Could regular tooth brushing and flossing help you manage your blood glucose more effectively? That intriguing possibility has emerged from studies of the complex relationship between diabetes and gum disease.
Research suggests that nearly half of all Americans over 30 have a serious form of gum disease known as periodontitis (or periodontal disease), but the problem is particularly common among people with diabetes, who have double the risk.
In fact, periodontal disease is so closely linked to poorly controlled blood glucose that it has come to be called the “sixth complication of diabetes,”along with eye disease (retinopathy), altered sensation (neuropathy), kidney disease (nephropathy), cardiovascular disease, and delayed wound healing.
Yet, some research suggests that there may be a two-way relationship between diabetes and periodontal disease. In other words, while it is accepted that elevated glucose levels can increase the risk for periodontitis, some evidence now suggests that untreated gum disease creates a constant state of low-grade inflammation, which might worsen insulin resistance and actually increase one’s risk of developing diabetes.
While the latter assertion remains somewhat controversial, there’s no doubt that preventing your self from getting periodontal disease is a must for good oral health and all-around well-being.
Inflammation is the culprit
Your gums are made of bone and soft tissue and act as the support structure for your teeth. During the course of a day, the teeth become covered with bacteria and other substances, which form a sticky, colorless coating known as plaque.
If plaque isn’t removed on a routine basis, it can harden to form tartar, which damages teeth. But plaque and tartar at the base of a tooth also cause the gums to become red and swollen, a condition known as gingivitis.
Good oral hygiene can prevent and treat gingivitis, but if poor dental care continues, the condition can worsen and develop into periodontal disease.
When periodontitis strikes, the gums begin to separate from the teeth and form spaces known as “pockets.” Bacteria collects in this space between the gums and teeth and more plaque and tartar form below the gum line, which can become infected and cause an abscess. Over time, inflammation in the gums damages bone and can make teeth loosen and fall out.
People who smoke have an increased risk for periodontitis, as do men and women who are obese. Some medications (such as those for glaucoma) can increase the risk for gum diseases by reducing the flow of saliva, which your mouth needs for protection from infections, and by causing abnormal growth of gum tissue.
Having diabetes is a major risk factor for developing periodontal disease, especially when blood glucose isn’t well controlled. One large study found about 60 percent of people with diabetes have some evidence of periodontal disease.
And a major health survey conducted by the U.S. government found that people with diabetes who have poorly controlled blood glucose (defined as HbA1c of 9 percent or higher) have a significantly increased risk for developing periodontal disease.
There are several reasons why people with diabetes have a high risk for gum problems. For one, having diabetes alters the immune system’s natural ability to attack and destroy the bacteria living on the teeth and gums that start trouble in the first place.
Also, poorly controlled blood glucose levels impair the body’s capacity to heal the damage of periodontal disease.
Periodontal disease is often treated with a form of deep cleaning known as scaling and root planing. In this procedure, a dentist or dental hygienist uses special instruments (in some cases, laser tools) to remove tartar and smooth over any rough spots where bacteria can accumulate.
Your dentist may also prescribe medication to treat periodontal disease, such as a mouth rinse called chlorhexidine, a bacteria-killing medicine. Chlorhexidine can also be administered in the form of a tiny implant inserted into gum pockets, allowing the medicine to be released slowly over time.
Antibiotics, both in the form of pills and gels applied to the gums, may also be used. In some cases, surgery may be necessary to remove tartar deposits, or to repair bone and tissue damaged by periodontal disease.
The relationship between diabetes and periodontal disease has been called “bi-directional.” That’s because not only does poor glucose control harm the gums, but there is also reason to believe that developing periodontal disease may make diabetes harder to manage.
What’s more, some—though not all—studies suggest that treating periodontal disease can provide a modest reduction in blood glucose levels.
A 2014 review of 10 clinical trials published in the journal PLoS One, which included 1,135 diabetes patients, found that those undergoing nonsurgical treatment for periodontal disease had modest improvements in HbA1c, which dropped by 0.36 percent, on average, after three months.
However, the benefit may only have been temporary, since six months after treatment, their HbA1c was similar to that of people in a control group who didn’t undergo treatment. However, it is not completely clear if simply treating periodontal disease can have a durable effect on glucose control.
Furthermore, in a 2013 study published in JAMA, researchers set out to compare 257 people with diabetes and periodontal disease who received scaling and root planing, and who rinsed with chlorhexidine, with the same number of patients who didn’t undergo treatment for gum disease.
The goal was to find out if periodontal treatment lowered HbA1c levels, but the study was terminated early when it became clear that the treatment didn’t improve glucose control.
More research, including larger numbers of patients, is likely needed to definitively answer whether treatments to address periodontal disease are able to help people with diabetes control their blood sugar.
Of course, there are many other reasons to treat periodontal disease, so the benefits may still favor such treatments, and perhaps certain individuals will experience an improvement in their glucose levels too.
Other health threats
Even if treating periodontal disease only provides a small improvement in control of blood glucose, if any, there are still excellent reasons to keep this scourge in check that go beyond saving your smile.
For starters, keep in mind that having diabetes increases the risk for cardiovascular disease, and it is now well established that periodontal disease further increases that risk, most likely by creating a persistent state of low-grade inflammation in the body.
Furthermore, recent research also links periodontal disease with chronic kidney disease (CKD). Here again, chronic inflammation may be the culprit.
According to a 2015 study in the journal BMC Nephrology, people who have periodontal disease and CKD have double the risk of dying compared to people free of both conditions. (It is not clear if that risk was greater for people with CKD and no periodontal disease.)
Gum disease may develop over a long time, but when this condition takes hold, it’s hard to ignore. Your gums may turn reddish and feel swollen and tender. Bleeding is common.
Your gums may recede, making your teeth appear longer. Some teeth may feel sensitive or loose, or even fall out. Chewing on food may hurt. Some people who have never had a problem with bad breath suddenly develop a persistent case of this embarrassing problem.
If you develop any of these symptoms, see your dentist right away. More importantly, take all of the necessary steps to prevent gum disease: Brush with toothpaste that contains fluoride at least twice a day; Floss nightly and ask your dentist or about using a gum pick or other device to help remove plaque; Visit your dentist’s office for a cleaning and checkup every six months.
Read more about how tooth infections can hurt your heart.
Timothy Gower is an award-winning journalist who writes about health and medicine. His work has appeared in more than two dozen major magazines and newspapers, including Prevention, Reader’s Digest, and the Los Angeles Times.