Diabetes and Oral Health

Diabetes impacts more than 415 million people worldwide. Diabetes is now a global epidemic, and in 2017, diabetes caused an estimated 4 million deaths worldwide. More than 4.9 million people in the UK have diabetes, and 13.6 million people are now at increased risk of type 2 diabetes in the UK. You’re more at risk of type 2 diabetes if you have a close family member who has diabetes; 850,000 people are currently living with type 2 diabetes but are yet to be diagnosed

Diabetes and periodontitis (advanced gum disease) are chronic non-communicable diseases whose prevalence increases with age. There is a two-way relationship between periodontitis and diabetes. People with poorly controlled diabetes (type 1 and 2) suffer from increased periodontal inflammation, destruction, and breakdown. This can also affect dental implants due to delayed wound healing. Patients with poorly controlled diabetes seem to have delayed osseointegration (the connection between living bone and dental implants) following surgery. People with periodontitis have an elevated risk of pre-diabetes or developing type 2 diabetes. You may think that you are doing well managing your gum health, but you may not be doing enough because you may have an increased risk of gum problems if you are pre-diabetic or diabetic. Healthy patients with periodontitis exhibit a higher chance of developing pre-diabetes and diabetes. People with severe periodontitis have an increased risk of developing type 2 diabetes. Periodontitis is significantly associated with poorer glycaemic control (HbA1C) and higher blood-glucose levels (glycaemia) in people with diabetes and those without the disease. There are higher levels of insulin resistance in people with periodontitis.

Hyperglycaemia is associated with an increased risk and severity of periodontitis. There is a dose-dependent relationship between glycaemia and periodontal destruction. Patients with diabetes are three times more likely to develop gum disease. The control of diabetes is more complicated when periodontitis is also present in a patient (co-morbidity). People with diabetes who have good glycaemic control experience no more periodontitis than people without diabetes. People with diabetes should be regularly monitored on a preventive care regime with their dentist and hygienist. The Hemoglobin A1c (HbA1c) test measures the amount of blood sugar glucose attached to your hemoglobin. Hemoglobin is the part of your red blood cells that carries oxygen from your lungs to the rest of the body. It measures this over 2-3 months rather than a momentary finger prick test, which gives a snapshot in time. They do not require fasting and are not affected by diet or exercise. Conditions which may affect the test are pregnancy, advanced cancer, anemia, sickle cell trait, liver and pancreatic diseases, and malaria. For people without diabetes, the normal range for the hemoglobin A1c level is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% mean you have prediabetes and a higher chance of getting diabetes. Levels of 6.5% or higher mean you have diabetes.

The critical difference between screening tests and diagnostic tests is that screening tests do not give a confirmed diagnosis of diabetes. If you would like your HbA1c levels testing at your hygienist appointment this service is available for just £25.00. We do need 24 hours notice in order to prepare for the test, so please call ahead and let reception know you would like the test. If your test returns a high HbA1c result, you will still need to visit your GP for advice and possible further testing. However, screening can enable early diagnosis and intervention and improve treatment outcomes in periodontal treatment, implant treatment and glycemic control.

Useful websites

www.diabetes.org.uk – for information on diabetes

www.efp.org – for information on diabetes and oral health




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C. Bradley


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