Dr. Gautam Sharma
Presence of periodontal disease which is the disease of gums and supporting tissues of the teeth can dysregulate the glycemic control therefore complicating diabetes. The Periodontitis and Diabetes has two way relationship. Diabetes increases the risk for periodontitis, and periodontal inflammation negatively affect the glycaemic control. Periodontal disease negatively impacts quality of life affecting confidence, social interactions and food choices.
If a person bleeds during the brushing or biting on hard surfaces like an apple, recession of gingiva, presence of hard deposits on tooth surface, swollen gums and loosening of teeth then he must immediately report to a periodontist (a specialist doctor who treats diseases of gums and supporting tissues of teeth) for a consultation. Periodontitis does not cause pain in the initial stages and many patients remain unaware until the condition has progressed enough to result in tooth mobility. Majority of the patients who receive the treatment in the initial stage of the gum disease become completely healthy.
In majority of cases, the periodontal disease is caused due to bacterial infection. Initially, the margin of gums will look red, puffy and swollen to the patient. This is due to the adherence of a microscopically visible thin film known as plaque on the tooth surface. The film contains a lot of bacteria in its structure and if remains uncleaned changes into a hard structure called calculus which is visible to naked eye as yellowish-white deposits on the tooth. If this plaque and calculus remains undisturbed on a tooth structure then it may lead to further destruction of the periodontal tissues due to persistence of bacteria and response of the body to the microorganisms. Further, it may lead to formation of periodontal pocket and loosening or loss of tooth.
In non- diabetic individuals, periodontitis is associated with higher fasting blood glucose levels and glycated haemoglobin (HbA1c) , and severe periodontitis is associated with increased risk of developing diabetes. In people with type 2 diabetes, periodontitis is associated with worse diabetes complications. Both type 1 and type 2 diabetes mellitus are associated with elevated levels of systemic markers of inflammation. Treatment of periodontitis results in improved blood glucose levels.
People with diabetes are more prone to infections, including periodontal disease. Periodontitis is sixth complication of diabetes. Healing is also compromised in diabetes due to presence of excessive sugar or glucose in the blood. Diabetes is a major risk factor for periodontitis and the susceptibility to periodontitis is increased by approximately threefold in diabetics. The elevated inflammatory state in diabetes contributes to both microvascular and macrovascular complications, and hyperglycaemia can result in the activation of pathways that increase inflammation.
Periodontitis not only complicates diabetes control but it’s one of the most common contributors of atherosclerosis and thrombus formation, which causes cardiac complications. It can also complicate pregnancy, lung infection and kidney disease. Females suffering from periodontitis may have complicated pregnancy events and may give birth to low birth weight (LBW) and preterm babies having complications including cerebral palsy, impaired learning, vision and hearing difficulties, chronic health issues, psychological problems etc.
Keeping good oral hygiene by brushing twice daily using a soft-bristle toothbrush, regular flossing of the teeth and rinsing with an antibacterial mouthwash can help maintaining dental tissues in a healthy state. Brushing after dinner is mandatory which can help preventing the incidence of periodontal diseases and dental caries. Teaching and demonstrating children the correct technique of brushing the teeth at an early age by a dental expert can be highly beneficial as they will follow it for their whole life. Parents have to become the role model as children will follow their habits and if parents are following the good oral hygiene regimen then their children will automatically adopt it.
A simple and inexpensive procedure of oral prophylaxis by a periodontist can completely treat the gingival inflammation in an initial stage while the advanced cases may need surgical intervention. Removal of the plaque biofilm and the calculus from the tooth surface by oral prophylaxis decreases the bacterial load, hence the inflammation is reduced and therefore many systemic complications can be prevented. Everyone should visit a dentist in six months so that the dental problems can be detected at an early stage, treatment administered and damage to the dental tissues can be prevented. Many systemic diseases have their manifestation in the oral cavity and timely examination of dental tissues can help detecting the systemic disease including diabetes. One of the common manifestation of diabetes is multiple periodontal abscesses and sometimes the dental surgeon is the first one to detect that the patient is suffering from diabetes.
Oral health is a neglected area of health and promoting oral health should be taken into consideration while making policies for the general health because dental diseases are highly prevalent and are associated with significant morbidity. Dentistry is not expensive but ignorance is. Extensive damage to teeth and its supporting tissues need more expertise of the treating dentist, more resources and time, therefore the treatment cost escalates. Screening and early intervention can reduce this cost.
(The author is a Dental Surgeon, University of Jammu and Former President of Indian Dental Association, Jammu.)
Dr. Gautam Sharma