There is a large history of medical research that draws a link between diabetes mellitus and periodontal disease. Essentially, the research has often proposed that diabetics are more likely to contract periodontal disease and develop more chronic symptoms than non-diabetics.
However, simply having diabetes is not enough to suggest a patient will be more susceptible and suffer more from periodontal disease. The duration of the disease, the number of diabetic complications and the control of the disease are the key factors in how likely it is that a diabetic will suffer from periodontal disease and how serious it will be.
Recent research has found that diabetics with good glycaemic control have displayed good levels of recovery, levels that are comparable to non-diabetic subjects.
What is Diabetes?
There are two types of diabetes:
- Type 1: Type 1 diabetes occurs when the pancreas is afflicted by B-cell destruction. This destruction leads to a complete immune deficiency.
- Type 2: Type 2 diabetes occurs as a result of a progressive insulin secretory defect. The subsequent state of hyperglycaemia and insulin resistance leads to an alteration of the B-cell function. As opposed to Type 1, which is often hereditary, Type 2, diabetes is linked to lifestyle factors such as obesity and alcohol consumption.
Both types of diabetes have been linked to periodontal disease and health in medical research. The following diabetic mechanisms have been described as increasing the rates of contracting periodontal disease and decreasing recovery rates:
The effect that diabetes has on the immune system has often been thought to be a causative factor in increased rates of periodontal disease in diabetics. Periodontal disease is a bacterial infection so a decreased immune response would make it easier for the disease to make its way into the gums and also make it more difficult to fight the disease once it has been contracted.
Gingivitis and the way Gram negative bacteria are dispersed around the mouth are key causative factors in the contraction of periodontal disease and both of these have been found to be more prevalent in diabetic subjects. Increased glucose levels in the Gingival Crevicular Fluid of diabetic patients could also create an environment that makes it easier for the harmful pathogens to grow.
It’s worth noting however that other studies have shown that the difference in microflora between diabetic and non-diabetic populations is so minimal that it is unlikely to be a major factor in the contraction and control of periodontal disease.
Effect of Diabetes On The Healing Process
Periodontal disease is a chronic disease, which means that the inflammation and the repair process occur simultaneously. Creating the proper balance between the repair and inflammation is essential in recovery.
Studies on rats have shown that the presence of diabetes inhibits the wound healing process, this combined with the fact that diabetes inhibits the immune response means that diabetic patients may require more intensive and long-lasting treatment than a non-diabetic patient would.
Diabetes and Periodontal Therapy
The general consensus is that diabetics experience the same outcomes from non-surgical and surgical periodontal therapy as a non-diabetic patient does. The only difference is that disease recurrence, or pocket rebound, may be more prevalent. The impact the diabetes has on immune response and wound healing also means that diabetic patients may face greater post-surgery complications than a non-diabetic would.
While the research varies greatly regarding diabetes and periodontal disease contraction levels there is strong evidence to suggest that a diabetic will be more likely to suffer from disease recurrence. However, the control of diabetes has a strong influence on how likely it is that the disease will recur.
The link between diabetes and increased rates of periodontal disease contraction is unclear. It does seem clear however that diabetes can influence the treatment and recovery process and glycaemic control is imperative in successfully treating periodontal disease.
Despite the effect that diabetes has on recovery diabetics can recover from periodontal disease if a holistic approach to treatment is taken. That means dentists and dental surgeons treating diabetics need to contact the patients treating doctor to gain an understanding of the length and severity of the diabetes. The length and severity should then be the first things that are taken into account when the treatment plan is formulated.
If you have diabetes and are worried about your dental health contact dHealth Dentistry today. Our holistic approach to dentistry will ensure that all of your medical history is taken into account before we commence with a treatment plan, so you get a plan that works for you and gets you on the path towards health.