Teeth, Gums, Diabetes and Death

First, the personal background.

I was first diagnosed with periodontal disease just before I left the RAAF 22 years ago. I had the same cleaning routine, every three months for a year, with the service paying. I didn't continue after that, because everything seemed good.

Nobody had mentioned that it is an incurable disease, at least while you still have teeth. Of course, if you don’t treat it that isn’t forever.

Over the next ten years, I had some minor dental work, but no serious problems. Then, quite suddenly, I got a major infection and abscess and was told that I needed treatment by the periodontist again. That was the first time I was told that it was an incurable disease, and that I should have been getting regular periodontal cleaning treatment ever since the first diagnosis.

Over the next five years, under an excellent periodontist in Melbourne, I managed to retain most of my teeth (lost four) and had several flare-ups. One of those I ignored for a few days because I was travelling; that one nearly killed me when it got out of control and I was treated just in time. I now carry Amoxycillin when I travel, just in case.

Now for the good news. At the time I was diagnosed with diabetes in 2002 I was seeing my new and also excellent periodontist on the Gold Coast every three months. He commented that I had improved significantly after a year of no smoking. But the improvement a year later when I had reduced my A1c and gained some control over my BGs was even better.

I now only attend every four months, and on two of those appointments I now only see the dental hygienist because I've improved too much to justify the periodontist's time.

Now – the serious bit for other diabetics.

Below I’ll list some links for those that want to read further, but I’ll summarise briefly here. I haven’t read all of the hundreds of papers – but skimming through the conclusions there is a gradual trend to general agreement on the following:

The bad news:

Periodontal disease and diabetes mellitus is a two-way relationship. Poor control of either degrades control of the other. See Periodontitis and diabetes interrelationships
That paper concludes with a quite unexpected additional possibility:
"Thus, there is potential for periodontitis to exacerbate diabetes-induced hyperlipidemia, immune cell alterations, and diminished tissue repair capacity. It may also be possible for chronic periodontitis to induce diabetes." Induce diabetes? Further research should be done there.

Postscript January 2009. See Diabetes and Dental health for more comment on causality.

Mortality (that word has a sense of finality) is significantly increased in diabetics with Periodontal Disease. http://care.diabetesjournals.org/cgi/reprint/28/1/27

The good news:

The two-way relationship can work in your favour. Improved control of Periodontal disease can assist with glycemic control and vice-versa. See http://www.medscape.com/medline/abstract/16584339

So - look after your pearly whites, folks. We all get lazy at times, as my periodontist is quick to remind me, but as a diabetic bad teeth and gums can literally be the death of us.

Cheers, Alan,

Everything in Moderation - Except Laughter.

If you are interested in further reading, this is a link to over 100 papers listed in PubMed:
http://tinyurl.com/y92tbs
And a similar link for medline (with some duplications)
http://tinyurl.com/t69s8