World Diabetes Day: the vital link between gum disease and diabetes

From nature.com

On World Diabetes Day, 12 November 2024, the European Federation of Periodontology (EFP) called attention to the growing body of scientific evidence that underscores the critical connection between gum disease (periodontitis) and diabetes.

As diabetes continues to impact millions of lives globally, understanding its effects on oral health (as well as the effects of gum disease on diabetes) is essential for improving overall health. This year's theme, Diabetes and wellbeing, emphasised the need for accessible care and support for all individuals living with diabetes - and that includes prioritising gum health.

Anton Sculean, chair of EuroPerio11, the premier congress in periodontology, hosted by the EFP, said: ‘Recent research has shown that diabetes is not only a major risk factor for periodontitis but that the relationship between the two conditions is bidirectional, meaning they both influence and exacerbate one another. Moreover, moderate/severe periodontitis is associated with an increased risk of all-cause and CVD-related mortality in adults with diabetes.'

People with diabetes are significantly more susceptible to developing severe gum disease, with studies showing that they are at a threefold higher risk. The connection between these conditions is particularly evident in patients with poorly controlled blood sugar levels. The higher the level of hyperglycaemia, the more severe the gum disease tends to be. This is due to the impact of high blood sugar on the immune system, which weakens the body's ability to combat infections, including those in the gums. Additionally, diabetes disrupts the body's inflammatory response, resulting in an exaggerated immune reaction in the gums that leads to further tissue damage.

Conversely, periodontitis can complicate diabetes management. The inflammation caused by gum disease isn't confined to the gums; it can spread throughout the body, increasing systemic inflammation and, in turn, impairing insulin sensitivity. This makes it harder for people with periodontitis to control their blood sugar levels, contributing to a vicious cycle that complicates both conditions. Furthermore, it has been demonstrated that severe periodontitis may be a risk indicator to develop diabetes in patients initially normoglycemic.

Emerging evidence shows that treating periodontitis can lead to improved glycaemic control in people with diabetes, highlighting the importance of integrated care. This finding reinforces the need for dental professionals to work closely with other healthcare providers, ensuring that patients receive comprehensive care that addresses both their oral health and diabetes management.

The EFP has been a leader in raising awareness about the strong link between gum disease and diabetes. This topic will take centre stage at the upcoming EuroPerio11 congress in Vienna (14-17 May 2025). A dedicated session will explore clinical considerations for managing patients with diabetes and periodontal disease, including screening for diabetes in dental settings.

This World Diabetes Day, the EFP called on healthcare professionals, policymakers, and the public to ensure that gum health is part of diabetes care and to improve the well-being of people living with diabetes by supporting comprehensive and holistic healthcare systems that address the complex connections between oral and general health. 

https://www.nature.com/articles/s41415-024-8192-z

TRICARE Tips for Managing Diabetes and Your Oral Health

From newsroom.tricare.mil

Diabetes is a common condition in the United States. According to the Centers for Disease Control and Prevention, more than 38 million American adults currently have diabetes.

“Even though diabetes is common, many people don’t know about its connection to oral health,” said Douglas Elsesser, a program analyst with the Dental Program Section of the TRICARE Health Plan. “Uncontrolled diabetes can negatively affect your oral health in many ways.”

If you have diabetes, it’s important to keep it under control. Here are some examples of how diabetes can affect your oral health:

• Reduced saliva production. Saliva helps clean bacteria and neutralize acids that cause tooth decay. Having less saliva increases your risk for cavities.
• Rapid bacteria growth. High blood sugar levels allow bacteria in the mouth to multiply quickly. Oral bacteria causes gum disease and other infections.
• Increased plaque build-up. Plaque is a film of bacteria that sticks to teeth. Unchecked diabetes increases plaque build-up. This increases your risk for gum disease.
• Decreased ability to fight infections. People with diabetes are more prone to gingivitis and advanced gum disease. These infections can destroy gum tissue and bone, leading to tooth loss.

