Optimal oral health care for people with diabetes is an indispensable habit, even more so in these times of a coronavirus pandemic. Good oral hygiene, as well as a prompt and effective dental intervention to prevent or treat gum disorders, helps to prevent and/or control inflammatory diseases (such as periodontitis) that originate in the mouth but have an impact on general health (due to their systemic nature) and often alter glycemic control in people with diabetes.

Minimizing these inflammatory phenomena is now crucial for this group of people, especially as they are already at higher risk than the general population of developing worse and suffering more complications (including death) if they grow COVID-19. In addition, it is estimated that 40% of diabetics would be over 65 years of age, adding up to two important risk factors for the worst prognosis for this viral infection. 

It is estimated that 40% of diabetics would be over 65 years of age, adding up to two important risk factors for the worst prognosis of this viral infection. People with diabetes are an essential risk group in the situation in which we find ourselves and, therefore, in addition to being more careful in general during this stage of confinement, they should take extreme measures in terms of dental and interdental hygiene, also relying on the use of oral antiseptics.

For the same reason, these people with diabetes shouldn't postpone their visit to the dentist in the event of any significant event. In the event of periodontal infection, significant gingival bleeding, suppuration, or periodontal abscesses, it is advisable to contact your dentist to assess the need for some type of emergency periodontal treatment to avoid situations that may negatively influence your general health. It is also essential that you eat a healthy and balanced diet and, to the extent that this situation allows, take daily physical exercise.

One of the complications associated with diabetes is periodontitis, gum disease of infectious origin, and chronic inflammatory nature resulting from an imbalance between bacterial aggression and the patient's immune response to it.

In the case of the person with diabetes, his or her exaggerated immune and inflammatory response causes the infection and destruction of periodontal tissues to be more severe and to evolve more rapidly than in an individual without diabetes, especially in those with poorer glycemic control. In addition, this local infection could spread since both bacteria, and inflammatory mediators can enter the blood, producing a systemic inflammation associated with the elevation of proinflammatory cytokines.

This increase in the inflammatory load associated with periodontitis can be particularly significant in the case of diabetes and COVID-19. In addition, it is now known that people with previous comorbidities, such as diabetes, cardiovascular disease, and high blood pressure, are at higher risk of slower recovery, worse outcomes, and more complications (including death) if they develop SARSCov-2 disease.

 There are several reasons why a patient with diabetes has to isolate and take much more care of himself or herself:

1) The person with diabetes has a compromised immune system, which response inadequately to bacterial, fungal, or viral infections. In the case of the coronavirus, this will facilitate its dissemination inside the lungs, against which the patient's immune system will try to oppose resistance. This fight is based on the exaggerated release of large quantities of pro-inflammatory cytokines, substances whose mission is to eradicate the virus but which, as a side effect, produce a situation of inflammation not only at a pulmonary level but also in a generalized way.

2) This elevation of inflammatory markers in the blood will be responsible for the production of insulin resistance and, consequently, a greater height of glycosylated hemoglobin levels. Therefore, COVID-19 in a patient with diabetes can significantly increase the risk of blood glucose being out of control, with consequent complications.

3) On the other hand, some of the treatments used in patients with COVID-19 (e.g., high-dose steroids) also cause an increase in both blood pressure and glycated hemoglobin levels, which may lead to uncontrolled diabetes in these patients. In addition, one of the complications observed in patients with COVID19 is cardiovascular disease, both due to the viral infection and the treatments used against it (such as chloroquine-type antimalarials).

4) In addition, many patients with diabetes, especially those of older age, already present a cardiovascular complication, thus increasing the risk of aggravation of the diabetic disease.