How Does Diabetes Affect Periodontitis Disease?

Periodontitis is a common and chronic inflammatory disease that is characterised by the destruction of the teeth’s supporting structures: the periodontal ligament as well as the alveolar bone. It is quite highly prevalent (affecting 10-15% of the total adults), with multiple, negative health impacts on quality of life. 

Epidemiological data confirm that diabetes (both type 1 and type 2) is a major risk factor for periodontitis or periodontal disease (which is also known as gum disease). Susceptibility to periodontitis is increased by as much as threefold in those with diabetes. There exists a clear relationship between the degree of hyperglycaemia (or high blood sugar) and the severity of periodontitis. 

Periodontitis Meaning

Periodontal diseases, in a collective manner, is one of the most common diseases affecting humankind. Classification of the disease is complex and is based on clinical presentation, rate of disease progression, age at diagnosis, and systemic as well as local factors that may increase the risk. 

Tissue destruction caused by periodontitis results in the eventual breakdown of collagen fibres of the periodontal ligament, which results in the formation of a periodontal pocket between the tooth and the gingiva. 

Pocketing is not clearly evident through visual inspection, and assessment with the use of a periodontal probe is necessary. During the initial stages, the condition is asymptomatic: there is not much pain, and many individuals are unaware that they have a problem until the condition has progressed substantially to result in the mobility of the teeth. 

The pockets further deepen because of an increase in the destruction of the periodontal ligament’s fibres, which is also known as attachment loss. 

Advanced periodontitis is often characterised by gingival bleeding, gingival erythema and oedema, gingival recession, suppuration from periodontal pockets, drifting of teeth, and eventual tooth loss.

Association Between Periodontitis and Diabetes

Diabetes is an unequivocal and major risk factor for periodontitis. The risk of this gum disease is increased by as much as threefold in diabetic individuals in comparison with non-diabetic individuals. The level of glycaemic control is of prime importance when it comes to determining the increased risk. 

Most of the research has focused on type 2 diabetes as a significant risk factor for periodontitis. That said, type 1 diabetes also ups the risk of periodontitis, and all those with diabetes, including children and young adults, must be considered at an elevated risk of developing periodontitis. 

Diabetes causes alterations in blood vessels, such as thickening. As a result, these thickened blood vessels can disrupt the flow of nutrients and the removal of waste matter from the tissues of the body. This reduction in blood flow can eventually weaken the mouth’s gums and bone, putting individuals at greater risk for infection.

Improper management of diabetes can lead to high blood sugar levels in mouth fluids, too. This, unfortunately, promotes bacterial growth that can cause periodontal disease or gum disease. Conversely, infections arising from untreated periodontitis can lead to a spike in blood sugar levels, making it much harder to control diabetes. 

Another distinct factor (such as smoking) is extremely harmful to oral health even for those individuals without diabetes. That said, an individual with diabetes who smokes regularly is at a higher risk for periodontal disease in comparison with those who do not have diabetes.

These diabetes-associated factors, in combination with poor oral hygiene, can cause periodontitis or periodontal disease.

Some of the most striking changes when it comes to uncontrolled diabetes are reduction in defence mechanisms and increased susceptibility to infections, which lead to destructive periodontal disease. According to several clinicians, periodontal disease in those with diabetes follows no specific, consistent pattern. Extremely acute gingival inflammation, rapid loss of bone, deep periodontal pockets, and frequent periodontitis abscess are common occurrences in diabetics with poor oral hygiene. Diabetes leads to impaired defence mechanisms that involve both micro- and macro-vasculatures. 

This increased susceptibility to infection and a decrease in healing capacity along with altered metabolism of collagen could explain the increased levels of periodontal destruction.

On a Final Note:

Periodontal or gum diseases are infections of the gums and the bone that hold the teeth in their place. Periodontitis is a condition that can manifest in those with diabetes that has not been controlled well. Moreover, the response of the body to gum infections, too, can cause blood glucose problems. Taking optimal care of your gums and teeth (such as flossing and regular brushing) can help in preventing mouth problems that are linked to diabetes. Those with diabetes can keep their teeth and gums healthy by keeping a check on blood sugar levels and getting routine dental check-ups done.

References:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228943/
• https://www.cedars-sinai.org/health-library/diseases-and-conditions/d/diabetes-and-gum-periodontal-disease.html#:~:text=Diabetes%20causes%20blood%20vessel%20changes,at%20greater%20risk%20for%20infection.
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3467897/