Elizabeth Martinelli tells Stephanie Fsadni that dentists can spot whether a patient has diabetes and explains the link between the condition and gum disease.

Gum disease may result in tooth loss and make one’s diabetes harder to control.

A dental check-up may reveal much more than decay as the mouth is a gateway to our general health. Among others, it could show signs of eating disorders and poorly-controlled metabolic diseases, such as diabetes.

A dentist is in “an ideal position” to spot if patients have undiagnosed diabetes or whether they are at risk of developing the condition (pre-diabetes), says Elizabeth Martinelli, a specialist in periodontics.

“Many people with Type 2 diabetes are often undiagnosed,” claims Martinelli, who is a Type 1 diabetic.

“When someone visits a dentist, the dentist not only examines the patient’s mouth but they will also ask questions about their medical history and their lifestyle, including diet.”

From these questions the dentist might identify risk factors for diabetes such as finding out if the patient has a family history of diabetes, an increased BMI and a diet high in sugar.

“This information combined with findings of particularly severe forms of gum disease [periodontitis] without other explanations may lead the dentist to suspect that the patient may have undiagnosed diabetes. In these situations the dentist would inform the patients of their finding and advise them to see their medical doctor to be screened for diabetes.”

People with diabetes have a higher chance of getting gum disease (periodontal disease), considered one of the known complications of diabetes. Other symptoms of diabetes may be dry mouth, burning mouth, yeast infections of the mouth or poor healing of mouth wounds.

Gum disease is caused by plaque, which is the film of bacteria that builds up naturally on the teeth.

“If the film of plaque is allowed to build up over some days, it becomes quite organised and the more harmful sorts of bacteria start to predominate. As a reaction to this, the body tries to fight this infection and the gums become inflamed [gingivitis],” explains Martinelli.

“In some people, if the plaque is allowed to stay, this can lead to further problems resulting in the destruction of the bone and supporting gum of the tooth [periodontitis].”

Gum disease thus results in tooth loss. One may have gum disease if one has ever noticed: red, bleeding or swollen gums; pus from the gums; a foul taste; longer-looking teeth; loose teeth; increasing spaces between your teeth; or calculus (tartar) on your teeth.

“If you have noticed any of these problems, it is important to see a dentist as soon as possible. Gum disease may be present and get worse with no apparent symptoms to you, so even if you do not think you have gum disease now, you should still get regular dental check-ups as part of managing your diabetes,” Martinelli suggests.

Diabetes and periodontitis are both complex chronic diseases and a two-way relationship exists between them. Martinelli says: “Prolonged high blood sugar [hyperglycaemia] seen in some patients with diabetes is associated with poor gum [periodontal] health. But we also now know that severe gum disease [periodontitis] adversely affects blood sugar [glycaemic] control and complications in diabetic patients.”

The main scientific reason for this link is the way both diabetes and periodontal disease affect inflammation within the body.

“Before a person develops Type 2 diabetes, the levels of generalised inflammation within the body increase, leading to the decrease in the function of the insulin-producing cells with the pancreas and insulin resistance. Diabetes also drives the formation of AGEs [Advanced Glycation Endproducts], which promote inflammation, including the exaggerated inflammatory response seen in periodontal tissue destruction.

“Gum disease can also lead to increased inflammation levels – and oxidative stress – within the body, therefore providing a conceivable link for the effects of periodontitis on diabetes.”

Martinelli compares treatment of periodontitis to that of diabetes in that the problem is never fully fixed but is instead managed to reduce its effects on patients.

“The goal of periodontal treatment is to establish the right conditions in the mouth so that the remaining bone and gum attachment is preserved. Teeth with a reduced but healthy attachment may continue to function for several years.”

Treatment of gum disease

1. Advice and support for the patient to learn how to perform detailed daily tooth cleaning at home to efficiently remove the plaque from all accessible surfaces of the teeth. Generally this will involve a combination of tooth brushing and the use of interdental brushes to clean in-between the teeth. Mouthwash cannot be used in place of a good brushing and interdental cleaning regime.

2. Root surface debridement, which involves the complete and thorough cleaning of the teeth by the dentist or dental hygienist with the aim of removing the bacterial plaque and calculus deposits from the teeth, both above and below the gum line. To accomplish this painlessly it is usually necessary for the teeth and gums to be anaesthetised by means of injections, and the treatment may need two to six sessions to complete. Antibiotics cannot replace periodontal treatment.

3. If the treatment is successful then you will need to see your dentist or hygienist for regular cleaning as part of a programme of supportive periodontal therapy. This is important to prevent further disease from developing. If there are still some problems after initial treatment, then you may require further, more advanced treatment such as periodontal surgery.