Diabetes and Periodontal Disease : Dual Relationship

Introduction:

Diabetes and periodontal disease are two prevalent and interconnected health conditions that share a Bidirectional relationship.

 Research has shown that individuals with diabetes are more susceptible to periodontal disease, and those with periodontal disease may have difficulty controlling their blood sugar levels.

 This article aims to delve into the relationship between Diabetes and Periodontal disease, highlighting the impact they have on each other and the importance of comprehensive oral care for individuals with diabetes.

Diabetes and the Risk of Periodontal Disease:

Factors affected in periodontal of diabetic patients :-

Vascular changes :

• Thickening & hyalinisation of vascular walls.
• Disease resistant thickening of capillary basement membrane.
• Swelling & proliferation of endothelial cells.
• Splitting of capillary basement membrane.

Finally .. leading to diabetic induced changes in basement membrane—->>>>>
That inhibit TRANSPORT of:

• oxygen(O2)

• white blood cells(WBC)

• immune factors &

• waste products-
  • —>>>> All of which could affect tissue repair & regeneration.

PMNL’s functions-

Disturbed functions of PMNL’s in diabetic patients include :

• Reduced phagocytosis
• Intracellular killing of neutrophils(PMNLs)
• Impaired adherence of neutrophils (PMNLs)
• Impaired chemotactic response

All these disturbed functions of PMNL’s due to diabetes Cause periodontal problems.

Biochemistry of GCF ( gingival crevicular fluid )

Alteration in constitution & flow rate of GCF have been shown associated with diabetes.

• Cyclic AMP( promote mobilisation of glucose & fatty acids) level seems to be reduced when compared with non- diabetic patients.
• Changes in plaque microflora:
• Hyaluronidase activity is lower in diabetic patients , leading to more plaque formation . This plaque cause more periodontal problems.
• Formation of advanced glycation end products(AGE) :

The link between these two conditions stems from the fact that poorly controlled blood sugar levels in individuals with diabetes can weaken the immune system and impair its 9y to fight off infections, including gum infections. Elevated glucose levels in saliva also create an ideal environment for bacteria growth, which further contributes to the development of periodontal disease.

The Impact of Periodontal Disease on Diabetes:

Periodontal disease not only affects oral health but can also have a detrimental impact on diabetes management.

The chronic inflammation associated with periodontal disease can lead to insulin resistance, making it more challenging to regulate blood sugar levels.

Furthermore, individuals with diabetes who have periodontal disease may experience more difficulty in controlling their diabetes due to increased systemic inflammation.

Bidirectional Relationship:

The connection between diabetes and periodontal disease is not only one way; these two conditions can exacerbate each other.

Uncontrolled diabetes can worsen periodontal disease, while untreated periodontal disease can negatively impact diabetes management.

This vicious cycle emphasizes the significance of effectively managing both conditions simultaneously to ensure optimal overall health.

Treatment:

1. Periodontal treatment in patients with uncontrolled diabetes in contraindicated.
2. If suspected to be a diabetic , following procedure should be performed.
   a. Consult the patient’s physician.
   b. Analyse laboratory tests, fasting blood glucose, postprandial( after food) blood glucose, glycated haemoglobin, glucose tolerance tests, urinary glucose.
   c. If there is a brittle diabetic patient, optimal periodontal health is necessity.
   d. Glucose level should be continuously monitored & periodontal treatment should be performed when the disease in a well controlled state.
   e. Prophylactic antibiotics should be started 2 days preoperatively Guidelines
3. Clinician should make certain that the prescribed insulin or any other anti-diabetic medicine has been taken , followed by a meal
4. Morning appointments are ideal after breakfast because of optimal insulin levels.
   3.After any surgical procedures, postoperative insulin dose should be altered.
5. Tissue should be handled atraumatically & minimally ( lass than 2 hours) as possible.
6. For anxious patients, if preoperative sedation is required epinephrine , concentration should not be greater than 1:100000
7. Diet remmondation should be made .
8. Antibiotics prophylaxis is recommended for extensive therapy,.
9. Recall appointments & fastidious home oral care should be stressed.

Prevention and Management Strategies:

Managing diabetes and periodontal disease requires a multidisciplinary approach involving healthcare professionals from various specialties.

Individuals with diabetes should incorporate regular dental check-ups and oral hygiene practices into their diabetes management routine.

This includes brushing teeth at least twice a day, flossing daily, and using mouthwash to prevent bacterial growth.

Moreover, individuals with diabetes should ensure they maintain proper blood sugar control to minimize the risk of periodontal disease.

Collaboration between dentists and endocrinologists is essential for coordinated care.

Dentists can help identify early signs of periodontal disease and provide preventive treatments, while endocrinologists can assist in optimizing blood sugar control.

This integrated approach can improve oralhealth and contribute to better diabetes management.

Conclusion:

The relationship between diabetes and periodontal disease is complex and bidirectional, with each condition potentially aggravating the other.

Individuals with diabetes must pay special attention to their oral health and seek comprehensive dental care.

Likewise, dental professionals should be aware of their patients’ diabetic conditions and actively collaborate with other healthcare providers to ensure optimal outcomes.

By addressing both conditions together, individuals with diabetes can enhance their overall health and well-being.

reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228943/

also read :

1. why to brush twice daily..?
2. what are interdental aids.?
3. Halitosis /bad breath.
4. proper brushing technique.