In 2000, the U.S. Surgeon General report on Oral Health in America stated oral and dental diseases are the ‘silent epidemic’. The report stressed the importance of optimal oral health for general health and well-being. Periodontal disease is one of the most common diseases known to mankind. It includes:

  • Gingivitis – inflammation confined to the gingiva and is reversible with good oral hygiene
  • Periodontitis – chronic inflammation that extends beyond the gingival tissues and damages the supporting structures of the teeth (the periodontal ligament and alveolar bone)

According to the Centers for Disease Control and Prevention (CDC):  

  • 47.2% of adults 30 years and older have some form of periodontal disease (mild, moderate, or severe)
  • 70.1% of adults 65 years and older have periodontal disease
  • Periodontal disease is more common in men than women (56.4% vs 38.4%)

The classification of periodontal disease is complex and takes into account:

  • Clinical presentation
  • Age at diagnosis
  • Rate of disease progression
  • Systemic risk factors such as diabetes mellitus
  • Local risk factors such as poor oral hygiene
  • Hereditary factors and family history of periodontal disease   

 

Diabetes – a systemic risk factor for periodontitis

Diabetes mellitus is a growing health problem and its prevalence is dramatically increasing. In the United States, 30.3 million adults are living with diabetes. Approximately 84 million adults have prediabetes, though 90% of them don’t know it.

People with diabetes are more likely to have periodontal disease than people without diabetes. In fact, periodontal disease is often considered a complication of diabetes. Diabetics are at risk for severe periodontitis.

What is the pathogenic mechanism linking diabetes and periodontitis?

Periodontitis is a chronic inflammatory disease. The complex poly-microbial composition of the subgingival biofilm (dental plaque) stimulates a prolonged altered inflammatory response. This inflammatory response is characterized by unregulated secretion of host-derived mediators of inflammation such as cytokines. 

Inflammation is a central feature of the pathogenesis of diabetes and periodontitis. Both type 1 and type 2 diabetes mellitus are associated with elevated levels of systemic markers of inflammation. This contributes to both microvascular and macrovascular changes and cause periodontal tissue breakdown. 

Research shows the relationship between diabetes and periodontal disease goes both ways. Periodontal disease may also make it more difficult for diabetic individuals to control their blood sugar levels. The local production of cytokines in the periodontal tissues may effect insulin signaling resulting in poor glycemic control and increased risk for other diabetic complications.

How virtual care can improve periodontitis management in diabetic patients

Dentists are aware of the importance of a diabetic medical history in patients since various oral conditions are associated with diabetes such as xerostomia (dry mouth), candidal infections, and periodontitis. It is important all healthcare providers on a diabetic care team educate their patients about maintaining optimal oral health at home. Dentists can use teledentistry to educate patients about plaque control aids, flossing and brushing techniques, and antimicrobial therapy in between office visits.

In 2007, the World Health Organization acknowledged the link between oral health and general health and proposed an action plan to improve research, information systems, and oral health education. In a recent study, researchers indicated periodontitis may be a useful risk indicator for diabetes screening. Dentists have an important role to play in screening for prediabetes in patients with periodontitis. 

 

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Simitha Singh Rambiritch

Simitha Singh Rambiritch is a Dentist from South Africa with a Masters in Science in Oral Medicine and Periodontology from the University of the Witwatersrand (Wits). She was a clinician in the South African public and private sector and an oral medicine and periodontology lecturer for dental and oral hygiene students at the Wits School of Oral Health Sciences for almost 8 years. She also authored several publications in the South African Dental Journal. Simitha was the 2013 recipient of the Margot Lachmann Fellowship, for excellence in cancer research, with a focus on early diagnostic biomarkers in premalignant and autoimmune conditions and their conversion rate to oral cancer. She was invited to present her findings at the 9th International Congress on Autoimmunity in Nice, France.

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