It has become increasingly clear that, in many cases, a holistic approach to oral health care is beneficial for patients. This means assessing each patient’s overall health and ensuring the cause of any issues is effectively treated. Often, when general and dental health problems are linked, it can be helpful to work together with general practitioners to treat the patient as a whole. With this in mind, consider the association between periodontitis and systemic diseases such as diabetes. What is the link, and what can dental teams do to help?
Diabetes as a risk factor for periodontitis
Globally, 537m people have diabetes, with 61m people in Europe living with the condition. It is a chronic non-communicable disease, caused by either insufficient (type 1) or ineffective (type 2) insulin, which regulates blood glucose. As a result of this, diabetic patients can experience either hyperglycaemia (elevated blood glucose) or hypoglycaemia (low blood glucose).
The risk factors for diabetes are similar to those for periodontitis, with age, family history, ethnicity, and high blood pressure, as well as obesity, smoking, alcohol consumption, and gestational diabetes likely to put patients at higher risk.
Uncontrolled diabetes can lead to a range of health complications including stroke, heart attack, nerve damage, foot problems, and eye problems being key concerns. However, dental professionals will be aware of its connection with periodontitis.
Hyperglycaemia seen in poorly controlled diabetics can significantly worsen periodontitis, either raising their risk of getting the disease, or increasing its severity. Additionally, uncontrolled diabetes may lead to poorer outcomes from periodontitis therapy when compared to well-controlled diabetic and non-diabetics. Therefore, people with uncontrolled diabetes are at a higher risk of bone and tooth loss.
Concerningly, one million diabetics are undiagnosed in the UK, meaning that some periodontitis patients may have diabetes without knowing it. Because this risk factor is unknown to both patients and dentists in this scenario, it is important to ask patients with periodontitis some screening questions about their family history and lifestyle and advise them to visit their GP for testing where appropriate.
Once their diabetes is under control, periodontitis therapy can be carried out to its full potential. This applies to known diabetics too. They may think that their condition is well controlled, but periodontitis may be a sign that they need to see their GP.
Is periodontitis a risk factor for diabetes?
Conversely, it has been suggested that periodontitis is a risk factor for diabetes. This is not a new idea. It has been discussed in the literature for centuries, and in 2016, 57 medical conditions were associated with periodontitis, with this number likely to have risen since then.
There are a number of theories as to why periodontitis may lead to diabetes, these include metastatic infection caused by transient bacteraemia, metastatic injury caused by microbial toxins, and metastatic inflammation caused by immunological injury. Ultimately, untreated periodontitis circulating around the body may cause systemic inflammation, exacerbating/causing diabetes and elevating HbA1c levels (average blood sugar levels), and increasing diabetic complications.
Research suggests that treating periodontitis has a more significant impact on reducing HbA1c levels than common diabetes recommendations like weight loss and diet change. However, another study has shown that when diet, exercise, and medication are provided without sub-gingival professional mechanical plaque removal (PMPR), pocket depth was reduced, highlighting that bi-directional relationship.
Supportive care and maintenance
To improve a patient’s long-term situation, ongoing support and maintenance is key. Diabetic control is essential for managing pocket depth. Therefore, it is important to ask patients screening questions to help gauge their level of compliance with their diabetes management and help to ascertain how much support they might need to seek medical advice from their GP.
Personalised oral hygiene advice can also be incredibly helpful, as patients with periodontitis may require oral hygiene adjuncts to help keep bacteria levels to a minimum.
Often, I recommend Perio plus Regenerate mouthwash from Curaprox to patients who require comprehensive protection in cases of gingival issues. The mouthwash contains 0.09 per cent chlorhexidine and hyaluronic acid to deliver an antibacterial effect whilst soothing and hydrating the gingiva. Additionally, Perio plus Regenerate contains Citrox, which is a natural bioflavonoid extracted from bitter oranges. This oral hygiene adjunct is ideal for patients who need additional help with managing periodontal disease, and should be used occasionally to help promote the healing of the gingiva.
Exploring the link with diabetes is crucial for effectively caring for patients with periodontitis. By providing a holistic approach to care, clinicians can treat the patient as a whole, with the assistance of a GP. This helps manage both conditions at the same time, and identify patients who may be at a higher risk for developing both periodontitis and diabetes.
References available on request.