From Our 2008 Archives

Gum Disease May Make Diabetes Worse

Researchers Say Good Oral Hygiene Is Important for Controlling Type 2 Diabetes

By Salynn Boyles
WebMD Health News

Reviewed By Louise Chang, MD

June 6, 2008 — Taking care of your gums may be one of the best things you can do for your health if you have diabetes.

Poorly controlled diabetes has long been recognized as a major risk factor for gum disease, but there is a growing body of research suggesting that untreated gum disease, in turn, makes diabetes worse.

"It is definitely a two-way street," says Stony Brook University professor of oral biology and pathology Maria E. Ryan, DDS, PhD. "If there is oral infection and inflammation, as with any infection, it is much more difficult to control blood glucose levels."

Ryan summarized the research on gum disease and type 2 diabetes in a symposium at the 68th annual scientific session of the American Diabetes Association (ADA) in San Francisco.

Many Unaware of Gum Disease-Diabetes Link

Ryan tells WebMD that health care providers who treat type 2 diabetes are only now beginning to recognize the importance of good oral hygiene for controlling the disease.

American Diabetes Association Vice President of Clinical Affairs Sue Kirkman, MD, agrees.

"This is definitely something the diabetes community needs to know more about," Kirkman tells WebMD. "It is now clear that periodontal disease can make diabetes control worse, and there is even some evidence that it increases the risk for diabetes complications."

Those complications include heart disease, blindness, kidney disease, and amputation.

Nearly 21 million Americans have diabetes, and it is believed that nearly a third have severe gum disease with significant loss of gum attachment to the teeth.

Bleeding gums are a sign of periodontal disease, but infection and inflammation often occur with no visible signs of trouble.

"[Gum] disease is often silent," Ryan says. "This is especially true for smokers, who often have significant inflammation with no bleeding."

In her presentation at the ADA meeting, Ryan reported on an unpublished study she conducted with colleagues from Stony Brook University suggesting a direct correlation between insulin sensitivity and severity of gum disease in people with prediabetes.

The suggestion from the study is that treating gum disease could actually slow down the progression to diabetes in those at high risk of developing the disease.

Previously reported research in a population of American Indians with very high rates of type 2 diabetes showed gum disease to be a strong predictor of death from diabetes or heart disease — independent of other risk factors.

Treating gum disease has also been shown to have a positive impact on blood sugar and diabetes control in other studies.

Doctors Should Ask About Teeth

So how does gum disease affect blood sugar control and diabetes?

One theory is that chemicals produced when gums are inflamed enter the bloodstream through the gums and stimulate cells to become insulin resistant, Ryan says.

Whatever the mechanism, Ryan says people with type 2 diabetes — and anyone at risk for developing the disease — should have regular dental exams.

And clinicians who treat people with diabetes need to keep gum disease on their radar screens.

"We aren't suggesting that physicians examine patients for oral disease because you can't really tell just by looking in someone's mouth," Ryan says. "But every diabetic should be asked if they have seen a dentist within the last year. If they haven't, they should definitely make an appointment."

SOURCES: American Diabetes Association 68th Scientific Session, San Francisco, June 6, 2008. Maria E. Ryan, DDS, PhD, professor of oral biology and pathology; director, clinical research, school of dental medicine, Stony Brook University. Sue Kirkman, MD, vice president of clinical affairs, American Diabetes Association. National Institute of Diabetes and Digestive and Kidney Diseases. Saremi, A. Diabetes Care, January 2005; vol 28. American Diabetes Association: "Total Prevalence of Diabetes & Pre-diabetes."

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