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                                                        DR. DAN PETERSON

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DIABETES AND GUM DISEASE

Gum disease is linked to diabetic control

Gingivitis-Causing Bacteria
"The treatment of certain oral conditions, in particular periodontal disease, has been reported to improve metabolic control in diabetic patients."*

      Like other complications of diabetes, gum disease is linked to diabetic control. People with poor blood sugar control get gum disease more often and more severely, and they lose more teeth than do persons with good control.  Diabetes can cause blood vessels to thicken and become less elastic which decreases the flow of oxygen and nutrients to body tissues and slows the removal of harmful waste. So if your blood sugar levels are not under control the sugar or glucose levels in your salvia increase and feed the bacteria in your mouth and set the stage for gum disease.

     In fact, people whose diabetes is well controlled have no more periodontal disease (infections of the gum and bone) than persons without diabetes. Children with insulin-dependent diabetes mellitus are also at risk for gum problems

     Thickening of blood vessels is a complication of diabetes that may increase risk for gum disease.  Diabetes causes blood vessels to thicken, which slow the flow of nutrients to the mouth and slows the removal of harmful wastes away from the mouth.

     When diabetes is poorly controlled, high glucose levels in mouth fluids may help germs grow and set the stage for gum disease.

     Smoking increases the risk for gum disease.  If you are a smoker with diabetes, age 45 or older, you are 20 times more likely than a person without these risk factors to get severe gum disease, bone loss and tooth loose!

Manifestations of Diabetes with undiagnosed or poorly controlled diabetes may include:

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Extensive gum disease

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Tooth loss

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Poor wound healing

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Oral diseases

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Oral infections

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Dental Caries

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Pain in the tongue

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Dry mouth

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Burning mouth

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Taste and salivary dysfunction

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     Treatment of periodontitis (gum tissue) depends on how much damage the disease has caused.  In the early stages, the dentist will use deep cleaning (Scaling and Root Planing) to remove hardened plaque and infected tissue under the gum and smooth the damaged root surfaces of teeth.  This allows the gum to re-attach to the teeth.  A special mouthrinse or antibiotic might also be prescribed to help control the infection.

Deep cleaning -Scaling and Root Planing-is successful only if the patient regularly brushes and flosses to keep the plaque from building up again.

     Periodontal or gum surgery may be needed when gum disease is very advanced and the tissues that hold a tooth in place are destroyed.  The dentist will clean out the infected area under the gum, then reshape or replace the damaged tooth-supporting tissues.  These treatments increase the chances of saving the tooth.

          If you have diabetes....

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It is important for you to know how well your diabetes is controlled and to tell your dentist this information at each visit:
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Tell them current symptoms.

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Frequency of  low blood sugar episodes

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Medications used, dosage and frequency.

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When your last meal before the appointment occurred and the type of carbohydrate consumed.

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How often you have glucose testing and what your latest lab and self monitored glucose levels were.

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Any changes you have notice in your mouth since the last appointment.

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See your doctor before scheduling treatment for periodontal disease.  Ask your doctor to talk to the dentist or periodontist about your overall medical condition before treatment begins.

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You may need to change your meal schedule and the timing and dosage of your insulin if oral surgery is planned.

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Postpone non-emergency dental procedures if your blood sugar is not in good control.  However, acute infections, such as abscesses, should be treated right away.

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Try 20mg Doxy BID or Periostat

For the person with controlled diabetes, periodontal or oral surgery can usually be done in the dentist's office. Because of diabetes, healing may take more time. But with good medical and dental care, problems after surgery are no more likely than for someone without diabetes.

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News Updates on Gum Disease and Diabetes

Diabetes and Gum Disease

Yet again dentists find themselves on the front lines of a larger medical front. Dentists are  well positioned to help prevent and combat the complications of diabetes. Treating gum disease in diabetic patients can help them keep their diabetes under control. Evidence of this was noted by Dr. Sebastian Ciancio in an April 2004 Dental Practice Report article, "A conversation with Dr. Sebastian Ciancio."
http://www.dentalproducts.net/xml/display.asp?file=2351

"We have data that shows if patients are diabetic and we treat their periodontal disease, their diabetes improves markedly," Dr. Ciancio observed.