Poor oral health also makes diabetes harder to manage. Gum disease causes inflammation, which can spike blood sugar levels, which is a concern for people with diabetes.

To properly care for your oral health, you can adopt these practices:

• Brush your teeth twice a day and floss daily.
• Seek treatment right away if you show any signs of gum disease. Early signs of gum disease include swollen gums, gums that bleed easily, and bad breath that won’t go away.
• Coordinate treatment with your dentist and physician.
• Quit smoking and using tobacco.
• Limit the amount of sugar you eat and drink.
• Chew sugar-free gum to increase saliva flow.

https://newsroom.tricare.mil/News/TRICARE-News/Article/3826414/tricare-tips-for-managing-diabetes-and-your-oral-health 

One secret to preventing dementia, diabetes, and heart disease may lie in your oral health habits. Here’s the dental routine to follow

From fortune.com

While the connection between oral health and general health is well documented, it’s not generally discussed at well or dental visits. It should be: An April 2022 report from The National Institutes of Health found that 90% of adults ages 20 to 64 experience tooth decay, while almost 50% of adults 45 to 64 have gum disease. 

Dr. Michael Roizen, chief wellness officer at Cleveland Clinic, says oral diseases have a large association with overall health. Research has shown that there’s an association between your dental health habits and whether or not you develop diabetes, Alzheimer's, stroke or heart disease.

When we don’t take care of our oral health, says Roizen, dental caries (tooth decay) and gum disease can enter the bloodstream, contributing to plaque disruption in the arteries, or promoting inflammation in the brain and other areas of the body. “Flossing your teeth is the equivalent of 8,000 steps a day,” says Roizen. “Which is pretty darn powerful.”

Think of the body as a human doughnut

In 2019, the World Health Organization named tooth decay in permanent teeth as the most common health condition in its Global Burden of Disease report. Oral diseases affect about 3.5 billion people worldwide

What we often don’t realize is that this isn’t bad just for our mouths, but our bodies. “People think of their heads and teeth as disconnected from the rest of their bodies, but they’re not,” says Dr. Maria Ryan, DDS, Ph.D. in oral biology and chief clinical officer at Colgate-Palmolive Company. Viewing the body as one connected system helps reinforce how it can influence all areas of wellness and the importance of maintaining good oral hygiene, says Ryan.  

Naveem Jain, founder of Viome, a company that builds personalized toothpaste and supplements based on a person’s microbiome, compares the human body to a donut. “There is a tube that goes through us,” says Jain, noting that billions of microbes enter the body through that tube as we breathe. “When the protective barrier is broken, you have system inflammation in the body. If you have a leaky gum, it’s the same concept. If our heart is bleeding or even our fingers, we’d be trying to figure it out. If our gums are bleeding, eh whatever. In both cases, all of your microbes have a free path into the bloodstream.”

That path is where trouble starts, says Ryan. It’s no surprise then that in one study, published in Hypertension, an American Heart Association journal, found that  people with gum disease were twice as likely to have a heart attack and three times as likely to have a stroke than those without inflammatory gum disease. “People think, ‘What’s the worst thing that can happen? I can lose a tooth,’” says Ryan. “Well, it could be worse than that.”

Poor oral health can also impact our confidence

If the prospect of developing heart disease or diabetes isn’t enough to get you to the dentist, maybe the idea of looking good will. After all, dental hygiene is also front and centre in all of our human interactions. If you’re self-conscious about bad breath or missing teeth, it might affect your ability to move through the world with confidence. “That can impact someone’s ability to get a job, or their relationships,” says Ryan. “It’s important on so many levels.”

And weak teeth can impact the way you’re able to address more mundane aspects of your health. Ryan uses the example of a healthy diet. If a physician recommends eating more fruits and vegetables to a patient with poor oral health, the patient may feel stuck eating foods such as apples, carrots, and broccoli if missing teeth and cavities are a factor, Ryan says. 

