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

 Diabetes and oral health go hand in hand

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

The relationship between diabetes and oral health is dangerous friendships. They have a lot 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 is going to 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 have a positive impact on 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.

The patient with diabetes, especially if it is not controlled, has a greater predisposition to suffer from periodontitis and for it to evolve more quickly. In addition, the elevation of glucose not only occurs 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 also 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, especially advanced, have an increased risk of suffering from the incidence of diabetes in the following years, about those who do not have periodontitis or have it in its more initial phase. 

Once diabetes has been diagnosed, it is important to know that poor oral hygiene influences the control of the disease. Today we know that patients with diabetes and periodontitis are at increased risk for diabetes-related complications. Evidence is important regarding retinopathies, cardiovascular diseases, and nephropathies. There are even studies that 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, not only in the blood but also in the periodontal tissues, of pro-inflammatory 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 as a consequence.

In the other direction, as a consequence of periodontitis, there is an elevation of pro-inflammatory cytokines in periodontal tissues, such as IL1beta, IL6, or TNFalpha, but also in the bloodstream, along with elevations 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, as it is also 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 very good oral hygiene. This implies not only having a good toothbrush but also interdental, by using interdental brushes and/or dental floss. During this year 2020, a large epidemiological study has been 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, the use of an interdental brush, and eventually, the use of an antiseptic mouthwash are good weapons to prevent the appearance of 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 important factor not only in avoiding the loss of teeth but also in 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 to diabetes. Here we can include tobacco, overweight/obesity, inactivity, diets rich in refined sugars and saturated fats, etc. And we can influence this from our consultations. 

Something we should all include in our oral health team is 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, to motivate him/her in each consultation.
It is also important that we inform patients who have metabolic 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 doctor so that he or she can make the diagnosis of 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, as a consequence, improve the patient's quality of life and reduce complications.

November 14 world diabetes day

It's important that our message gets through and that we don't just talk about diabetes and its classic complications on that day. It's time to talk about periodontitis, too, and the importance of treatment in helping to control blood sugar.

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