Plus, the American Diabetes Association Web site flatly states: "Gum disease can make diabetes harder to control." http://www.diabetes.org/type-2-diabetes/mouth-care.jsp

Dentists can be among the first to urge patients to get tested for the chronic disease. As a dentist may be the first health- care professional to suspect a patient has diabetes, dentists can order appropriate tests or refer patients to physicians to be tested.

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Type 2 Diabetes and Gum Disease Increases Risk of Death by Three Times

A recent study suggest people with type 2 diabetes should be be certain they are taking excellent car of their teeth and gums.  According to a study published in the journal Diabetes Care on the effects of periodontal disease on mortality, people with severe periodontal disease had more than THREE TIMES the risk of dying of cardiac or renal disease. Johns Hopkins Medical Letter Vol. 17, Issue 2 pg 1 April 2005

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The American Diabetic Association now defines Type 1 DM (less common) and Type 2 DM (most common) based on the disease etiology. These "types" are defined by impaired glucose tolerance, impaired fasting glucose, and include gestational diabetes.

What's the relationship between DM and periodontal disease? Numerous studies have demonstrated that:

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Individuals with more advanced systemic complications from DM usually have a higher frequency of periodontal disease...and it is not because these individuals have more plaque and calculus.

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In study after study, those with poorly controlled DM - both Type 1 and Type 2 - have greater bone loss and more missing teeth than well-controlled individuals.

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Furthermore, uncontrolled diabetics were at risk for progressive periodontal problems including frequent dental infections and experienced poor healing.

The dental consequence of having DM is clear:

  1. make certain that your periodontal condition is treated and well-maintained. One reason for this is that the presence of advanced periodontal disease and dental infections may increase insulin resistance and contribute to a worsening of the diabetic state.
  2. It is possible for dental infections to become life-threatening to an uncontrolled diabetic.

Diabetics should take heart. As their dental problems are cared for, their glycemic control improves. As their diabetic condition comes under control, their dental problems can more easily be treated. It has been established that a well-controlled diabetic experiences the same short-term responses to periodontal therapy as non-diabetic individuals. While procedures rendered to diabetic individuals should be of shorter duration and less traumatic so as not to stress their systems, well-controlled diabetics can expect to receive "normal" care for all their dental needs, including periodontal surgeries and dental implants

Committee on Research, Science and Therapy of the American Academy of Periodontology. J Perio 71:664-678, 2000

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In-dental-office screening for diabetes mellitus 

     Diabetes mellitus (DM) is undiagnosed in approximately half of the patients actually suffering from the disease. In addition, the prevalence of DM is more than twice as high in patients with periodontitis. Thus, a high number of patients with periodontitis may have undiagnosed DM.
     During routine periodontal examination bleeding gums is a sign of periodontitis.  This blood may be used for diabetes mellitus screening
in a dental office setting.

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Serious Oral Infections May be Associated with Diabetes

     According to the Journal of Prosthetic Dentistry, diabetics have a increased vulnerability to bacterial and fungal infections and an increased risk for the development of periodontal disease, which in turn can adversely affect control of blood sugar levels.  Diabetes may:

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increase the resorption of bone in gum disease

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initiate pocket formation

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cause development of oral candidiasis

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cause development mucormycosis, fungus infection

Oral hygiene measures should be initiated early to prevent the development of gum abscesses, which are particularly susceptible to fungal invasion.**
** Journal of Prosthetic Dentistry, Vol. 86, No 6, December 2001

Once the periodontal infection is successfully treated, it is often easier to control blood sugar levels.

Good diabetic control is the best protection against gum disease!

Resources

Detection and Prevention of Gum Disease in Diabetes.

February 06, 2008

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              (information provided by the National Oral Health Information Clearinghouse)

Improving Awareness and Dental Care of the Diabetic patients. Dr. Gehrig and Daniels PPAD Vol 16, No.1 pg 84-87, 02/04
*Diabetes Mellitus and Oral Disease, Ponet, Tabaj, Maglione, Melato, Acta Diabetologica, Volume 38, Issue 2 2001 pg 57-62.
**Journal of Clinical Periodontology; Volume 29 Issue 3 Page 216 - March 2002. Beikler, A. Kuczek, G. Petersilka and T. F. Flemmig

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          If you have any questions please e-mail me at: drdpeterson@scottsbluff.net
                                                                                 308-436-3491 Office number

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