When all of these factors impede a person’s ability to be social and engaged on a personal level, their mental health can suffer. One 2022 study documented the connection between poor oral health and increased anxiety and depression.

While the overall connection between oral health and overall health is well documented, it’s not generally discussed at well or dental visits.       GETTY IMAGES

How to protect your oral health and overall well-being

A big part of addressing the oral health crisis is prevention and education, says Ryan who leads Colgate-Palmolive’s five-year, $100 million Know Your OQ (oral health quotient). It aims to shift some of these statistics and increase awareness on the importance of simple and consistent oral hygiene. 

The American Dental Association and WHO recommend six basic steps for preventing gum disease: 

1. Brush twice a day for two minutes
2. Floss once a day.
3. See your dentist every six months.
4. Limit sugary drinks and snacks.
5. Avoid all forms of tobacco
6. Use protective equipment during sports 

It might seem like really basic information, says Ryan, but if everyone was doing it the stats on oral health wouldn’t be what they are. 

Dr. Tien Jiang, a practicing dentist who teaches oral health policy and epidemiology at Harvard School of Dental Medicine, says she takes every opportunity she can to weave education into her interactions with patients so her approach is more preventative than reactive whenever it can be. “Just like high blood pressure, with a lot of dental diseases or concerns—for instance, an early cavity—you can’t feel anything,” says Jiang. “You might not feel anything until it’s advanced. You can have a patient come in and a dentist diagnoses five cavities and they’ve been feeling fine.”

But at that point, the situation has turned urgent and the patient is in tremendous pain—especially in the case of periodontal disease, says Jiang. To add insult to injury the patient now also faces a steep dental bill to cover care and save the tooth. “We have an uphill battle,” she says. “We want to diagnose but there’s always a suspicion that the dentist just wants to make money.”

From Ryan’s perspective, this makes education and normalization of these ideas critical to shift the trajectory of how we frame and prioritize our oral health. 

Relatedly, she says, knowing where to get dental care could also be a barrier. Aside from dental practices, dental schools offer cleanings, as well as federally qualified health centres (FQHC). “Not just preventative strategies, but also the signs and symptoms so if they have disease they go and get it managed. There are so many places to get care.”

https://fortune.com/well/article/oral-health-connection-diabetes-heart-disease-alzheimers/ 

Diabetes and Toothlessness Together Worsen Cognitive Decline

From neurosciencenews.com

Summary: A new study found that having both diabetes and complete tooth loss accelerates cognitive decline in older adults. The study emphasizes the importance of regular dental visits, adherence to diabetes treatment, and cognitive screenings for those with both conditions.

Source: NYU

Having both diabetes and tooth loss contributes to worse cognitive function and faster cognitive decline in older adults, according to a new study published in a special issue of the Journal of Dental Research focused on aging and oral health. 

“Our findings underscore the importance of dental care and diabetes management for older adults in reducing the devastating personal and societal costs of Alzheimer’s disease and other related dementias,” said Bei Wu, vice dean for research at NYU Rory Meyers College of Nursing and co-director of the NYU Aging Incubator, as well as the study’s lead author.

Diabetes is a known risk factor for cognitive decline and dementia. Several of the hallmarks of diabetes—high blood sugar, insulin resistance, inflammation, and related heart disease—are thought to contribute to changes in the brain.

A growing body of research has revealed a similar connection among poor oral health, particularly gum disease and tooth loss, and cognitive impairment and dementia. Like diabetes, inflammation plays a key role gum disease, and these inflammatory processes may contribute to cognitive decline. In addition, painful gums and missing teeth can make it difficult to chew, leading to changes in diet that can result in nutritional deficiency.

Nutritional deficiency, which can also be worsened by impaired glucose tolerance and insulin sensitivity in diabetes, is another risk factor for cognitive impairment and dementia.

