Diabetes and gums

Of all the connections between mouth and body, this is the best established. It is also the only one in which the effect of dental treatment can be demonstrated in a laboratory value.

Why diabetes harms the gums

• Persistently raised blood sugar alters the small blood vessels; the gums are less well supplied.
• The defence cells that remove bacteria work less effectively.
• Wounds heal more slowly — including the microscopically small wounds at the gum margin.
• In the tissue, compounds of sugar and protein are formed which intensify the inflammatory reaction and promote the loss of bone.
• The flow of saliva is often reduced and the sugar content of the saliva is raised — both additionally favour caries.

The result: periodontitis occurs more often in people with diabetes, begins earlier and runs a more severe course. Professionally it counts as one of the secondary diseases of diabetes — alongside eyes, kidneys, nerves and vessels, only less well known.

And in the other direction

A chronic inflammation releases messenger substances that dampen the action of insulin on the body's cells. The pancreas has to work against this and control becomes more difficult. People with untreated periodontitis have on average poorer long-term blood sugar values than comparable patients with healthy gums.

After periodontal treatment, studies show long-term blood sugar falling by an amount of the order of what an additional medicine can achieve. For a dental measure that is remarkable — and an argument that belongs in both consulting rooms.

What to do

• State the diabetes at the dental practice, with the current long-term blood sugar value. It changes the treatment plan and the follow-up interval.
• Have the gums measured at least once a year, not just every two years.
• Shorter follow-up intervals — as a rule three to four months.
• Clean the interdental spaces daily. Where the risk is increased, this step is not negotiable.
• Watch out for dry mouth and drink enough; sugar-free chewing gum stimulates saliva.
• Watch out for fungal infection. Whitish deposits, a burning mucosa and cracks at the corners of the mouth occur more often with diabetes and should be treated.
• Make appointments in the morning and after a meal, to avoid hypoglycaemia in the treatment chair. Having some glucose with you is a sensible precaution.

The other way round: when the practice finds something

Pronounced periodontitis in a person who knows nothing of a diabetes is a serious indication. Quite a few cases of diabetes are only recognised late. When a dentist asks about unusually strong thirst, frequent urination, tiredness or unexplained weight loss and suggests a visit to the GP, that is not overstepping her remit but well founded.