According to a recent review in Frontiers in Dental Medicine, periodontal diseases affect up to 90% of adults worldwide. 463 million adults are thought to have diabetes, and an additional 374 million have pre-diabetes, a state of hyperglycemia (high blood sugar) that does not yet reach the criteria for type 2 diabetes. With the two conditions now known to be connected, here’s what dental professionals need to know about diabetes and periodontal disease.
The link between periodontal disease and diabetes
There is now a significant body of evidence supporting a bi-directional relationship between periodontal disease and diabetes. Those with periodontal diseases are much more likely to have diabetes, and a greater proportion of those with diabetes suffer from periodontitis, to the extent that periodontitis is now widely recognized as “the sixth complication of diabetes”.
The severity of periodontitis tends to be greater in those with diabetes, particularly when diabetes is poorly controlled. However, periodontitis makes glycemic control harder to establish and maintain, potentially creating a vicious cycle in which the two conditions reinforce each other.
The exact mechanisms that underlie the relationship between periodontal disease and diabetes are not yet fully understood. The working theory is that pathogenic oral bacteria can enter the bloodstream more readily via infected periodontal tissue, triggering an inflammatory response that includes hyperglycemia. In turn, elevated blood sugar can create a more favorable environment for the proliferation of pathogenic oral bacteria.
In people with both diabetes and periodontal disease, there is also an increased risk of diabetic complications like cardiovascular disease, stroke and renal disease, compared to the risk in those with diabetes alone.
Playing our part
Given the prevalence of both diseases, their impact on each other, and their implications for health and longevity, diabetes should be on every dental professional’s radar. However, due to the disconnect between dental and medical healthcare, it can be difficult to effectively integrate diabetes risk management into oral care. The European Federation of Periodontology (EFP) recently launched the Perio & Diabetes Project to address this issue, aiming to raise awareness of the two diseases and how they can be fought together.
1.Thorough anamnesis
In their guidelines for oral healthcare professionals, the EFP emphasizes the importance of gathering a comprehensive medical history from patients with diabetes. This should include the type and duration of diabetes, how well their condition is managed, when their blood glucose levels were last checked, and the results of their most recent HbA1c tests.
2. Diabetes screening
According to the Frontiers in Dental Medicine review, half of those with diabetes and 90% of those with pre-diabetes are unaware of their condition. Periodontitis, as a known complication of diabetes, can therefore serve as a valuable early warning in undiagnosed patients. If detected early, pre-diabetes can be arrested or reversed with lifestyle interventions, and diabetes can be managed with lower risk of complications, including periodontal disease.
In patients presenting with periodontal disease, blood sugar levels can be measured in the chair with a simple finger-prick HbA1c test. Dental professionals are also encouraged to familiarize themselves with other risk factors for diabetes and incorporate them into periodontal risk assessments.
3. Oral-systemic education
The relationship between oral and systemic health is not yet common knowledge among the general population. Take the time to educate your patients on this connection, informing those with diabetes about their increased risk of periodontal disease, and vice versa. Discuss individual risk factors with the patient, explore how they can impact their long-term oral and systemic health outcomes, and offer tailored advice. It may help to refer them to the EFP’s patient-centered Perio & Diabetes guide.
4. Periodontal therapy
In patients with periodontal infection, prompt non-surgical periodontal therapy can have a significant positive impact on glycemic control. In the Frontiers in Dental Medicine review, it is noted that periodontal therapy has been shown to reduce HbA1c levels in patients with type 2 diabetes after three months. The effect was comparable to that of adding a second anti-diabetic medication to metformin, the current “gold standard” drug.
5. Preventative measures
In patients with diabetes but no active periodontal disease, a program of preventative care is the recommended course of action. This should include regular monitoring and screening, with more frequent recall if individual risk is high.
6. Tailored home care advice
When it comes to preventing or managing periodontal disease and diabetes, much of the work happens at home. Dental professionals can set their patients up for success by offering oral hygiene advice tailored to their individual needs and recommending appropriate home care products.
Toothpastes and mouth rinses formulated for gum health can be helpful in both prevention and treatment protocols. Look for products with antibacterial agents that target biofilm bacteria and reduce gingival inflammation, tenderness and bleeding. These include stannous fluoride, as found in meridol® toothpaste, and chlorhexidine gluconate, as found in Colgate PerioGard toothpastes and mouth rinses, Colgate Savacol Antiseptic Mouth & Throat Rinse, and meridol Med CHX 0.2% Mouth Rinse (where available).
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