“Poor oral health, diabetes, and cognitive decline are all connected, and we’re beginning to understand how they may influence and exacerbate one another,” said Wu. 

While both diabetes and missing teeth are risk factors for dementia, little research has focused on the effects of having both conditions in the course of cognitive decline. To address this gap, Wu and her colleagues turned to the University of Michigan’s Health and Retirement Study, analysing 12 years of data (2006-2018) from the longitudinal study in order to observe cognitive changes over time.

The researchers included 9,948 older adults who were grouped by age (65 to 74, 75 to 84, and 85 and older) in their analysis. The Health and Retirement Study included measures of memory and cognitive function, assessed every two years, along with questions about tooth loss, diabetes, and other health and demographic factors. In this analysis, the researchers were particularly interested in older adults who had lost all of their teeth.

While both diabetes and missing teeth are risk factors for dementia, little research has focused on the effects of having both conditions in the course of cognitive decline. Image is in the public domain

They found that older adults aged 65 to 84 with both diabetes and complete tooth loss had worse cognitive function than their counterparts without either condition.

Over time, older adults aged 65 to 74 with diabetes alone experienced accelerated cognitive decline, and those aged 65 to 84 without any teeth also experienced accelerated cognitive decline, but older adults aged 65 to 74 with both diabetes and complete tooth loss had the fastest rate of cognitive decline. 

The relationship among diabetes, tooth loss, and cognitive decline was inconclusive for adults 85 and older, which may be explained by this group having overall greater cognitive impairment, potentially being healthier (as unhealthy individuals may be less likely to survive into their late 80s), or perhaps having more experience managing their diabetes. 

For older adults with both poor oral health and diabetes, the researchers stress the importance of regular dental visits, adherence to diabetes treatment and self-care to control blood sugar levels, and cognitive screenings in primary care settings. 

“Access to dental care for older adults—especially those with diabetes—is critical, and health care providers should educate their patients about the connection between oral health and cognition,” said Wu. 

https://neurosciencenews.com/diabetes-oral-health-cognition-22774/ 

Diabetes and Dental Care

From diatribe.org

Having diabetes along with years of high glucose levels can cause problems with your teeth and gums. Learn why dental problems may occur, what to do about them, and how to prevent them. 

People with diabetes, particularly those who over time have higher than recommended blood glucose levels, are at greater risk of developing dental problems, most commonly gum disease and loss of teeth.

Here is a list of daily self-care actions that can help keep teeth and gums healthy, as well as guidance on when and how often to seek dental care. 

Basics of diabetes-related dental problems

Simply having diabetes does not set you up for dental problems; it’s having elevated glucose levels over time that sets the potential for dental problems into motion. As is the case with other long-term diabetes complications where one problem can lead to another in the absence of glucose management, preventive self-care, and regular check-ups, the same is true for tooth and gum problems. 

Higher blood glucose levels can decrease the amount of saliva in your mouth and change its contents. Saliva, the fluid that keeps the mouth moist, is produced in the salivary glands located in and around the mouth. Saliva helps you chew and swallow foods and beverages, and helps prevent damage to the teeth and gums from harmful bacteria. 

High glucose levels feed harmful bacteria that form an unhealthy coating on teeth. This coating is plaque, which can cause cavities and gum irritation because it builds up on the teeth near the gum line. If you don’t remove this plaque with regular brushing and dental cleanings, it hardens into tartar. And if this build-up of tartar is not removed with regular dental cleanings, it will eventually lead to gum disease. 

Common dental problems with diabetes

• Cavities are areas of decay on the surface of teeth that lead to tiny openings in the tooth. It is the most common dental problem. To prevent the openings from growing, cavities should be cleaned out and filled with a material that hardens. 

• Gum disease, also referred to as periodontal disease, is the most concerning dental problem seen in people with diabetes. The first stage is inflamed gums, also known as gingivitis or inflammation. It develops due to the build-up of plaque and tartar at the gum line. The gums may become noticeably red and swollen, and may bleed easily. If left untreated, gingivitis can progress to periodontitis. This is an infection of the gums and bones, which if left untreated, can cause teeth to loosen. To learn more about the different stages of periodontal disease, click here.  

