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Monday, November 06, 2006

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:
And a similar link for medline (with some duplications)

A post-script, posted 5th October 2010

A friend of mine, who is a Type 1 diabetic in the UK, just posted this report of a dental problem. Although not directly related to periodontitis I thought it may reinforce the need for dental health and also includes some sound advice on what to do if you ever have the same extraction need.

Here is Patrick's post, slightly edited:
I've had one very rotten wisdom tooth taken out and I'm a complete WIMP when it comes to dentists, that's why I hadn't been in years and is also why I've had the problems I've had.

Anyhooo I'm sure there's a few of you out there who are as nervous as me so here's a link to a very good site.


There is a wealth of info for scaredy cats and also a list of NICE friendly dentists.

My thread is here http://www.dentalfearcentral.org/forum/showthread.php?t=13006

Now I'm aware there's more than a few food gurus in here, I'm not and never will be one of them so if you're one of those lazy low maintenance T1 like me then I hope the following is of some use.

Bearing in mind we're at a higher risk of dry sockets, we are more prone to infection and we take longer to heal I think stuff like this is worth paying attention to.

1. Follow your dentists advice on post tooth removal care.

Do NOT smoke. ( diabetics shouldn't anyway but I know some of us do)
Do NOT drink alcohol
DO rinse with warm salt water after each meal ( half teaspoon of salt per glass of warm water)
DO buy some Corsodryl and use that to rinse the salt taste away
DO drink lots of water
DO brush carefully but avoid the gum where the tooth was - the salt rinse and Corsodryl will see to that.

The longer you can stomach a liquid diet ( tomato soup for me as it has no bits in it) the better then you don't run the risk of getting food stuck in the gum.

Be aware that if you're used to a high carb diet, switching to just soup is going to present liquid problems at the other end

Breakfast has been either microwaved scrambled eggs mixed with sliced hot dog sausages. Or one crumbled weetabix mixed with half a sliced banana ( sliced into quarter of the round slices) and full fat milk but wait till it goes all soft before you eat it. I switched to egg on the basis that it tends to bind the gut up - a good thing when all you've really had in there is soup

Lunch has been soup mixed with more sliced hot dog sausages and buttered bread, the butter helps to keep the bread in one piece so you can keep it away from the gum.

Evening meal - more soup. bread and sausage.

I have also invested in low fat yoghurt for between meals to ensure there's plenty of good bacteria kicking around - this seems to have really sped up the healing process.

All the above foods do NOT fall to bits in your mouth and therefore do not get stuck in the gum as it heals - avoid rice and nutty breads etc for this reason.

Two things are going to happen, firstly you're going to lose any excess weight you had and secondly you're going to hate the taste of soup I'm ok with the latter on the basis of the former!

Lastly and for a rare few this will help. I'm T1 diabetic so the reduction in carb means a massive reduction in insulin requirements, be aware that Ibuprofen / Neurofen will remove your low blood sugar physical warning signs. Test more frequently and if like me, you're on a basal / bolus DAFNE system, you'll really need to work out what you're going to do with insulin.

Remember no two T1 diabetics are the same but my basal insulin was split 18u and 18u morning and evening. At the moment due to diet changes, i'm running 12u morning and 8u evening - this also due to the weight loss which makes you less insulin resistant.

Before you go in for the tooth out, please bear in mind you may not want to eat for up to 24 hours - to do that safely as a diabetic you need to ensure you reduce your basal insulin BEFORE you have the tooth out. Also ensure you eat a good meal before going in so that your blood sugar can be kept high enough to be safe. 24 hours of running a little higher than normal won't kill you. Knowing what I know now, I'd have changed over to this diet a week or so before the tooth came out so that I was better prepared for it.

Lastly and I can't stress this enough, I haven't needed any painkillers since the day the tooth came out - I've had no swelling at all and on day 5 it looks like my appetite has returned. I have lost approximately 1.5 stone in a little under a month ( I cut out coffee and tea with sugar, chocolate of any kind, ALL wine etc ) and I think I've got another 2 or 3 weeks of this diet to go so I'm guessing another half stone will drop off. I've gone from a 35" waist down to a 32" waist. [note for US readers. One stone is 14 pounds.]

The point I'm getting at is simply that losing middle body fat is a GOOD thing, I just didn't expect to have this many positive side effects after having something done I was very very nervous about. All of a sudden I'm hitting the exercise bike on Monday with a figure worth fighting for

So if you're out there and nervous, you can't be any more than I was and I'm fine, as is my diabetes control which has been almost perfect for the entire period.


Cheers, Alan


Anonymous said...

Dr. Steinman's theory of the genesis of dental decay says the direction of flow through the dental tubules determines dental health. The direction is reversed in nutritional and endocrine imbalance. Thus controlling the diabetes is essential for keeping the correct flow. This is far more important than any procedures done in the mouth. See http://www.copalite.com/Fraser_Literature_Review.htm for an explanation of this theory.

Alan said...

I know nothing about Steinman or the validity of his theory; however, I've allowed publication of the comment without endorsement for those interested. The article appears to be related more to tooth decay than periodontal disease.

In any case, I still believe that as diabetics we need to do both - take good care of our teeth and actively manage our diabetes.

It's not a matter of which is more important. Both are important.