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Saturday, January 03, 2009

Diabetes and Dental health

A couple of years ago I wrote about the two-way relationship between Diabetes and Periodontal disease in Teeth, Gums, Diabetes and Death .

My main intent at that time was to emphasise that dental hygiene and blood glucose levels seem to be closely related. Poor dental hygiene causes poor blood glucose levels and poor blood glucose levels exacerbate dental problems. The reverse is also true, with improvements in either leading to improvements in the other. For more discussion on that read the earlier article.

One of the cites I provided, Periodontitis and diabetes interrelationships, had an interesting comment: "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? I noted that further research should be done there.

Further research has now been done and that possibility is becoming a little more plausible. This paper was published online on April 4, 2008 in Diabetes Care 31:1373-1379, 2008: Periodontal Disease and Incident Type 2 Diabetes

OBJECTIVE—Type 2 diabetes and periodontal disease are known to be associated, but the temporality of this relationship has not been firmly established. We investigated whether baseline periodontal disease independently predicts incident diabetes over two decades of follow-up.

RESEARCH DESIGN AND METHODS—A total of 9,296 nondiabetic male and female National Health and Nutrition Examination Survey (NHANES I) participants aged 25–74 years who completed a baseline dental examination (1971–1976) and had at least one follow-up evaluation (1982–1992) were studied. We defined six categories of baseline periodontal disease using the periodontal index. Of 7,168 dentate participants, 47% had periodontal index = 0 (periodontally healthy); the remaining were classified into periodontal index quintiles. Incident diabetes was defined by 1) death certificate (ICD-9 code 250), 2) self-report of diabetes requiring pharmacological treatment, or 3) health care facility stay with diabetes discharge code. Multivariable logistic regression models assessed incident diabetes odds across increasing levels of periodontal index in comparison with periodontally healthy participants.

RESULTS—The adjusted odds ratios (ORs) for incident diabetes in periodontal index categories 1 and 2 were not elevated, whereas the ORs in periodontal index categories 3 through 5 were 2.26 (95% CI 1.56–3.27), 1.71 (1.0–2.69), and 1.50 (0.99–2.27), respectively. The OR in edentulous participants was 1.30 (1.00–1.70). Dentate participants with advanced tooth loss had an OR of 1.70 (P <>

CONCLUSIONS—Baseline periodontal disease is an independent predictor of incident diabetes in the nationally representative sample of NHANES I."

What that means in layman’s terms was clarified in Endocrine Today online in November when an interview with one of the authors, Ryan T. Demmer, PhD, MPH was published. He said that these findings add a "new twist" to the association, suggesting that periodontal disease may lead to diabetes.

"It has been generally accepted that periodontal disease is a consequence of diabetes despite the fact that this association has not been studied with the same methodological rigor applied to coronary and stroke outcomes," he told Endocrine Today. "We found that over two decades of follow-up, individuals who had periodontal disease were more likely to develop type 2 diabetes later in life when compared to individuals without periodontal disease." For more details read that Endocrine Today issue where it is discussed with several other researchers in this field.

I still suspect that type 2 has a genetic cause, but I now believe that periodontal disease can be a trigger for type 2 diabetes in the same way that a poor diet or lifestyle can be. There is also the possibility the genetic tendency to type 2 diabetes may also be the initial cause of the precursor conditions of periodontal disease or obesity.

I already knew that it was important to have very good dental hygiene as a type 2 diabetic. Now it seems that it may be equally important for those of us who have offspring following in our genetic foot-steps to pass that message on loud and clear to them.

Cheers, Alan


Anonymous said...

Hi, Alan,

I know you from asd a few years ago. Hope all's well.

Seeing this on your blog, I'm curious.
Diabetes Links
Test, test, test
Jenny Ruhl
Blood Sugar 101
Gretchen Becker
Diabetic Talk
David Mendosa
Regina Wilshire
GLUCOBATE: Be sure to click on any link after it loads.

It LOOKS like the glucobate is a link you've added along with Jenny's etc. Is it really?

:-) skinny

Alan said...

G'day skinny. Nice to see you again.

As I note in the disclaimer near the ads:

"I do not control which ads are displayed by Google Ads nor do I endorse the products advertised."

Some of the ads I disagree with but it got much too time-consuming to cull them. So I added the Glucobate link.

It's intended to make readers a little more skeptical when they see ads for miracle products.

Click on the link, then when the page loads click on any link to get to the next page. That will make it all clear.

It works well. I get too many sensible people reading here and they rarely click on the ads. I use the ads for statistics mainly; I certainly won't get rich on the income:-)

Cheers, Alan

Rusty said...

I just want to thank you for all this wonderful information. I was up late last night tryting to read as much as I could.
Bless your heart!

Michael Hoskins said...

Alan: Thank you for posting this online info about Diabetes and Dental Health. Though I'm 21 months or so late, I do appreciate reading it. I'm a Type 1 diagnosed at age 5, and have now hit the 26 year mark of living with diabetes. My dental health has never been great, and now I'm paying the price. Have had pretty severe periodontal disease for most of the year, and am seeing some rapidly receding gums under the two caps/one bridge that I've got in there. Hope to get some treatment soon, but with insurance costs it's just not possible. Look forward to keeping you updated, and hopefully reading more of your posts down the road! Thanks for sharing your story!