• Dry mouth can be caused by high glucose levels, as well as certain medications and stress. Simple self-care strategies to manage dry mouth are: staying hydrated by drinking water or other sugar-free liquids, chewing sugarless gum or using lozenges, and maintaining good dental care (see below).  

• Thrush is a fungal infection that causes painful, creamy white patches on the tongue or inner cheeks of the mouth. Thrush is also called oral candidiasis. High blood glucose levels can lead to excess sugar in the saliva, creating an ideal environment for this fungus to thrive. 

• Burning mouth syndrome is a scalding or tingling feeling in the mouth that may also be accompanied by numbness, dry mouth, or altered sense of taste. This can be challenging to diagnose.       

• Signs and symptoms of dental problems

• Gums that appear red and swollen or are bleeding

• Gums that appear to be pulling away from teeth (referred to as receding gums) 

• Loose teeth

• Spaces between teeth that increase in size

• Dry mouth (could be a sign of high glucose levels and new-onset diabetes) 

• Bad breath not improved by regularly brushing teeth

• 

  
  

• How to prevent diabetes-related dental problems

  As is true for the prevention or delay of most diabetes-related problems, there are actions to take daily to prevent dental problems, like doing daily dental care and keeping glucose, blood pressure, and lipids well managed. There are also actions to take annually or more frequently, if needed; these are to get preventive care and follow up for any problems.   

  Daily actions 

  • Get and keep glucose levels in a desired target range. Good glucose management over time can help reduce the risk of or slow the progression of dental problems. Work with your diabetes health care providers to come up with glucose targets that are best for you. 

  • Brush teeth at least twice a day with fluoride toothpaste. Better yet, brush your teeth after every time you eat. Use a toothbrush with soft bristles.

  • Floss teeth at least once a day. Flossing more often or after every time you eat is better. 

  • Check your gums regularly for signs and symptoms of dental problems. 

  • Limit the consumption of foods and beverages high in added sugars. When you do consume these foods and beverages, try to brush and floss your teeth afterwards.  

  • Do not smoke, or if you do, quit smoking. Smoking or the use of other tobacco products can increase the risk of getting gum disease. Get help quitting by calling the (USA) National Quitline at 1-800-QUITNOW or 1-800-784-8669, or visit smokefree.gov. 

  Annual or as-needed actions 

  • Get your teeth cleaned, X-rayed, and inspected by a general or family dentist at least once a year. Typically, a dental hygienist in the dental office will do the cleaning and take the X-rays. The dentist will review your X-rays and inspect your mouth, including checking for signs of oral cancer. You will be informed  if you need follow-up care. Let these healthcare providers know you have diabetes. Do not expect your primary or diabetes care providers to ask you about your dental health. 

  • Make your next dentist appointment at the end of the current appointment. Or, put a reminder in your calendar to make your next appointment. 

  • Follow up on any problem identified or recommendation made at your dental cleaning and check-up. For example, your dentist might recommend that you get a cavity filled or see a specialist for a procedure or further evaluation. There are specialists with advanced training in several areas of dentistry. Perhaps your general dentist has identified areas in your mouth where your gums are receding. Your dentist might refer you to a periodontist. Or if you need a root canal, your dentist may refer you to an endodontist. 

  • Learn about the common dental problems that occur in people with diabetes and their signs and symptoms. Tell your dental hygienist and dentist about any signs and symptoms you might have. Share general information about your current glucose levels and diabetes management. If you have had a problem with your teeth and gums, ask the dentist whether you should have your teeth cleaned and inspected more often than once a year. 

