Bi-directional Relationship between Diabetes & Periodontal Disease

o We know that diabetes increases the risk of infection from any source. Periodontal (gum) disease is an infection and complication of diabetes which is often unrecognized.

o People with poorly controlled diabetes are much more susceptible to periodontal disease; with a 2 to 4 time’s greater risk of developing periodontal infection than people without diabetes.

o Once periodontal disease is established in a patient with diabetes, metabolic control (glycemic control or blood sugar levels) of diabetes is complicated from the constant reservoir of gram-negative anaerobic bacteria that sit at the bottom of the gum pockets producing infection and low grade inflammation throughout the body.

o That is why it is important for diabetic patients to achieve and sustain the same level of glycemic control as a healthy, non-diabetic individual.

o Good glycemic control, and HbA1c value of less than 6% for most patients, significantly reduces the risk for the serious complications of diabetes, including periodontal disease.

o The presence of periodontitis increases the risk of worsening glycemic control; (perhaps 6-fold increased risk of worsening glycemic control over time).

o Research also suggests chronic periodontal infection causes systemic inflammation that enhances insulin resistance and hyperglycemia. Insulin resistance makes it difficult for patients and their physicians to achieve and sustain optimal glycemic control, and increases the risk for coronary heart disease.

o Some studies show that diabetic patients with periodontitis require less insulin following treatment of periodontal disease.

o Although more research needs to be conducted, studies that have measured the difference in HbA1c after treatment of periodontal disease reported improvements in HbA1c ranging from 0-2 percentage points in HbA1c levels.

o Patients with poorer glycemic control may have more rapid recurrence of deep pockets and less favorable long-term response to treatment.

o When a periodontal infection goes untreated in diabetic patients, this puts them at greater risk for developing the long-term complications associated with diabetes and cardiovascular disease.

o Comply with your health care provider’s recommendations of HbA1c testing at least every 3 months, and request copies of the results are forwarded to your dentist. This allows your dental care provider to monitor your glycemic control against your periodontal status.

Copyright Casey Hein 2008

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