Educational Articles

Periodontal disease as major risk factor for systemic diseases (Part II)

Recent studies show that chronic periodontal disease may contribute to diabetes. While it has been established that people with diabetes have increased susceptibility to oral infections and are more prone to develop periodontal disease, new research is suggesting that periodontal disease may, in turn, be a risk factor for diabetes.

Periodontal disease can cause bacteria to enter the bloodstream and activate immune cells. These activated cells produce inflammatory biological signals (cytokines) that have a destructive effect throughout the entire body. In the pancreas, the cells responsible for insulin production can be damaged or destroyed by the chronic high levels of cytokines. Once this happens, it may induce Type 2 diabetes, even in otherwise healthy individuals with no other risk factors for diabetes.

Hyperlipidemia or high serum cholesterol, not impaired glucose tolerance, seems to be a significant risk factor for periodontal disease in diabetics. Therefore, lipid-lowering therapies, such as low-fat diets, lipid lowering drugs and exercise, are vitally important for diabetics who want to improve their quality of life, as well as their oral health. The same approach may also prove beneficial in non-diabetic patients with high cholesterol.

The presence of periodontal disease may aggravate glycemic control and increase the risk for vascular diabetic complications, including stroke, transient ischemic attack, angina, heart attack and heart failure. Several studies showed that control of periodontal infection through mechanical surgical and non-surgical therapy combined with systemic antibiotics may improve glycemic control and reduce the risk of diabetic complications. Management of diabetic patients includes frequent periodontal maintenance visits (every 3 months), relatively short and stress-free appointments, preferably in the morning, and a good communication with the treating physician. Antibiotics are not necessary for routine dental procedures in diabetic individuals, but may be considered in the presence of overt oral infections.

Periodontal disease and diabetes form a classic vicious cycle. Poorly controlled diabetics respond differently to bacterial plaque at the gum line and have more harmful proteins in their gingival tissue, causing destructive inflammation of the gums. In turn, beneficial proteins are reduced, interfering with the healing response to infection. In the presence of untreated periodontal disease, the same inflammatory mediators, released by bacteria, contribute to destruction of pancreatic cells and deregulate insulin production. Current research suggests that diabetics with periodontal disease should be treated to eliminate periodontal infection. Controlling periodontal disease may help control the course of diabetes.

The next step to determine for sure whether or not periodontal disease can cause diabetes is to perform clinical studies and intervention trials, which answer the question, when periodontal disease is treated, does the risk for diabetes decrease? Until we have results from intervention studies to better understand the role periodontal disease may play in diabetes, as well as heart disease, preterm births and respiratory disease, the best advice is for people to take excellent care of their oral health to help ensure they keep their teeth as well as maintain overall health.

Severe periodontal disease poses additional threat to pregnant diabetics. Recent study published in the Journal of Periodontology, compared type-I diabetic and non-diabetic women in their 20-39th week of pregnancy. Many women experience periodontal problems, such as bleeding and swollen gums, during pregnancy. But the more advanced periodontal disease was observed in pregnant diabetics, who are already considered high risk for pregnancy problems, may affect blood sugar control during critical time. Exacerbating the problem, periodontal disease may independently be a risk factor for preterm, low-birth weight babies. Periodontal disease may trigger increased levels of biological fluids that induce labor, and this response may be amplified in diabetics. This self-perpetuating destruction could potentially further complicate diabetic control and pregnancy outcome in diabetic subjects.

Past studies have shown that women with periodontal disease may have up to seven times more likely to deliver preterm low birth weight babies. Present research shows that the risk for women with generalized periodontal disease is even higher. While there is a definite dose response, the trend for preterm birth was observed in women with as little as two sites with attachment loss.

Current research vividly demonstrates just how connected our body's processes can be. Periodontal disease is a bacterial infection, and the infection may impact other parts of the body. Treating periodontal disease and reducing the bacterial load may benefit diabetic control as well as pregnancy outcomes. The recommendation of the American Academy of Periodontology is that all women considering pregnancy should have a periodontal evaluation and get any problems with their oral health under control before becoming pregnant. However, women who are already pregnant should not shy away from periodontal care. The safest time to perform any kind of periodontal treatment is in the second trimester. Periodontal evaluation should be routinely included in the care of diabetic patients. Prompt intervention and appropriate periodontal treatment may make a tremendous difference in your patients' health.

Presently, the major rationale for the treatment of periodontal disease is to prevent progression of the disease to preserve dentition. The above discussion points out the potential impact of periodontal disease on systemic health. An additional rationale for periodontal therapy is to prevent untoward effects on systemic health.

We hope this brief review of current research will be helpful to you. Please, do not hesitate to contact Dr. Carrie Berkovich with any questions regarding periodontal-systemic connection or to discuss any of your case. We look forward to helping you achieve great health and a beautiful smile!

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