Understanding the link between Diabetes Type 2 and Gum Disease

Welcome to True Smiles Dental Blog where we explore educational content on teeth and health! As part of improving the health of the Marrickville community and patients we serve, we are going to focus on the most common chronic conditions affecting Australian population: Diabetes Type 2, and its interesting relationship with our oral health. This connection is often overlooked yet vital to understand so that we cannot only benefit from our dental health but our general health.

What is Diabetes?

Before delving into the relationship and its intricacies, let’s understand diabetes as a condition. Diabetes is a chronic health condition, meaning it is a long-term condition that affects the body and its ability to turn food into energy. In Australia, approximately 1.2 million people live with Diabetes. There are two main types:

• Type 1: inherited or due to cellular changes where the pancreas (the organ responsible for energy production and sugar absorption) cannot produce its own insulin
• Type 2: due to lifestyle factors such as poor diet and lack of exercise and where the body does not have sensitivity or reaction to insulin.

As a side note, insulin is a hormone that binds onto receptors of our cells to allow sugar to be absorbed into the body which then starts the process of energy production.

For both types of diabetes, it is generally characterised by the excess amount of glucose within the blood serum rather than within cells, muscles and organs where they should be. This is where those who suffer from diabetes that are not well-controlled leading to symptoms of extreme hunger and thirst, increased urination and excessive fatigue. Typically the treatment for type 1 is to introduce insulin within the body whereas type 2 is where those who are affected are to take medication to modify the sensitivity of the insulin receptors so that they are able to allow sugar to enter in the cells. Type 2 patients are also encouraged to improve their lifestyle factors such as increasing frequency of exercise and healthier diet.

Now because there is excess sugar within the blood serum, this can also trigger inflammatory responses within the body and lead to an increased risk for other chronic conditions such as hypertension, impaired bleeding (taking longer to stop bleeding) and lowered immunity.

Gum Disease – in detail

Now some of you reading this may already have a general gist and understanding of gum disease but for formality, let’s delve into some detail about it. At True Smiles Dental, our team of dentists and oral health therapists may have discussed briefly with you some signs of bleeding, pocketing (refer to our pocketing blog) or tenderness when we poke around your gums. These are symptoms of gum disease.

There are two main types of gum disease: Gingivitis and Periodontal disease. In this blog post, we will not delve into the specific drivers but the main common one we see is affecting the population is plaque-induced.

To briefly mention, gingivitis is a form of acute gum disease where it purely affects the gum tissue only – there is usually signs of bleeding, puffy gums, persistent bad breath and some soreness of the gums. Periodontal disease or periodontitis is where there are all the symptoms of gingivitis but now affecting the bone that is underneath the gum. The reason why we stress on the bone health as well because it is what holds the teeth securely. If there are signs of bone loss, this where the stability of the teeth gets compromised

Now in order for any form of gum inflammation to start, it is due to the lack of disruption of plaque and our body’s response to the plaque that causes the symptoms as aforementioned above to occur. This is why we stress on the importance of proper flossing daily and twice daily brushing in order to disrupt the plaque regularly and not allow the inflammatory response to go out of hand to lead to problems to the gums.

Although optimal oral hygiene can do well to control and prevent deterioration of gum health, uncontrolled diabetes can cause the gums to be more sensitive to changes in the level of plaque and when gum disease is uncontrolled, the diabetes can be more difficult to control. Let us delve into some of the science to better understand this bidirectional relationship:

• Chronic inflammation: chronic inflammation refers to the inflammation that is ongoing with episodes of remission (quiet periods) and acute flare ups (symptoms particularly noticeable). Although healthy practices can help maintain at this level of remission which is our aim for your gums for those affected with periodontal disease. Now in diabetes, the high sugar levels in the blood trigger systemic inflammation throughout the body and causes changes to blood vessels such as increased blood flow and migration of immunity cells including the gums. This explains why the gums can be more sensitive to even minimal plaque level changes making them more susceptible to gum bleeding and pain.

