Diabetes and Oral Health Care

Diabetes and Oral Health Care

The Relationship between Diabetes and Gum disease/ Periodontal Disease has been extensively examined. The increased prevalence and severity of  Periodontitis (it is one kind of gum disease, due to this disease severe level of bone destruction and clinical attachment loss happened around the  teeth). In fact the American Dental Association in 2009 stated that for standards for medical care assessment of patient’s history of dental disease as part recommended medical history in Diabetic patient Evaluation. The better one’s oral health, the better diabetes control and vice versa.

Diabetes and Oral Health Care

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Usually, this  following questions are asked by patients :

1) Does the presence or severity of Gum or Periodontal Disease affect the metabolic state in diabetic patients ?

2) Does Gum/Periodontal  treatment aimed at  reducing bacterial challenge and minimizing inflammation have measurable effect on glycemic (Blood glucose ) Control?

3) What is the co-relation between Diabetes and Oral Health Care?

  • In Diabetic patients with Periodontis, Gum/Periodontal  treatment therap Periodontal treatments on  glycemic control .
  • It have been seen that  Gum /Periodontal treatment like (Scaling and Root planing, Periodontal flap Surgery) Using systemic Antibiotic  resulted in decreased insulin demand . In this way, Dental Treatment can create  significant improvement in Glycemic control in Diabetic Treatments .

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In a more recent case series evaluating scaling and root planing combined with Doxycycline therapy for 2 weeks . a small group of type 1 diabetic patients with improved oral health also had significant improvement in glycemic control. One another study , which was done in  type 2 diabetic patients, In this study poorly controlled Type 2 diabetic and severe Periodontitis  patients  had been given  Gum/Periodontal  treatment (Scaling and root planing  with  using systemic Doxycycline for 14 days.) Those treated with  Doxycycline  had a greater  reduction in the prevalence of P. gingivalis. In this study, all patients had significant improvements in Gum/Periodontal Status. It also demonstrated significant improvement  in glycemic control around 3 months after treatment, which gradually reverted to baseline levels  at 6 months .

It is well known that systemic inflammation plays a major rule in insulin sensitivity and glucose dynamics. Periodontal //Gum disease can induce an elevated systemic chronic inflammatory state as reflected in increased serum CRP, Inter Lukin -6  and fibrionogen levels seen in many people with periodontists. Inflammation induces insulin resistance and such resistance often accompanies systemic infections Systemic infections increase tissue resistance to insulin through a variety of mechanisms, preventing glucose from entering target cells , causing elevated blood glucose levels , and requiring increased pancreatic insulin production to maintain normoglycemia. Insulin resistance may persist for weeks or even months after  the patient has recovered clinically from their illness .

It is possible that chronic gram negative periodontal /gum infection may also result in increased insulin resistance and poor glycemic control. In patients with periodontitis, persistent systemic challenge with periodontopathic bacteria and their products may act to make well- recognized systemic infections. This mechanism would explain the worsening of glycemic control associated with severe Periodontists. Periodontal treatment/Gum treatment  designed to decrease the bacterial insult and reduce inflammation might restore insulin sensitivity over time , resulting in improved metabolic control.

 

 

Dr. Dipanjan Das (BDS, MDS)

Dental Surgeon & Consultant Periodontist and Oral Implantologist

 

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