Gum disease and Diabetes

Gum is the pink-red tissue attached to and surrounding the necks of teeth and adjacent bone. Healthy gums are pink, stippled and tough and have a limited sensibility to pain, temperature and pressure. They are like a collar around the tooth. They have a rich blood supply.Gum disease explainedGum disease is an infection by germs (bacteria) in the gums around the teeth. It is one of the most common infections in people around the world. Gram-negative bacteria gather in the plaque around the teeth and cause inflammation in the gums. This is known as gingivitis. If left untreated this infection increases and affects the underlying bone as well. The attachment loss deepens the sulcus creating pockets that contain millions of bacteria; this stage is the transition between gingivitis that is gingival infection and periodontitis that is an infection of the gums and its underlying structures. The gums and bone around the teeth dissolve over time making the teeth lose, ultimately leading to tooth loss. This condition is now called periodontitis.Periodontitis affects about 50 per cent of all adults and about 85 per cent of people over the age of 65 years.Gum and DiabetesDiabetes is marked by increased blood sugar levels occurring due to the defective activity of insulin. The complications in Diabetes are caused by consistently high levels of sugar or glucose in the blood.Diabetes affects all organs. The oral manifestations include delayed wound healing, xerostomia or dry mouth as well as increased risk of gum and periodontal disease. Periodontitis has been called as the sixth complication of Diabetes. Diabetes affects all periodontal parameters like:bleeding scoresprobing depthsloss of periodontal attachmentloss of teethPeople with Diabetes and poor sugar control can experience microvascular as well as macrovascular complications.Microvascular complications include damage to the eyes, kidneys, and nerves. Macrovascular complications mean damage to the blood vessel walls throughout the body, this is called atherosclerosis. This atherosclerosis is the cause of further organ damage (including damage to the oral cavity) Most complications occur due to affected blood vessels which in turn affect the blood supply to different body parts.Dental visitsIdeally, an annual dental check-up is advised to a keep complication at bay. But it is necessary to visit your dentist if you have:Red, swollen and bleeding gumsPainful gumsPus or fluid discharge from gumsSwelling of cheeks, chin face or neckLoose teethIncreasing gaps in teethContinuous bad breathGum disease is diagnosed with a clinical examination. X-ray of jawbones with teeth called as an OPG which shows bone involvement may also be done..The relationship explainedDiabetes, marked by high levels of blood glucose, leads to the formation of AGEs or Advanced Glycation End-products.Accumulation of AGE's in the blood and tissues has been linked to Diabetic complications. People with Diabetes with gum disease have higher blood sugar levels as compared to those with healthier gums. Even in people without Diabetes, gum disease has been found to increase the blood glucose levels Inversely having chronic gum disease (along with other factors) actually increases the risk of the onset of Type 2 Diabetes. 50 to 90 per cent of the population affected by gum disease has shown an increased risk of Diabetes. A new study has found that pregnant women with periodontal disease have an elevated risk of developing gestational Diabetes (even if they do not drink alcohol or smoke) thereby increasing the risk of complications during the pregnancy.Professor Francesco D'Aiuto from the University of London conducted a research study to find the correlation between gum disease and Diabetes. He found that gum infection causes inflammation which in turn leads to insulin resistance thus increasing the blood glucose levels. Intensive treatment of gum disease reduced the levels of HbA1c in people with Type 2 Diabetes. The one year research included a test group of 264 people with Type 2 diabetes with gum disease. Half the people were given intensive treatment with root planning and gum surgery. The other half was given regular treatment like scaling and polishing of teeth. The results showed the levels of HbA1c reduced by 0.6 per cent more in advanced treatment patients than the standard group. It also showed improved kidney function and improved blood vessel function than the standard group. The study concluded that good oral health helped in reducing complications associated with Diabetes.Scientists believe that the bacteria that infect the gums escape into the bloodstream and trigger a reaction from our immune system. This leads to the release of certain molecules that have harmful effects on other parts of the body, resulting in worsened blood glucose control.Gum disease treatment can help manage Diabetes by reducing blood sugar levels. The improvement can be compared to and is similar to adding a second drug for Diabetes control. If there is a family history of Diabetes, then along with a healthy lifestyle, taking care of gums will help the individual to stay healthy. Effective control of periodontal disease in people with Diabetes reduces the levels of AGE's in the blood thus controlling the blood glucose levels. The level of glycaemic control is also a key factor. Those with poor control have more loss of attachment and are more prone to recurrent disease. .Treating gum diseaseScaling and polishingThis helps remove plaque, tartar, calculus which sticks to or between the teeth and between teeth and gums which cannot be removed by a toothbrush. A scaler is a specialised instrument used to clean the teeth. After cleaning/scaling the teeth are polished with a polishing paste and brush to remove marks or stains and to make the teeth smooth. Sometimes more than one sitting is required for cleaning when tartar and calculus are more. One sitting usually lasts for 30-45 minutes. The dentist may use an anaesthetic paste to numb the gums and minimise gum sensitivity during the procedure.Root planningIn some cases, root planning and debridement may be required especially in patients suffering from periodontitis. Deep cleaning is done under the gums to remove bacterial plaque from the roots of teeth. A local anaesthetic is given to numb the area first. This procedure takes about 60-90 minutes. Patients may experience pain and discomfort for up to 48 hours after the treatment. Painkillers and anti-inflammatory drugs will be prescribed by the dentist if required..Periodontal surgeryIn severe periodontitis, gum surgery is required. Removal of infected gum tissue is called gingivectomy. In severe cases, flap surgery with tissue and bone grafting is done. Sometimes the affected teeth also might have to be removed. Surgery requires 60-90 minutes and is done under local anaesthetic. An antibiotic cover along with anti-inflammatory drugs is prescribed by the dentist. A dentist may refer you to a specialist known as a periodontist for the surgery.MouthwashesMouthwash may contain chlorhexidine or hydrogen peroxide. Most mouthwashes need to be diluted with water before use. Mouth wash should only be used for the prescribed duration.VitaminsVitamins B-complex and C are prescribed to enhance the immunity and to fasten the healing process.Oral AntibioticsOral antibiotics like amoxicillin and metronidazole are prescribed depending on the type of infection and patient history.PainkillersParacetamol and Ibuprofen are drugs of choice. They act by reducing the pain as well as the inflammation caused in the tissues.Local antibiotic gelsThese are used locally as they are to be applied on gums after deep cleaning.