When you think about diabetes complications what comes to your mind? I have asked this question in many of my presentations. I hear, heart disease, stroke, kidney disease or nephropathy, high blood pressure, eye damage or retinopathy, and foot problems or neuropathy. The one that is often forgotten is the sixth complication of uncontrolled diabetes, Periodontal disease.
Periodontal disease, also known as gum disease, is a serious infection of the gums that damages the soft tissue and destroys the bone that supports the teeth. This can lead to tooth loss. Periodontal disease is the most common oral disease affecting those with diabetes. There is a vicious cycle going on because periodontal disease causes the blood glucose levels to rise and this, in turn, worsens the periodontal disease and increases the chances of having complications of diabetes. Adults ages 45 or older with poorly controlled diabetes (A1C >9%) are three times more likely to have severe periodontitis than those without diabetes. People who smoke and have persistently elevated glucose levels have nearly a five times greater risk for developing periodontitis. About one third of people with diabetes have severe periodontal disease (bone loss greater than 50%).
Poor blood glucose control increases the risk for other disorders of the mouth such as xerostomia, tooth loss, dental caries and abscesses, oral candidiasis, oral lichen planus, and burning mouth syndrome. All of these can be prevented by having good glucose control. We need to remember to educate our patients with diabetes on good oral hygiene. Brushing teeth (whether real or false teeth) 2-3 times a day, using toothpaste that contains fluoride and flossing at least once a day. Routine dental appointments every 6 months or as directed will help with prevention or early detection of any oral health issues. Oral health and overall health are related. Periodontal disease is preventable. Good oral hygiene and regular dental exams are important steps in preserving good health.
Tammi Grumski, CRNP, BS, CDCES