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Periodontal diseases – gingivitis and periodontitis – are the most prevalent inflammatory diseases among humans. Periodontitis, which is more severe than gingivitis, involves damage of the gums, bones, and other tissues that support the teeth. It is provoked by pathogens in dental plaque both above and below the level of the gums. In Western countries, periodontitis affects more than half of the population and around the world 750 million people suffer from severe forms of the disease.
If left untreated, periodontitis can cause tooth loss, which in turn can lead to problems with eating and speaking, aesthetic damage to the smile, and lower self-confidence and quality of life. Periodontitis is associated not only with a greater risk of diabetes (see below) but also with a higher risk of suffering from other conditions including cardiovascular disease, Alzheimer’s disease, certain forms of cancer, complications during pregnancy, and erectile dysfunction.
Diabetes mellitus (usually referred to simply as “diabetes”) is defined by hyperglycaemia (high blood-sugar levels) and has two major forms. Type I diabetes mellitus results from a lack of insulin because of an autoimmune reaction in the pancreas, whereas type 2 diabetes mellitus occurs as a consequence of insulin resistance associated with chronically high blood-sugar levels. There is now a global epidemic of diabetes, with one in 11 adults (415 million people) across the world suffering from the disease, the majority (about 90%) from diabetes type 2. In 2017, about 4 million people died as a result of diabetes. There are an estimated 212 million people worldwide with undiagnosed diabetes.
High blood-sugar levels over a long period of time can seriously damage blood vessels, which can lead to problems in different parts of the body. People with diabetes are at greater risk of suffering heart attacks, strokes, eye problems (retinopathy), kidney problems, and foot problems that can result in amputation.
There is a bidirectional (two-way) relationship between periodontitis and diabetes. This means that healthy patients with periodontitis have a higher chance of developing pre-diabetes and diabetes, while people with severe periodontitis have an increased risk of developing type 2 diabetes. Periodontitis is significantly associated with poorer glycaemic control (HbA1c) and higher blood-glucose levels (glycaemia) both in people with diabetes and in those without the disease. There are higher levels of insulin resistance in people with periodontitis. Diabetes increases the risk of suffering periodontitis and it also increases the risk of the progression and severity of the disease. However, when periodontitis is successfully treated it may help improve a patient’s diabetes. Periodontal treatment in people with diabetes results in a significant reduction in HbA1c levels three months after periodontal therapy.
If your doctor has told you that you have diabetes, you should make an appointment with a dentist. Provide your dentist with an update of the results of your diabetes control and any changes in medication. Your dentist will give you personalised advice on what you need to do. Even if you do not have gum disease, you should still get regular dental check-ups as part of managing your diabetes. It is important to keep your mouth and body as healthy as possible with regular dental and medical care. And it is important to follow some basic oral-hygiene rules (clean your teeth and gums twice a day and use interdental brushes) as well as control of your weight, avoid smoking, and eat healthy foods.
Controlling diabetes is more complicated when a patient also has periodontitis. People who have both diabetes and periodontitis are at greater risk of suffering from certain severe medical complications – including heart disease, chronic kidney disease, and retinopathy – than people who have diabetes alone.