• Glycation: Increased levels of sugar in the blood can lead to the process called glycation. This describes the process of glucose molecules binding to the protein and lipids forming Advanced Glycation End Products (AGEs, for short). Given that it is in its unnatural form, it becomes slightly foreign, incompatible with the normal humanly function and thus, triggers multiple immune cells creating an overstimulated and overactive response leading to a heightened immune response. This then leads to the increased production of destructive enzymes and molecules which are called, inflammatory cytokines, such as tumour necrosis factor-alpha (TNF-a) and certain interleukins. In this process, not only does it destroy some of our good cells but it also decreases our immune threshold meaning typically a certain amount of plaque that would not warrant any signs of gum inflammation and tissue damage would now due to this lowered threshold.

• Altered Immune Response: As mentioned above, due to the multiple levels of triggering the immune system due to its lowered immune threshold from chronic inflammation and AGEs also leads to the decreased effectiveness to counteracting bacteria that can worsen gum disease. It creates an environment favouring the pathogenic bacteria, namely Porphyromonas gingivalis, which is a cornerstone for the process of periodontal disease. Although our focus is in the mouth, this same process is happening everywhere in the body which can lead to worsen bodily function such as neuropathy (nerve), retinopathy (eye) and diabetic foot.

Bidirectional relationship between Periodontal Disease and Diabetes

Now that we understand some basic science of both conditions, there has been established evidence from systemic reviews and meta-analyses that indicate that periodontal therapy has led to the significant reduction in HbA1c levels (average blood sugar levels over months), as well as individuals with poorly controlled diabetes with 2 to 3 times more likely to develop periodontal disease compared to well-controlled diabetes. A systematic review also found that approximately 60% of people with diabetes will experience some form of gum disease. Interestingly, diabetes is a modifying factor to the rate of periodontal disease progression which we use as a diagnostic key in determining this. Therefore, it can be commonly seen that the severity of diabetes can be one of the determining factors to the severity of gum disease and vice versa.

Recommendations from True Smiles Dental

At True Smiles Dental, our team of oral health therapist and dentists understand the importance of improving and maintaining not only your oral health but your general health in ways we can. Based upon scientific understands and putting it into practice, here are some recommendations to our diabetic patients:

• Regular monitoring of glucose levels: keeping a close monitor of your blood sugar levels fasting and non-fasting and providing this information to your general practice doctor can be useful in determining the level of controlled.

• Optimal oral hygiene: brushing twice daily, flossing or using interdental brushes regularly to enhance mechanical removal of plaque can ensure minimal amount of plaque and triggers to the immune system and thus, minimising tissue damage. In your hygiene appointment at True Smiles Dental, your oral health profession can provide you more detailed advice and instructions on how to maintain optimal hygiene.

• Nutrition: In terms of diet tailored to glycaemic control which will benefit regulating blood sugar levels but also periodontal health. Generally, whole foods rich in complex carbohydrates, fibre and vitamin and minerals particularly vitamin C has been particularly helpful in promoting healthier gums and oral microbiome which can be protective against pathological bacterial species.

• Regular maintenance visits: As periodontal disease can be more susceptible in those with diabetes, it is best recommended to visit our oral health therapists regularly for your hygiene maintenance visits. Whether it be 3 monthly or 6 monthly, this is best determined by your oral health therapist. The main goal is to ensure there is minimal inflammation of the gums and optimal oral hygiene is best kept at home between the visits.

At True Smiles Dental in Marrickville, we are passionate about providing comprehensive care that puts the mouth back into health. As discussed, the relationship between diabetes and gum disease is prevalent, and understanding both can lead to better management of both conditions. Contact our team today on 02 7728 7272, email us on [email protected] or book online at truesmilesdental.com.au for your hygiene appointment to get started on improving and maintaining your dental health. Let us start your journey together towards health 😊.