Diabetic Teeth and Gum Problems

Both type 1 and type 2 diabetes mellitus (DM) are associated with a higher prevalence of periodontitis, an infection of the gums and the tooth-supporting bones and ligaments of the mouth. Its symptoms include redness, swelling, and pain around the teeth, in addition to loose teeth. The disease progression includes the development of plaques between the teeth and gums, infection of the gums (gingivitis) when bacteria multiply in the plaque, and finally destruction of the tissue supporting the teeth, eventually resulting in tooth loss. About 50 percent of the U.S. adult population may have gingivitis, manifested as bleeding gums, while at least 14 percent have moderate to severe periodontitis. Although infection with oral bacteria is necessary for periodontitis, other risk factors must be present for the disease to progress. Smoking and poorly controlled DM are its major modifiable risk factors. The National Health and Nutrition Examination Survey (NHANES) III found the prevalence of periodontitis to be 17.3 percent in adult diabetics compared to 9 percent in nondiabetics. Moreover, diabetics experience earlier and more severe periodontitis than non-diabetics, and diabetics with poorer glycemic control have worse periodontal disease than well-controlled diabetics. Studies have shown no difference between diabetics and nondiabetics, however, in their response rates to the treatment of periodontitis, which consists at first of mechanical scraping and antibiotic therapy such as tetracycline or doxycycline.

DM may increase the likelihood of periodontal infections for a number of reasons. The diabetic damage to blood vessels impairs oxygen delivery to tissues, which creates a favorable environment for the growth of certain bacteria. This vascular damage also impedes the delivery of immune cells, which already have decreased function due to DM, to sites of infections. Diabetics have impaired production of collagen, a necessary protein for proper tooth attachment. DM is also associated with a higher rate of xerostomia, or dry mouth due to decreased saliva production, which may promote the progression of infection in plaques.

An alternative or complementary explanation is that some individuals may have genetic predispositions to both DM and periodontitis. An interesting idea is that periodontal disease itself may worsen diabetes. Inflammatory molecules (cytokines) released from periodontal pockets of infection may interfere with insulin and glucose metabolism. There is evidence to suggest that periodontitis may worsen glycemic control in diabetics. Additionally, temporary improvement in glycemic control has been reported after treatment of periodontitis with antibiotics.

Good oral hygiene, including brushing, flossing, and routine dental care with the removal of plaque, is important for the prevention of periodontitis in diabetics and nondiabetics alike. Gingivitis usually responds to these measures also, but more advanced periodontitis may require the surgical removal of infected tissue. Systemic antibiotics like tetracycline or doxycycline may also be administered. As with most complications of DM, good glycemic control is important and may reduce the severity of periodontitis in diabetics.