  If you need extensive dental work that will require surgery, not eating for hours, and/or the need to eat only soft foods for a period of time, remind the dentist doing the procedure that you have diabetes. Let the dentist know what glucose-lowering medications you take and if your medications can cause hypoglycaemia. Discuss how to manage these medications before and after surgery. Ask to schedule the procedure for the first thing in the morning. You may also want to discuss this with your diabetes health care providers to work out an optimal plan.

• Perspective from a person with diabetes 

  To gain insights into the practical and emotional aspects of diabetes-related dental problems, we talked to Lizzette Kopco. Liz is a 31-year-old molecular biologist and has had type 2 diabetes for roughly 8 years. She is a community advocate with Diabetes Sisters and a podcaster. 

  Before her diagnosis with early-stage periodontal disease during a random routine dental cleaning, she was not aware of the connection between diabetes and dental problems. “Though my gums bled a lot when I flossed my teeth, I was told only that high blood sugar levels could cause problems if they were left untreated or not well-managed for too long,” says Liz. 

  “My periodontal disease progressed to stage 2, which required deeper under-gum cleaning and antibiotics because I was unable to get routine cleanings for a time due to lack of dental insurance and affordable dental care, as well as COVID restrictions,” she says. To slow the progression of her periodontal disease, Liz now brushes her teeth with a prescription-strength fluoride toothpaste and flosses regularly. She gets dental cleanings every 3 months and follows up with her dentist if anything feels out of the ordinary. 

  Liz’s words of wisdom: Become knowledgeable about the connections between high glucose levels and diabetes complications, do the recommended daily self-care, and schedule regular cleanings. “Know that your daily self-care efforts matter,” says Liz. 

• https://diatribe.org/diabetes-and-dental-care

Diabetes warning: I’m a dentist and here’s why not brushing your teeth could be deadly

From the-sun.com

DIABETES is a serious health condition that can impact other areas of your wellbeing.

It's a lifelong illness that causes your blood sugar to be too high and if not treated properly, can lead to debilitating symptoms such as poor eye sight and gum disease.

1

If you're a diabetic and you don't brush your teeth properly, it could lead to other serious health problems, one dentist has warned           Credit: Alamy

It's because of this that one expert has highlighted the key dangers diabetics face when it comes to oral health.

Speaking to The Sun, London-based dentist Dr Monik Vasant explained that poorly controlled diabetics may have high blood sugar levels for a long period of time.

He said: "Too much sugar in your blood can lead to more sugar in your saliva.

"This provides a perfect breeding ground for bacteria, which produces acid and toxins that attacks your tooth enamel and damages your gums."

Dr Monik, who is currently working with Colgate Total on the #HappyHabits campaign, said it's important to note that when oral bacteria is not controlled effectively and inflammation associated with severe gum problems exists, this can also increase a person's risk of certain deadly diseases.

He explained that cardiovascular disease is one of them.

"There is some evidence to suggest that blocked arteries, heart disease and stroke may be linked to the inflammation caused by oral bacteria", he said.

When you have diabetes you are more at risk of cardiovascular disease than others who don't have the condition.

It affects your circulation and can lead to other issues with your feet and eyesight, as well as heart attacks and strokes.

Dr Monik explained that endocarditis is another issues that could be linked.

He said: "Bacteria from your mouth travels through the bloodstream and attaches to the lining of your heart chamber and/ or valves creating pockets of bacteria.

"This can disrupt the blood flow through the heart."

He added that pneumonia and other respiratory diseases are also caused when bacteria travels from the mouth to the lungs.

Dr Monik said it's imperative that diabetics take good care of their oral health.

He explained that people with type 2 diabetes are around three times more likely to develop oral problems than people without, and those with type 1 diabetes are also more at risk.

He said: "You’re more likely to develop things like gum disease which may result in bad breath, bleeding gums, gum recession, and eventually tooth loss. In addition, diabetics are at a higher risk of getting oral thrush which is a fungal infection of the mouth.

"Looking after your mouth health starts at home and doesn’t need to be costly or complicated.

