Patients With Diabetes Face Higher Risk of Gum Disease

A new study from the University of Pennsylvania School of Dental Medicine sheds light on why people with diabetes face a greater risk of developing periodontal disease.

Diabetes and Gum Disease

Researchers at the university have discovered that diabetes affects the balance of delicate good and bad bacteria in the mouth. When this balance is disrupted, bad bacteria begin to take over and create high levels of inflammation in the mouth. As a result, patients can develop gum disease.

The earliest stage of gum disease is known as gingivitis. During this stage, gums are mildly inflamed. Symptoms include redness, swelling and mild pain. Gingivitis is treatable and even reversible with early intervention.

If left untreated, gingivitis progresses to periodontitis. Patients with periodontitis are at risk developing severe, painful infection. Bone loss and tooth loss are other consequences of periodontitis, as are serious health complications that affect the heart and lungs.

Finding the Connection Between Diabetes and Gum Disease

The study was conducted by Penn researchers in conjunction with the Children’s Hospital of Philadelphia, scholars from Brazilian and Chinese universities, the PennVet Center for Host-Microbial Interactions, and the Penn Center for Musculoskeletal Diseases.

The goal of the project was to find a definitive cause-effect relationship between the conditions. Before this study, the position of the American Academy of Periodontology was there was no evidence that diabetes directly affected the bacterial balance of the mouth.

Researchers examined the oral microbiomes of mice and mice both with and without diabetes. They found that the environments were similar when the diabetic mice had normal blood sugar levels. When the blood sugar levels spiked, a condition known as hyperglycemia, the bacterial balance of the mouth changed significantly.

Diabetic mice with high blood sugar levels had higher rates of illness-causing bacteria.  

The diabetic mice also had developed periodontitis, bone loss and high levels of inflammation.

To further support the connection, researchers transferred the bacteria from the diabetic mice to mice without diabetes. The mice without diabetes experienced bone loss and inflammation. Suspecting that the key behind the condition was inflammation, the Pennsylvania researchers went one step further and injected the mice with anti-inflammatories before transferring bacteria. Those mice had less serious complications after being injected with the bacteria from the mouths of their diabetic peers.

The results of the study showed that changes in the mouth brought on by diabetes were responsible for increasing inflammation that impacted both gum tissue and bone.

What Does It All Mean for Diabetic Patients?

The development of periodontitis in the mice without diabetes showed that diabetes does impact the balance of bacteria in the mouth. This can lead to periodontitis, according to Dr. Steven P. Rogers, D.M.D., P.C.

"Dentists have known for years that a link existed between the two, and this research explains why the link exists," he said.

Rogers is a Grant’s Pass, Oregon, dentist, and sees patients with periodontal disease ranging from the early stages of gingivitis to advanced periodontitis.

"Diabetic patients can help reduce their risk of developing periodontitis by taking appropriate measures to control their blood sugar and practicing good oral hygiene," Rogers said.

Patients with diabetes should brush at least twice per day and floss at least once per day.

"Diabetic patients should also visit the dentist regularly and may need to see the dentist with more frequency than patients without diabetes," Rogers said.

According to statistics from the Centers for Disease Control and Prevention, 29.1 million Americans have diabetes. Of this 29.1 million, 8.1 million have not been diagnosed.

"Those individuals with diabetes that have not yet been diagnosed have a greater risk of developing gum disease because they are not actively monitoring their blood sugar, which leaves them at risk for inflammation," Rogers said.

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