If you're worried that "I'm trying my best with diet and exercise to control my blood sugar levels, but I'm not sure if it's enough," are you brushing your teeth properly?
For people over 40 who are starting to worry about their health, both diabetes and periodontal disease are familiar issues. Although diabetes and periodontal disease may seem unrelated, it has been found that they are closely related, forming a "two-way vicious cycle." Not only are people with periodontal disease more likely to develop diabetes, but it has also been pointed out that treating periodontal disease in people with diabetes may improve their blood sugar levels.
In this article, we will explain the "inseparable relationship" between diabetes and periodontal disease, and convey the importance of oral care that also helps control blood sugar levels.
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Diabetes and periodontal disease: a two-way vicious cycle
Diabetes and periodontal disease have a mutually detrimental relationship. Let's look at this from two perspectives: the mechanism by which diabetes worsens periodontal disease, and the mechanism by which periodontal disease worsens diabetes.
Mechanism 1: Diabetes worsens periodontal disease
People with type 1 diabetes have a higher incidence of periodontal disease than healthy people, and even people with type 2 diabetes with an HbA1c level of 6.5% or higher are known to be at a higher risk of developing periodontitis and the loss of the bone that supports the teeth (alveolar bone).
The main causes are hyperglycemia itself, but specifically:
- Increased proportion of sugar-loving bacteria
- Dysfunction of neutrophils in migration, phagocytosis, bactericidal functions, etc. occurs
- Advanced glycation end products produced by hyperglycemia alter the functional matrix of important periodontal tissue components such as collagen and laminin, making them fragile.
- High blood sugar can lead to dehydration, which can lead to dry mouth, impairing the self-cleaning function of saliva and making inflammation more likely.
High blood sugar has a negative effect on both the oral environment and the body's defense system, creating an environment in which periodontal bacteria can easily grow and making it difficult to suppress infection.
source:Diabetes Treatment Guidelines 2024 | Chapter 16: Diabetes and Periodontal Disease
Mechanism 2: Periodontal disease worsens blood sugar levels
Conversely, there is also a mechanism by which periodontal disease worsens diabetes. If severe periodontal disease is left untreated, it can worsen blood sugar control (HbA1c). A study that followed 2,973 non-diabetic patients conducted in the Pomeranian region of Germany found a significant correlation between the severity of periodontal disease and worsening HbA1c. The correlation was particularly pronounced in those with high levels of CRP, an indicator of inflammation in the body.
This is thought to be because periodontal disease is a mild chronic inflammatory disease. It is speculated that inflammatory substances (such as cytokines) produced in the gums by periodontal disease travel throughout the body via the bloodstream, interfering with the action of insulin (insulin resistance), and ultimately worsening the body's ability to lower blood sugar levels (glucose tolerance).
source:Diabetes Treatment Guidelines 2024 | Chapter 16: Diabetes and Periodontal Disease
source:Periodontal Status and A1C Change: SHIP Study
Treating periodontal disease improves blood sugar control
The "two-way vicious cycle" between diabetes and periodontal disease also means that treating periodontal disease can be expected to have a positive effect on blood sugar levels. In fact, the Japan Diabetes Society's guidelines state that periodontal treatment for type 2 diabetes patients is "Recommendation Grade A (strongly recommended)" because it is effective in improving blood sugar control.
It is believed that stopping gum inflammation through periodontal treatment reduces inflammatory substances that interfere with insulin action, resulting in improved insulin resistance and better blood sugar control.A meta-analysis of multiple studies found that periodontal treatment statistically significantly improved HbA1c by 0.36%.
Not all papers agree on this, but there are several reports that periodontal treatment is effective in improving HbA1c, so it is believed that there are some patients for whom periodontal treatment is effective.
source:Diabetes Treatment Guidelines 2024 | Chapter 16: Diabetes and Periodontal Disease
source:Japanese Society of Periodontology | Periodontal Treatment Guidelines Revised 2nd Edition 2014
Oral Care for Diabetics | Practical Guide
What specifically should people with diabetes (or those at risk) do to break the vicious cycle of diabetes and periodontal disease?
The key is to balance self-care with professional care.
- Regular dental checkups
- Proper daily tooth brushing using dental floss and interdental brushes
- A balanced diet and moderate exercise
People with diabetes are at higher risk of periodontal disease, so even if you have no symptoms, it is recommended that you have a dental checkup every six months. Having your teeth professionally cleaned can help detect and treat the disease early.
Brushing your teeth carefully with fluoride toothpaste is the foundation of self-care. It is especially important to care for the spaces between your teeth, where dirt is difficult to remove with just a toothbrush. Be sure to also use dental floss or an interdental brush to thoroughly remove plaque.
A balanced diet and moderate exercise are important not only for blood sugar control but also for preventing periodontal disease.
summary
Diabetes and periodontal disease have a "two-way relationship" that negatively impacts each other. Blood sugar control through internal medicine and oral care through dentistry are not sufficient on their own. They are like the "two wheels of a car," and it is important to advance both simultaneously. Why not consider "gum health" as an important part of blood sugar control and start reconsidering your dental care today?