"Simple things like remembering to brush twice a day for two minutes with an antibacterial toothpaste, cleaning in between the teeth, and changing your toothbrush or toothbrush head every three months will help to prevent common oral problems developing in the first place." 

KNOW THE SIGNS

Dr Monik said the key thing diabetics need to look out for, is bleeding gums.

He said: "The early signs of gum problems are things like red, sore or bleeding gums, bad breath, gum recession, loose teeth.

"The signs of oral thrush include white patches within the mouth, redness of the tongue and cracking of the skin at the corner of the lips.

"If you notice these, don’t ignore them and make an appointment with your dentist.

"Getting the right treatment early can prevent severe infections, tooth loss and other complications down the road."

Brushing and flossing properly is important for everyone, but especially so for diabetics as they’re more at risk of developing oral health issues, Dr Monik said.

"If we don’t follow simple oral care practices like brushing twice a day for two minutes with an antibacterial toothpaste, cleaning in between the teeth with floss or interdental brushes, and changing our toothbrush or toothbrush head every three months, we could end up with tooth decay and gum disease, which could in turn lead to painful cavities, abscesses or even tooth loss", he added.

Dr Monik said that we are all capable of managing our oral health at home by implementing simple regimes like brushing twice a day with an antibacterial toothpaste.

He said that this goes a long way in reducing the oral bacteria which may predispose common oral health issues.

"However, we must still acknowledge that poor oral hygiene can manifest in a number of different ways and knowing the signs of when to get checked out is important!

"If you are worried about your oral health and experience such symptoms like tooth pain, bleeding or swollen gums, non-healing ulcers, growths within the mouth, changes in the tongue's texture or colour I would encourage you to make an appointment to see your dentist", he added.

https://www.the-sun.com/health/4631818/diabetes-warning-dentist-not-brushing-teeth-deadly/ 

Diabetes warning: The ‘irreversible’ signs you can spot in your mouth

From nypost.com

If you’re diabetic, you’ll know how important it is to keep on top of your blood sugar levels.

Common signs of high blood sugar include an increased thirst and needing to go the bathroom more, but experts say there could also be indicators in your mouth.

Researchers say that people with severe gum disease (periodontitis) have a harder time keeping their blood sugar levels under control.

For those whose blood sugar is not well controlled, they may find they have trouble with gum disease, the American Dental Association (ADA) states.

A previous study published by experts at the ADA stated that people with diabetes may be at higher risk of developing gum disease than people without diabetes.

Gum disease is a serious infection that in most cases can be treated.

If it’s left untreated it can lead to tooth loss which is irreversible, this is because it can destroy the bone that supports your teeth.

As gum disease is an infection, it’s likely that diabetics will find it harder to tackle it than other people.

As gum disease is an infection, it’s likely that diabetics will find it harder to tackle it than other people.

Getty Images

The ADA said: “When it is not well controlled, diabetes also can slow the process of wound healing.

“This means that if you have diabetes, it may take longer for you to heal after dental treatments such as having a tooth removed or any other oral surgery.”

A previous ADA study found that in general, diabetic Americans were more prone to tooth loss than those who did not suffer with the condition.

Around 28 percent of the diabetics tested in the study had lost all of their teeth.

The NHS states that extra glucose in your blood can increase your chance of gum disease and infection.

Official guidance states that you should see a dentist straight away if you notice problems in your mouth.

Experts say that in order to improve gum health you should stop smoking.

Keep track

This is because smoking weakens your immune system. making it harder for you to fight a gum infection.

One of the main ways to help control your diabetes and prevent gum disease is to keep on top of your blood sugar levels.

If you’re diabetic it’s likely you will have been given a device so you can do this at home.

You will be told what your average blood sugar level is and this is referred to as your HbA1c level.

While they differ for everyone, the NHS says that if you monitor your levels at home then a normal target is 4 to 7mmol/l before eating and under 8.5 to 9mmol/l 2 hours after a meal.

