A diabetic is up to three times more likely to suffer from periodontitis

The relationship between diabetes and oral health is a dangerous friendship. They have much to do with each other, for better or worse. Their relationship is two-way, so what affects one will also affect the other. For example, a person with diabetes will be at greater risk for poorer oral health, specifically a greater risk for periodontitis; on the other hand, a person with periodontitis will be at greater risk for diabetes. Similarly, improved control of diabetes will help prevent the worsening of periodontal health, and good oral health will also positively impact diabetes control. 

Not controlling diabetes can make you more likely to lose your teeth. In fact, studies tell us that up to 15% of patients with diabetes lose all the teeth in their mouths.

Patients with diabetes, mainly if it is not controlled, have a greater predisposition to suffer from periodontitis and evolve more quickly. In addition, glucose elevation occurs not only in the blood but also in the saliva. This elevation is also related to a greater predisposition to caries.

On the other hand, people with poorly controlled diabetes are at greater risk of suffering other alterations in the oral cavity, such as candidiasis, which is closely related to high glycosylated hemoglobin or xerostomia.

It has been shown that in metabolically healthy individuals without diabetes, their glycosylated hemoglobin is, on average, 0.3% higher if they have advanced periodontitis. Likewise, there is also strong evidence that patients with periodontitis, incredibly advanced, have an increased risk of suffering from diabetes in the following years, unlike those who do not have periodontitis or have it in its more initial phase. 

Once diabetes has been diagnosed, it is essential to know that poor oral hygiene influences the control of the disease. Today, patients with diabetes and periodontitis are at increased risk for diabetes-related complications. Evidence is essential regarding retinopathies, cardiovascular diseases, and nephropathies. Even studies show a higher percentage of death from any cause in patients with diabetes and periodontitis than in patients with diabetes alone.

The link between periodontitis and diabetes is inflammation. Both are chronic, non-communicable inflammatory diseases. 

In the case of diabetes, poor blood glucose control leads to an elevation in the blood and the periodontal tissues of proinflammatory cytokines and end products of advanced glycation (AGE proteins). These stimulate the production of oxygen-free radicals by the immune system, as well as a poor inflammatory response, with the destruction of periodontal tissues.

In the other direction, as a consequence of periodontitis, there is an elevation of proinflammatory cytokines in periodontal tissues, such as IL1beta, IL6, or TNFalpha, but also in the bloodstream, along with peaks of acute-phase proteins such as C-reactive protein. This causes a low-grade systemic inflammation which results in insulin resistance, which will be before a glycemia alteration and the development of diabetes. 

Periodontitis is an oral disease that has been most associated with diabetes.

Diabetes indeed has other "undesirable friends" in the mouth, such as caries, xerostomia, burning mouth syndrome, candidiasis, or lichen planus, but it is another chronic inflammatory disease; periodontitis is the one that has shown the most association. In fact, a person with diabetes is up to three times more likely to suffer from periodontitis than a person without diabetes.

The best advice that can be given regarding oral health to prevent diabetes is to have excellent oral hygiene. This implies not only having a good toothbrush but also interdental by using interdental brushes and/or dental floss. In the year 2020, a large epidemiological study was published in South Korea, with more than 180,000 people, in which it has been shown that improving brushing techniques can reduce the risk of new cases of diabetes. Therefore, a good brushing, using an interdental brush, and eventually, using an antiseptic mouthwash are good weapons to prevent diabetes. 

In addition, periodic check-ups must be performed at the dentist to rule out the existence of periodontitis since, in this case, periodontal treatment will be an essential factor in avoiding the loss of teeth and preventing the appearance of diabetes. 

From the dental office of your preference, you can do much in this regard. On the one hand, we must know that the risk factors for oral diseases are also common in diabetesBut, onOn the other hand, we can include tobacco, overweight/obesity, inactivity, diets rich in refined sugars and saturated fats, etc. And we can influence this through our consultations. 

We should all include in our oral health team the modification of risk factors, that is, the promotion of healthy lifestyles. We are in a very favorable position about the patient since we see him/her assiduously, and this allows us to inform him/her about good habits and, on the other hand, motivate him/her in each consultation.

We also need to inform patientwith metabolicic risk factors that we quantify their risk, for example, by using specific questionnaires such as the "Find risk." If we want to go a step further, we could even screen for this risk by using random blood glucose tests, or better yet, glycated hemoglobin, which will give us information about the patient's blood glucose control in the last 3-4 months. 

All this will allow us to refer patients with moderate/high metabolic risk to their family doctors so that they can diagnose a hypothetical pre-diabetes or diabetes and, in that case, the appropriate treatment. We should not forget that more than 40% of people with diabetes are unaware that they have it, and pre-diabetes, which usually has no symptoms, remains undiagnosed in almost 80% of people. Therefore, a previous screening in our consultations can allow an early diagnosis by your doctor and, consequently, improve the patient's quality of life and reduce complications.

Its vital tOur message must get we don't just talk about diabetes and its classic complications on that day. It's time to speak about periodontitis and the importance of treatment in helping control blood sugar.

In addition, patients with diabetes often celebrate their day with talks at their associations; these venues are also an essential target for getting these people's attention, reinforcing these ideas, and motivating them to take the step of going to a dental clinic to keep their gums healthy.