Oral Connections

Diabetes is one of the most obvious systemic diseases that predisposes a patient to oral infections and in turn worsens the existing disease. Diabetes increases the risk of periodontal disease, and the risk is further increased for diabetics with poor glycemic control.⁵¹ According to the US Centers for Disease Control and Prevention, almost one-third of diabetics have severe periodontal disease with 5mm or greater attachment loss. Diabetes causes blood vessels to thicken, resulting in reduced circulation and a slower flow of nutrients to areas in the body where they are needed. This can create longer periods of healing and increase the potential for infection.

The inverse relationship - the effect of periodontal disease on diabetes - has been the subject of many recent investigations. Studies suggest periodontal disease may worsen glycemic control and contribute to complications (e.g., heart and kidney disease) associated with diabetes.^51,52 Evaluations of the benefit of periodontal treatments (e.g., scaling & root planning, tetracycline) on glycemic control have yielded mixed results. Some investigations have shown significant benefits on periodontal health and glycemic control^53,54 while others have only shown significant improvement in periodontal status.^55,56 Separate research has demonstrated a reduction in blood inflammatory mediators associated with insulin resistance following periodontal therapy.⁵⁷ The development of a triangular model linking periodontal disease, diabetes and obesity has been reported.⁵² The common factor linking all three diseases is inflammation. According to the report by Dr. Robert Genco, fat tissue can trigger production of proinflammatory cytokines, which can intensify infections and promote insulin resistance.

Understanding these connections should lead to more comprehensive disease management for patients, both diagnosed and undiagnosed. In many instances, the presence of an undiagnosed or uncontrolled diabetic might be more accessible to your care than realized. Commonly recognized oral symptoms may include severely inflamed tissues, ranging from red to magenta in color, acute gingival and/or periodontal abscesses (oftentimes recurrent and/or multiple), and rapidly advancing periodontitis along with candidiasis represented by fungal infections and commonly experienced painful xerostomic conditions.⁵⁷ Some dental offices choose to test patients for diabetes in the office. See the Resource Section for information on in-office testing.