If it’s tested every few months then a normal HbA1c target is below 48mmol/mol (or 6.5% on the older measurement scale).

https://nypost.com/2021/12/04/diabetes-warning-the-irreversible-signs-you-can-spot-in-your-mouth/ 

‘Extra attention’ to oral health pays off among patients with type 2 diabetes

From healio.com

A dental intervention among patients with type 2 diabetes improved their oral health-related quality of life, a pilot study in the Netherlands showed.

Periodontitis is a complication of diabetes mellitus, according to researchers. In addition, patients with diabetes appear to have a higher prevalence of other oral conditions such as dry mouth, Candida infections, taste disorders and oral malignancies.

“Clinical, fundamental and epidemiological research into the connection between diabetes and oral health has been accumulating over several decades,” Martijn J. L. Verhulst, a PhD candidate in the department of periodontology at the University of Amsterdam and Vrije Universiteit in the Netherlands, told Healio Primary Care. “We believed now was the time to investigate how clinicians in primary care could use that knowledge on a daily basis, in a way that actually benefits patients.”

Martijn Verhulst

Verhulst recruited 24 family medicine practices and randomly assigned them in a 1:1 ratio to be part of an experimental cohort or a control cohort. The practices chose which patients with type 2 diabetes would participate in the study. Those in the experimental cohort received:

• repeated messages about the importance of good oral health and the need to brush twice daily with a soft toothbrush and a fluoride toothpaste;
• frequent encouragement to visit a dentist and, since oral care is not covered under the Netherlands’ mandatory basic health care insurance, the paperwork that would be required to see a dentist twice annually; and
• kits that contained oral hygiene products and a brochure with information on the link between diabetes and oral health.

The family practitioners in the control cohort did not provide any “extra attention to oral health” for their patients with diabetes, Verhulst and colleagues wrote in Annals of Family Medicine.

The researchers reported that among the 764 patients in the study, 543 completed most of the 14-item Oral Health Impact Profile — a survey that measures frequency of functional limitations, physical pain, psychologic difficulties, handicaps and physical, psychologic and social disabilities — at baseline and 1 year later.

More patients in the experimental cohort said their oral health improved compared with the control cohort (35.2% vs. 25.9%; P = .046). A secondary post hoc analysis that included the 18 family medicine practices where 60% or more of the patients completed the Oral Health Impact Profile also favoured the experimental cohort (38.3% vs. 24.9%, P = .011). There was no significant improvement in the number of self-reported oral health complaints among the cohorts, and the researchers said that the experiment had a minimal effect on the general health of its participants.

Verhulst encouraged physicians to find time to discuss oral health with their patients.

“In a number of cases, this will result in the identification of previously undiagnosed periodontitis, which can then be treated appropriately,” he said in the interview. “Beyond this potential benefit, the impact poor oral health has on quality of life, social life, speech, self-confidence, chewing, pain, loss of productivity, etc., should be reason enough to strive for an interdisciplinary approach.”

Lisa Simon, MD, DMD

In many ways, this study proves what we already know about lots of other health outcomes and behaviours: motivational interviewing and longitudinal support from a primary care team helps empower patients. It is high time these principles were also applied to oral health.

This study leverages the team‐based care and trusting primary care relationships patients already had to help them achieve better oral health, something all of us who work in primary care should aspire to. I also think it is wonderful that this study focused on oral health‐related quality of life — a patient‐centred outcome.

While there is a developing evidence base that suggests oral health may affect diabetes outcomes, what is far more important is that oral health causes unnecessary suffering for far too many people. Independent of quantitative clinical outcomes, allowing people to live happier lives is an outcome worth celebrating.

Lisa Simon, MD, DMD

Fellow, oral health and medicine integration, Harvard School of Dental Medicine

https://www.healio.com/news/primary-care/20210622/extra-attention-to-oral-health-pays-off-among-patients-with-diabetes