Gum Care Helps Control Type 2 Diabetes and Its Complications

SATURDAY, June 7 (HealthDay News) -- People with type 2 diabetes can help control the disease by taking better care of their teeth and gums.

That's the case dentists were expected to make at the American Diabetes Association's annual meeting in San Francisco this weekend.

"Several recent studies have shown that having periodontal disease makes those with type 2 diabetes more likely to develop worsened glycemic control, and puts them at much greater risk of end-stage kidney disease and death," George W. Taylor, an associate professor of dentistry at the University of Michigan schools of Dentistry and Public Health, said in a prepared statement. "Given the numerous medical studies showing that good glycemic control results in reduced development and progression of diabetes complications, we believe there is the potential that periodontal treatment can provide an increment in diabetes control and subsequently a reduction in the risk for diabetes complications," he said.

Intensive periodontitis intervention, for example, can significantly lower one's levels of A1C, a measure of long-term glucose control.

"We have found evidence that the severity of periodontal disease is associated with higher levels of insulin resistance, often a precursor of type 2 diabetes, as well as with higher levels of A1C," dentist Maria E. Ryan, director of clinical research at the Stony Brook University School of Dental Medicine in New York, said in a prepared statement.

Periodontal, or gum, disease is an infection and chronic inflammatory disease of the tissues surrounding and supporting the teeth. As it is painless, most people don't know they have it, yet it is a major cause of tooth loss in adults.

Among the studies to be discussed linking gum disease and diabetes are:

• A 1988-1994 U.S. population data study that found having periodontal disease put a person at twice the risk of having insulin resistance as those without such disease.
• An unpublished Stony Brook University study of people displaying pre-diabetic insulin resistance that links the severity of a periodontal disease with their degree of insulin resistance. "We think periodontitis may adversely affect glycemic control, because the pro-inflammatory chemicals produced by the infection -- such as IL-1 beta, IL-6 and TNF-alpha -- could transfer from the gum tissue into the bloodstream and stimulate cells to become resistant to insulin," Taylor said. "Then insulin resistance prevents cells in the body from removing glucose from the bloodstream for energy production."
• A set of studies of the Pima Indians in the Southwest, a population with a very high rate of type 2 diabetes. One found those with periodontitis were more than four times as likely to develop worsened glycemic control; another showed that those with severe gum disease had more than triple the risk of dying from diabetic nephropathy or ischemic heart disease than those with less severe periodontal disease.
• A study, funded by the National Institutes of Health, that found a "statistically significant reduction" in A1C levels in people with type 2 diabetes after 15 months after routine periodontal treatment, Taylor said.

"When glycemia has been difficult to control, the physician might consider asking patients when they last saw their dentist, whether periodontitis has been diagnosed and, if so, whether treatment has been completed," Ryan said. "A consultation with the dentist may be appropriate, to discuss whether periodontal treatment has been successful or whether a more intensive approach with oral or sub-antimicrobial antibiotics is in order because, just as it is difficult to control diabetes while the patient has an infected leg ulcer, the same applies when there's infection and inflammation of the gums."

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