Type 2 diabetes is a global problem, one-tenth of the population presently suffer with it and the number is increasing. Projections are that 50% of the population will be affected by 2035!

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One major cause is obesity but there are also other shared risk factors for example high cholesterol, cardio vascular disease and periodontal disease.

A reverse association study carried out by the American Academy and European Federation of Periodontology revealed that early diagnosis of periodontal disease could reduce the risk of Type 2 diabetes.

A 22 year study of more than 500 high risk patients showed that those with the most severe periodontal problems at the start of the study were at a greater risk of developing diabetes in later life.

In addition, a cohort study of more than 500 high risk patients reported that those with severe to moderate periodontial disease had the highest risk of dying from cardio or renal complications than any other form of mortality.

Mechanisms connecting periodontitis and diabetes

Periodontitis is an inflammatory disease which leads to migratory tissue destruction caused by the post inflammatory immune response. Inflammation is characterised by the four cardinal signs of inflammation: redness, heat, swelling and pain.

The purpose of inflammation is to neutralise and remove micro-organisms and to restore normal function of the tissues. Prolonged or excessive inflammation leads to tissue damage that we recognise as periodontal disease.

“Periodontitis is characterised as a non-resolving inflammation that is ineffective at eliminating the initiating pathogens. It is a chronic persisting inflammatory state where the bacteria are never completely removed and where we have perpetuation of inflammation and tissue damage.”
(Lain Chapple – Periodontist)

When we experience bacterial infection a complex series of interactions take place involving a number of different cells and systems within the body. One critical group are called cytokines which play an important part within the body’s immune system; including being responsible for inflammation.

Different people respond differently to bacterial infection:

The inflammatory response differs, some people have a repressive response, that results in slight inflammation, some a normal response and some are highly responsive and therefore susceptible to periodontitis. This latter condition results in more tissue damage and a more advanced disease.
The ideal response is between the two extremes so that it is enough to combat the infection but not so much as to cause tissue damage.

This balance, or lack of it, is affected by environmental factors such as smoking, stress, nutrition and diabetes.

Diabetes is recognised as an inflammatory condition. Some inflammatory cytokines are found to be elevated in people with obesity and those with Type 2 diabetes.

Cytokines arise from adipose or fat storage tissue. Adipose tissue is not just a passive storage system for fat but an active endocrine organ; it secretes hormones that regulate appetite and metabolism. The higher the levels of adipose tissue the higher levels circulating inflammatory leptin.
The World Health Organisation calculates that 50% of Europeans are overweight and 20% are classified as obese. The situation is expected to worsen.

In conclusion studies confirm that diabetes is a risk factor for periodontal disease.

We know that severe periodontitis adversely affects glucose management in Type 2 diabetics and that severity of periodontal disease can predict the incidence of Type 2 diabetes.

Diabetes and periodontal disease are preventable and treatable as such dental professionals play an important part in educating patients as to risk in an effort to reduce an escalating health crisis.

Text copyright to Glenda May
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