A risk factor for gingivitis and periodontitis is diabetes mellitus. Several studies conclude that glycemic control in diabetic disease is a variable in the onset and progression of periodontal disease. The patient’s immunoinflammatory response influences the prevalence and severity of periodontitis, rather than the pathogenic bacteria present.
Diabetic patients have altered function of some immune cells, which increases the production of inflammatory mediators. These mediators are also present in the gums, which can increase inflammation, as well as attachment and bone loss. Changes also occur in the synthesis and maturation of collagen, which degrades and affects the healing of the periodontium, contributing to its destruction.
Symptoms of periodontitis in patients with diabetes mellitus
Patients diagnosed with diabetes mellitus are therefore at increased risk for periodontal disease. This has two main consequences: the possibility of tooth loss and poorer control of diabetes.
The symptoms that alert to the possibility of suffering periodontitis if you are diabetic are:
- Reddened, bleeding and/or swollen gums.
- Suppuration
- Bad taste in the mouth
- Longer teeth, in appearance
- Mobility or spaces between teeth
- Tartar or calculus accumulation
- Dry mouth
- Burning sensation
- Fungal infection
- Poorer wound healing
Association between periodontal disease and diabetes
On the other hand, chronic inflammation due to periodontal disease has, in turn, an impact on:
- Glycemic control
- Complications of diabetes (cardiovascular, cerebrovascular or peripheral vascular alterations)
- The function of the beta cells of the pancreas
- Insulin resistance
- Future development of type 2 diabetes
Also, although the association for both diseases is emerging for type 1 diabetes and low for gestational diabetes, there is evidence of an association between periodontitis and type 2 diabetes. This means that patients with advanced periodontitis suffer an increase in glycosylated hemoglobin (HbA1C) in type 2 diabetic patients and even in non-diabetic patients. In addition, it is possible that periodontitis initiates or increases insulin resistance in the same way that obesity does, resulting in poorer blood glucose control.
Treatment of periodontitis in patients with diabetes mellitus
Regular dental check-ups by the dental expert are recommended as part of diabetes management, as well as careful dental and gum hygiene at home, for good maintenance of oral and systemic health.
It has been shown that after 3 months of scaling and root planing treatment, there is an average reduction in HbA1C of 0.36%. These short-term glycosylated hemoglobin reduction levels are equivalent to adding a second drug to the treatment of diabetes, making mechanical treatment a treatment of choice. Type 2 diabetic patients would, in these cases, follow mechanical treatment and good oral hygiene follow-up. Patients with poorer glycemic control could, on the other hand, have a higher recurrence of the disease and a less favorable response to long-term treatment.