Periodontal disease affects the gums and the bone that holds your false teeth. In advanced stages, this damage leads to painful chewing problems and even tooth loss. It is an infection, but it is not infectious. The actual damage is caused by the body’s reaction to bacteria in the mouth. In some cases, patients’ bodies react violently to these bacteria, producing gingivitis and periodontitis. Periodontal disease can be associated with other diseases and can be considered a window of observation for the patient’s general medical condition.

Type 1 diabetes: insulin-dependent

o Present in children and young adults with a genetic susceptibility
o Islets of Langerhans in the pancreas are attacked by antibodies and disappear
o Cells cannot feed because insulin is needed for glucose to enter the cell Acidosis develops
o Kidneys remove too much glucose from the blood, which leads to dehydration and then death
o Insulin injections are needed

Type 2 diabetes: a disease of obesity

o Present in adults
o Pancreas cannot produce enough insulin
o Body becomes immune to insulin
o Controlled with diet or pills

What is the link between diabetes and periodontal disease?

Diabetic control

Like other complications of diabetes, gum disease is linked to diabetic control. People who do not have good control of their blood glucose levels suffer more severe gum disease, more often and lose more teeth. In fact, people whose diabetes is well controlled do not have more periodontal disease than people without diabetes. Children with insulin-dependent type 1 diabetes are also at risk of gum problems.

Blood vessel changes

Vasodilatation is a complication of diabetes that can increase the risk of gum and periodontal disease. Blood vessels carry oxygen and nutrients to body tissues, including those in the mouth, and take up waste products produced by the tissues. Diabetes causes the blood vessels to thicken, which slows down the flow of nutrients and the removal of harmful debris. This can weaken the resistance of gums and bone tissue, leading to infections.

In recent years, vitamin D deficiency has been linked to type 2 diabetes and heart disease, which generally occur simultaneously and are the most common cause of illness and death in Western countries. Both diseases stem from chronic inflammation, which causes insulin immunity and forms the basis of plaque that blocks arteries. Now, a study in guinea pigs at Washington University of Medicine in St. Louis suggests that vitamin D plays an important role in preventing the inflammation that causes type 2 diabetes and atherosclerosis. In addition, the way basic immune cells behave without adequate vitamin D could provide scientists with new therapeutic approaches for patients with these conditions.

Inadequate vitamin D also turns immune cells into fat transporters. Thus, researchers could better understand how diabetes and atherosclerosis are connected, generating new therapy options.

Vitamin D has been shown to lower blood glucose levels in guinea pigs, making them more sensitive to insulin. This may play a role in combating insulin immunity.

Several clinical trials on type 2 diabetes are underway, treating them with vitamin D to see if it can prevent some complications and inflammation in people. It could have a role in controlling periodontitis by creating a more effective immune system.
The function of the kidneys to activate vitamin D is up to 30% weaker in patients over 50.

Supplements are now recommended for all patients, especially in winter and permanently for those living in northern Europe where the sun’s power is low.

Patients over the age of 50 are advised to check their body’s vitamin D levels.

Source: Jisu Oh, Amy E. Riek, Isra Darwech, Katsuhiko Funai, Jiansu Shao, Kathleen Chin, Oscar L. Sierra, Geert Carmeliet, Richard E. Ostlund Jr., Carlos Bernal-Mizrachi. Deletion of the macrophage vitamin D receptor causes insulin immunity and monocyte cholesterol transport, which accelerates atherosclerosis in guinea pigs. Cell Reports, 2015 DOI: 10.1016/j.celrep.2015.02.043

Good diabetes control is the best protection against periodontal disease.

Studies show that the risk of diabetes complications, such as eye and heart disease or nerve damage, can be lowered by controlling blood glucose levels. Scientists say that good diabetes control can prevent many complications, including gum disease.

Bacteria

Many types of bacteria thrive on sugars, including glucose – the sugar linked to diabetes. When diabetes is not well controlled, high levels of glucose in saliva encourage the growth of bacteria and create the conditions for gum disease.

Smoking

The harmful effects of smoking, especially heart disease and cancer, are well known. Studies show that smoking also increases the chances of developing gum and periodontal disease. In fact, smokers are 5 times more likely to suffer from gum disease than non-smokers. For smokers with diabetes, the risk is even higher. If you are a smoker with diabetes, aged 45 or older, you are 20 times more likely to suffer from severe gum disease.

And if diabetes influences periodontal disease, the reverse is true…
Periodontal disease affects diabetes and makes it harder to control.

Summary

The severity of periodontal disease can be a measure of general medical condition and is relevant to diabetes and its complications.

A healthy mouth improves blood glucose control, which in turn prevents diabetes complications.