
• Diabetes
• Older age
• Decreased immunity, such as that occurring with leukemia, HIV/AIDS or chemotherapy
• Poor nutrition
• Certain medications
• Hormonal changes, such as those related to pregnancy or menopause
• Substance abuse
• Poor-fitting dental restorations
• Problems with the way your teeth fit together when biting

Some complications associated with gum disease include:

• Tooth loss
• Coronary artery disease
• Stroke
• Premature, low birth weight babies
• Poorly controlled diabetes
• Respiratory problems
• Rheumatoid arthritis
• Asthma

If your gums are puffy, dusky red and bleed easily, or show other signs or symptoms of periodontitis, see your dentist soon. The sooner you seek care, the better your chances of reversing damage from periodontitis, potentially preventing other serious health problems.

It is believed that periodontitis begins with plaque, a sticky film composed mainly of bacteria. Plaque forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing and flossing your teeth removes plaque. Plaque re-forms quickly, usually within 24 hours.

Plaque that stays on your teeth longer than two or three days can harden under your gum line into tartar (calculus). Tartar also may form because of the mineral content of your saliva. Tartar makes plaque more difficult to remove and acts as a reservoir for bacteria. You can't get rid of tartar by brushing and flossing, you need a professional dental cleaning to remove it.

The longer you allow plaque and tartar to remain on your teeth, the more damage they can do. Initially, they may simply irritate and inflame the gingiva, the part of your gum around the base of your teeth. This is called gingivitis, the mildest form of periodontal disease.

The continuing inflammation eventually causes pockets to develop between your gums and teeth that fill with plaque, tartar, and bacteria. Bacteria deposit endotoxin, a byproduct of their own metabolism, which is responsible for much of the inflammation around teeth. In time, these pockets become deeper and more bacteria accumulate, eventually advancing under your gum tissue. These deep infections cause a loss of tissue and bone. If too much bone is destroyed, you may lose one or more teeth.

Some research suggests that the bacteria responsible for periodontitis can enter your bloodstream through your gum tissue, affecting your lungs, heart, and other organs of your body. For instance, bacteria may travel to the arteries in your heart, where they might trigger a cycle of inflammation and arterial narrowing that contributes to heart attacks.