Gum disease, also known as periodontal disease, is the sixth most common disease in the world. People with diabetes are more likely to experience gum disease if they’ve had poor blood sugar levels for a long period of time.

What is gum disease?

Gum disease affects the gums and bone supporting the teeth and eventually leads to tooth loss. The good news, though, is that gum disease is preventable and can be easily treated in the early stages of the disease.

What does gum disease have to do with diabetes?

People with diabetes have an increased risk of developing gum disease. Poorly managed blood sugar levels can cause damage to nerves, blood vessels, the heart, the kidneys, the eyes and the feet. In the same way, the gums can too be affected.

Because high blood sugar levels lead to damage to blood vessels, this reduces the supply of oxygen and nourishment to the gums, making infections of the gums and bones more likely.

Uncontrolled blood sugar levels can cause levels of glucose to rise in the saliva and this creates a breeding ground for bacteria, increasing the risk of gum disease and dental decay.

Severe gum disease can negatively affect your blood sugar control and increase your chances of suffering from other common long-term complications of diabetes. The inflammation, which occurs in the gums, escapes into the bloodstream and upsets the body’s defence system which in turn affects blood sugar control. In other words, gum disease and diabetes are linked in both directions.

The European Federation of Periodontology recommends that following a diagnosis of diabetes you should inform your dentist and undergo a comprehensive dental check up.

People with diabetes should have regular dental check-ups, including a review of gum health. If your dentist or hygienist detects gum disease, they can help you with your treatment and initial management. You will need an intensive course of treatment and more regular follow-up visits compared to those who do not have gum disease.

What causes gum disease?

Your genes can increase your risk of developing gum disease, while tobacco use, diabetes and stress also increase this risk and can make the disease worse.

The main cause of gum disease is dental plaque. This is a sticky white coating which builds up on your teeth throughout the day. It is formed from food, bacteria and saliva.

Plaque deposits need to be removed from your teeth and gum line every 12 hours to prevent the plaque hardening into tartar (calculus). The bacteria in the plaque cause irritation (inflammation) in the gums leading to bleeding, redness and swelling. If left untreated the disease can progress and in time destroy the soft tissues and bone which hold your teeth in place.

What are the symptoms of gum disease?

In most cases gum disease is not painful and you may be unaware of it. However, if you have any of the following symptoms you should consult a dentist or hygienist:

  • Bleeding in the mouth when cleaning or eating
  • Swollen and red gums
  • Persistent bad breath
  • Shrinking (receding) gums
  • Gaps appearing between the teeth and the teeth moving apart
  • Loose teeth
  • Presence of pus around the gumline (abscesses)

If you have symptoms of gum disease, your dentist can provide you with a diagnosis and advice on preventing and treating gum disease.

Severe forms of gum disease will need a detailed gum examination to assess the scale of the problem. X-rays may be taken to assess damage to the supporting bone around the roots of the teeth, below the gum line.

Risk factors for gum disease

The following factors increase the risk of gum disease developing or worsening more quickly:

  • Poor control of blood sugar in people with diabetes
  • Poor plaque removal
  • Tobacco use (possibly including e-cigarettes)
  • Poor plaque removal5
  • Stress
  • Certain medications – including some blood pressure medications
  • Having a condition that affects the immune system – such as Addison’s disease or HIV

The stages of gum disease

Gum disease is classified on the severity of its development. There are three main stages of gum disease:

How is gum disease treated?

How is gum disease treated?

Keeping blood glucose levels under good control will help to prevent gum disease developing or spreading. Quitting smoking is also highly recommended to limit further damage.

Thoroughly brushing your teeth twice a day and cleaning in-between your teeth at least once a day can prevent periodontal disease and is an essential part of treatment.

Antiseptic mouthwash can help to reduce bacteria and plaque build-up but it is not a substitute for effective tooth cleaning and can mask more serious damage.

As well as improving personal plaque removal techniques, scaling may be required to remove tartar (calcified plaque). Your dentist or dental hygienist will use special tools to remove the tartar and then polish the teeth.

For patients with periodontitis, an intensive course of deep scaling below the gum margin to remove the plaque and tartar deposits from the roots of the teeth will be necessary. This is carried out by a dentist or hygienist who can give you an injection to numb your teeth and gums.

If there is no improvement after treatment with your dentist or hygienist, you may be referred to a periodontist (gum disease specialist). If patients do not respond to thorough deep scaling and if their plaque removal is excellent, surgery is an option in localised areas.

Following successful treatment, you will still be susceptible to relapse of the gum disease. Ongoing maintenance care is essential including keeping up your daily cleaning routine as is seeing your dental professional regularly to monitor your gum health and to pick up and treat any early signs of its return. Your dental team will advise you how often but typically this is every 3-6 months.

Treatment will involve maintaining strong oral hygiene. Brushing your twice a day in the morning and evening and flossing your teeth daily can help to keep your teeth clean. Mouthwash may also be recommended by your dentist and you may need to visit a dental hygienist.

It is also important to keep your blood sugar levels well controlled. This can be achieved by joining a diabetes education course and using blood glucose testing to inform meal choices.

Quitting smoking is also highly recommended to limit further damage.

If there is no improvement after treatment with your dentist or hygienist, you may be referred to a periodontist, or gum disease specialist.

Antibiotics or painkillers may be prescribed for treating acute necrotising ulcerative gingivitis, and severe periodontitis might require surgery to remove or replace gum tissue.

Is treatment of gum disease successful in people with diabetes?

Treatment of periodontal disease in people with diabetes, who have good control of blood sugar, can be just as successful as in patients who do not have diabetes.

Improving blood sugar control can improve the success of periodontal treatment in people with diabetes.

Also, there is scientific evidence that treatment of periodontal disease can result in improvement in blood sugar control in people with poorly controlled diabetes, and lower the risk of experiencing the other long-term complications.

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