The Close Relationship Of Periodontal Disease And Diabetes

Diabetes is a widespread metabolic disorder that affects the functioning of almost all essential organs in the body. It is also a disease that is spreading at a rapid rate, thanks to poor eating habits and an increasingly sedentary lifestyle. As previously economically backward nations see growth, particularly the populous nations of China and India, they too are seeing a rapid increase in the incidence and prevalence of diabetes.

Diabetes

There are other less common types of Diabetes also, however irrespective of the kind of diabetes, there is now an established link between the occurrence of diabetes and periodontal disease. In fact, there is increasing evidence that periodontal disease can also be a factor affecting the causation of diabetes and its long-term control.

Complications Of Diabetes

Some of the classical long-term complications as seen in diabetics all over the world include:

• Coronary Heart Disease ( Angina and Myocardial Infarction)
• Pain in the lower half of the body due to poor blood supply
• Blindness
• Kidney Failure
• Neural derangement

It has also now been understood thanks to a wealth of information collected from clinical studies all over the world that these complications are far likelier to occur in people who have a poor control over their Diabetes. This seems like a no-brainer however, it is remarkable how many people struggle to keep their blood sugar levels in the normal range even with the help of medication and regular medical care.

Periodontal Disease

Periodontal disease is an inflammatory condition affecting the gingival, periodontal ligament, alveolar bone and cementum of the teeth. Put simply, it affects all the supporting structures of the teeth. Interestingly, the earliest theories about the occurrence of periodontal disease focused on systemic factors rather than local factors and soon they were refuted by the seemingly more plausible theories that focused more on the disease-causing plaque found on the teeth.

Recently however, evidence has surfaced that systemic factors, particularly diabetes, play a role in the occurrence of periodontal disease as well. In fact, periodontal disease has been named as the sixth classical complication of diabetes.

Signs And Symptoms Of Periodontal Disease

1. Bleeding from the gums
2. Loosening of the teeth
3. Drifting of the teeth away from their normal position
4. Formation of Periodontal Pockets as well as recession of the gums

See Also: What To Expect From Dental Implant Surgery

It has been estimated that almost 90 percent of the global population suffers from some degree of periodontal disease. While the large majority of cases are manageable by non-surgical means, the others need to undergo surgical therapy along with long-term management to avoid a destruction of their dentition.

The Two-Way Relationship Of Diabetes And Periodontal Disease

It is clear that an obvious common link between the two diseases does not exist, yet there is enough scientific evidence to suggest that there is a link between the two diseases. In fact, the risk of developing periodontal disease is almost 2.5 times more when compared to a non diabetic individual.

The answer to this may lie in Advanced Glycation End products (AGEs) which are formed during Diabetes. These products get accumulated in different tissues of the body and cannot be removed. They then cause an inflammatory reaction, leading to the activation of the host defense mechanisms of the body against its own tissues, eventually causing destruction and damage.

This is the same pathology that affects other organs all over the body. The presence of these AGEs in the connective tissue of the periodontal tissues has been confirmed thanks to histologic studies.

If the entire surface area  of the periodontal ligament is added up around each tooth, then it is roughly the size of an average fist. This is a large enough area to affect the systemic health of person if it is inflamed and infected.

Periodontal disease is an inflammatory disease that releases the products of inflammation like cytokines and prostaglandins all over the body. These mediators of inflammation go and interact with the receptors responsible for transport of essential nutrients across the cells. The end result is a decrease in the sensitivity of these receptors to insulin which leads to a hyperglycemic state in the body also known as Diabetes.

Can Treatment Of One Affect The Other?

The evidence is very strong regarding the affect diabetes has on periodontal disease, while it is weaker and requires more clinical studies when it comes to the other way round. Every parameter from incidence of disease to severity of disease, and treatment success as well as long-term stability was found to be improved as the glycemic control of the patient improved. This is extremely significant and has huge ramifications for treatment planning.

Similarly, glucose levels were found to be better managed in patients after they had undergone periodontal therapy to help control the disease. As mentioned earlier, this link – while theoretically sound – is more difficult to prove in practice due to the huge number of things that can affect diabetes.

See Also: Complications Of Diabetes: Not So Sweet