Part Two, "The Link Between Oral Health and Over-All Health"-Diabetes

 This is part 2 of a fantastic series of articles explaining  the link between oral health and overall health. The article was written for dental professionals but really is great. So, please read through and remember to ask our team for any explanations that you may need.
Dr Brian Johnson

Diabetes and Dentistry

Diabetes mellitus (DM) is a relatively common metabolic disorder affecting approximately 10 percent, or 20 million Americans, with the incidence increasing. DM is a bi-directional disorder, affecting oral health and oral health affecting DM. Three primary types of DM are Type 1, Type 2 and gestational DM. Type 1 accounts for 10 percent and Type 2, 85-90 percent. Gestational DM occurs during pregnancy and in most cases resolves after childbirth.

Type 1 DM is generally diagnosed in childhood. Insulin deficiency is caused by autoimmune destruction of pancreatic beta cells. Onset and diagnosis occur rapidly, as symptoms of dehydration from hyperglycemia and ketoacidosis can lead to coma and death. Those with Type 1 DM require daily insulin injections. The body type for Type 1 DM is lean.

Type 2 DM was considered an adult disease, being diagnosed in overweight and obese adults over age 40. These traditional criteria are becoming blurred as more overweight young adults and children are being diagnosed. Insulin resistance precedes diagnosis of Type 2 DM. A confirmed diagnosis includes a defect in both the action and secretion of insulin. Diagnosis might be delayed for many years, until complications of DM are recognized. Type 2 DM is often controlled with diet and in some cases, oral medications.

Gestational DM may be a predictor of DM later in life, as 50 percent of those with gestational DM remain at risk of developing Type 2 DM later in life. Diagnosis of gestational DM provides an opportunity to initiate prevention strategies early.

 Periodontitis is a well-documented complication of diabetes mellitus (DM) and periodontitis might increase the risk of poor metabolic control. The subgingival microflora associated with periodontitis does not differ between those with and without DM, but those with DM have an exaggerated inflammatory response. In 1993, Dr. Löe proposed that periodontitis be considered the sixth complication of DM. The first five are: retinopathy, nephropathy, neuropathy, macrovascular disease and poor wound healing.

Those with DM have excess glucose in the blood due to a deficiency of insulin secretion or an increased cellular resistance to insulin actions. This leads to a variety of abnormalities involving fats, carbohydrates and proteins. One pathologic mechanism associated with excess glucose leads to the formation of advanced glycation end-products (AGEs). AGEs bind to receptor sites (RAGEs) on endothelial cells of the blood vessel walls and monocytes. These mechanisms are linked to the five identified complications of DM. This might also explain the link to periodontitis.

Periodontal inflammation dumps a variety of cytokines into the blood stream from oral tissues that travel to other areas and tissues of the body. These cytokines trigger an overall systemic immune response and antagonize insulin. In some cases, periodontitis is the first sign of DM. Thirty percent of those with Type 2 DM have yet to be diagnosed. Dentists and dental hygienists play an important role in the recognition of the early signs and symptoms of DM, often evident as periodontitis and poor healing following treatment.

 The author is Trisha O'Hehir, RDH, MS who is the Editorial Director at Hygienetown Magazine