Diabetes and Periodontal Disease--Part One: Overview

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Diabetes and Periodontal Disease

Part One–Overview

Periodontal, or gum, disease is one of the most prevalent diseases in America. The NIH (National Institute of Heath) and the AAP (American Association of Periodontists) report that over 50% of adults in the US suffer from the most severe form of periodontal disease, periodontitis.
And for people over 60 years of age that figure climbs to about 65%.

So, What Exactly Is Periodontal Disease?

It is defined as inflammation of the gingival tissues, gingival attachment (the fibers that attach the gum tissue to the tooth), the alveolar bone (the portion of the jaw bones that support the teeth), and the periodontal ligament (the ligament that connects the alveolar bone to the teeth). This inflammation is what makes periodontal disease especially dangerous for people with diabetes.

What Does Periodontal Disease Have to Do With Diabetes?

Studies have shown that adults with diabetes are three times more likely to have gum disease than those without diabetes. Also, the degree of hyperglycemia correlates to the severity of gum disease.

But it’s not just your teeth I’m talking about. Gum disease is a little-known but potentially deadly factor for diabetics:

  • Death from renal disease is three times more likely for diabetics with gum disease compared to diabetics without gum disease.

  • Death from cardiorenal disease (arteriosclerotic heart disease with kidney disease) is three times more likely for diabetics with gum disease than for diabetics without gum disease.

  • The degree of hyperglycemia correlates to the severity of gum disease

  • Diabetics who successfully treat gum disease lower their A1C on average by 0.4%

So, for diabetics, preventing and controlling gum disease is critical to remaining healthy, free of complications and ALIVE rather than dead. And it’s easy - a heck of a lot easier than a kidney transplant.

Help Me! I Don’t Wanna Die!

So now that you understand what periodontal disease is and how it has a profound effect on your diabetes and your general health as a diabetic, you might wonder how to prevent or treat periodontal disease. Not coincidentally, that is the topic for the next article.

From the NIH for all of the biochemists out there:

Schematic representation of the proposed two-way relationship between diabetes and periodontitis. Exacerbated and dysregulated inflammatory responses are at the heart of the proposed two-way interaction between diabetes and periodontitis (purple box), and the hyperglycaemic state results in various proinflammatory effects that impact on multiple body systems, including the periodontal tissues. Adipokines produced by adipose tissue include proinflammatory mediators such as TNF-α, IL-6 and leptin. The hyperglycaemic state results in deposition of AGEs in the periodontal tissues (as well as elsewhere in the body), and binding of the receptor for AGE (RAGE) results in local cytokine release and altered inflammatory responses. Neutrophil function is also altered in the diabetic state, resulting in enhancement of the respiratory burst and delayed apoptosis (leading to increased periodontal tissue destruction). Local production of cytokines in the periodontal tissues may, in turn, affect glycaemic control through systemic exposure and an impact on insulin signalling (dotted arrow). All of these factors combine to contribute to dysregulated inflammatory responses that develop in the periodontal tissues in response to the chronic challenge by bacteria in the subgingival biofilm, and which are further exacerbated by smoking
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Doc, I LOVED your write-up! It is more than critical to make people aware of this - I discuss these stats with my 12-year-old T1D son at least twice a month.

I feel the point you are making is one of the most important, and least internalized or acted upon for the diabetic community. So I would love to make your upcoming wiki posts as prominent as possible - in fact, I think we should even feature them on the website as well (not only on the forum).

As a scientist and an engineer, I had no problem reading and understanding it - in fact, your writing style is what I really enjoy reading, because there is nothing I like better than precise wording:-).

Is there a risk that it might be more difficult to understand by those who don’t have a scientific background? Should we possibly make the wording a bit easier? In fact, is there a way to make it more immediate, and to make people realize the danger in a more drastic manner?

For instance, I found this to be a particularly striking part of your article:

"Epidemiological data has confirmed that adults with diabetes are three times more likely to have periodontal disease than those without diabetes. Also, the degree of hyperglycemia correlates to the severity of periodontal disease.

But it’s not just your teeth I’m talking about. End stage renal disease is three times more likely in diabetics with periodontal disease than in diabetics who do not suffer with periodontal disease. Cardiorenal mortality is also three times more likely in diabetics with periodontal disease than in diabetics without periodontal disease. And diabetics who successfully treat their periodontal disease experienced an average 0.4% improvement in A1c."

Would it make sense to write this in a less scientific and possibly more dramatic manner, with more of a call to action? For instance something like this (it’s a quickie write, not a model but just an idea for the direction that I mean):

"Studies show that adult diabetics are three times more likely to have gum disease than those without diabetes. Gum disease is a little-known but deadly factor for diabetics:

  • Death from renal disease is three times more likely for diabetics with gum disease compared to diabetics without

  • Death from heart disease [I know, not quite exact here] is three times more likely for diabetics with gum disease than for diabetics without.

  • The degree of hyperglycemia correlates to the severity of gum disease

  • Diabetics who successfully treat gum disease lower their A1C on average by 0.4%

So, for diabetics, eliminating gum disease is critical to remaining healthy, free of complications and ALIVE rather than dead. And it’s easy - a heck of a lot easier than a kidney transplant."

Is this too dramatic? Personally, I’d love to see this as impactful as possible for someone he reads it for the first time - something that hits them in the gut. Or, possibly, another idea would be to have a scientific version and a vulgarized one?

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Michel, thank you so much for the critique. Your points, particularly on reading comprehension level, are well taken.

The way I write, and the way I speak to my patients, is under the assumption that they are pretty smart. I try not to use too many ten dollar words but sometimes it just gets away from me :nerd_face:.

I think your suggestions are spot on and I’ll make the changes. They will certainly make it a better article!

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I made the changes you suggested and it definitely makes it more readable and impactful.

I think that just the “vulgarized” version is appropriate. The chart and explanation from the NIH study should be enough scientific information for any geek who is interested. I don’t think for that crowd I would need to elaborate on cytokines and proinflammatory adipokines.

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heh - I really liked that part :slight_smile: I am that geek!

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@Michel
Michel, how do I make this article show up on the Diabedia Wiki? I already used the wrench icon to make it a wiki, but it doesn’t show up in the wiki category.

Thanks.

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If you look up at the top of the post, there is a pencil next to the title. It will allow you to edit both title and category :slight_smile: