What’s the Connection Between Diabetes and Oral Health?


Emerging evidence suggests that oral health, often overlooked by clinicians, is closely related to overall health and that this association has important implications for people with type 2 diabetes (T2D). While most studies are observational and cannot prove cause and effect, the association is strong enough that researchers can conclude that the link is real.

Photos of Robert A. Gabe
Robert Gabe, MD

Experts say endocrinologists and other specialists, as well as primary care physicians, should ask about oral health even if they don't directly examine the mouth. “One of the most important things to ask people with diabetes is the last time they saw a dentist and whether they had follow-up visits,” says Robert Gabbay, MD, chief scientific and medical officer for the American Diabetes Association (ADA). Medscape Medical News. The ADA promotes oral health through the 2024 Standards of Care.

systemic impact

“Periodontitis may be a risk factor for a variety of problems related to the cardiovascular, pulmonary, endocrine, musculoskeletal, central nervous and reproductive systems,” write the authors of a recent review of the effects of periodontitis on major organ systems. road. While there is no link specifically to diabetes, the review points to some recent evidence that suggests “oral health impacts overall health, and… dental health should never be viewed as a unique, distant, and secondary aspect of health.” The important part.

In line with this view, specifically for T2D, a recent study of more than 17,000 T2D patients participating in a Korean screening program found that periodontitis and an increased number of tooth decay were independent risk factors for cerebral infarction or myocardial infarction. The hazard ratios were 1.17 and 1.67 respectively).

Periodontitis Effects Compilation Photos

In a large cohort study, dental disease and poor oral hygiene were also associated with an increased risk of heart failure in people with T2D, and the authors suggested that managing oral health may prevent the development of heart failure.

A recent review suggests that periodontitis exacerbates and contributes to the progression of chronic kidney disease, which affects one in three people with diabetes.

Research has also shown that diabetes is associated with cognitive decline, with a review of oral health and dementia progression concluding: “Overall, the experimental results suggest that the link between oral health and cognition should not be underestimated.”

two-way effect

Research suggests that the association between periodontal disease and T2D may be bidirectional, although there is little awareness of this bidirectional relationship between patients and healthcare providers.

A recent review of this bidirectional relationship focused on pro- and anti-inflammatory factors in microvascular complications, oral microbiota, T2D, and periodontal disease and concluded: “When these two diseases occur simultaneously, specific/ To supplement therapeutic solutions and conduct new clinical trials to better control this interdependent pathogenic theme, epidemiological studies are necessary.

However, an Australian study showed that 54% of 241 participants had never received any information about the bidirectional relationship between periodontal disease and diabetes and lacked understanding of this association.

What is the mechanism?

How does T2D affect teeth and vice versa? “Basically, people with T2D have high blood sugar, and the sugar in their saliva promotes oral bacterial growth, plaque formation on teeth, and gum disease,” says Samir Malkani, MD, Endocrinology and Diabetes Chan School of Medicine at UMass Worcester, Massachusetts, says Clinical Director Medscape Medical News.

Photos by Samir Malkani
Samir Malkani, MD

“Patients will suffer from gingivitis and periodontitis, and because the gums and jaw are one unit, if the gum disease becomes very severe, the jawbone will fall out and the teeth may fall out,” he said. There's also inflammation in the mouth, and “when there's inflammation throughout the body, it affects the entire body.”

Recent European research suggests that “although the mechanisms underlying these associations are unclear, poor oral health may contribute to the perpetuation of systemic inflammation.” According to the authors, common oral infections, periodontal disease, and tooth decay are associated with metabolic profiles of inflammation. inflammatory metabolic profiles are associated with increased risk of cardiometabolic disease, and they predict future adverse changes in metabolic profiles.

awareness, accessibility, collaboration

Malkani said that despite the evidence, the link between oral health and diabetes (of any type) has not captured the attention of clinicians or patients. He noted that a systematic review included 28 studies involving nearly 28,000 people in 14 countries. The review found that people with diabetes “have insufficient oral health knowledge, poor oral health attitudes, and fewer dental visits. [and] Oral health education and dental referrals from nursing staff were rarely received.

Social determinants of health have a “huge impact” on whether people will develop T2D and its associated complications, including poor oral health, according to a 2022 National Council on Clinical Care report to the U.S. Congress. Recommendations: Federal policies and programs that can more effectively prevent and control diabetes and its complications.

The committee “approaches its mandate through the lens of social ecology and the expanded chronic disease care model,” the report's authors wrote. “It is clear that diabetes in the United States cannot be viewed simply as a medical or health care problem, but must be addressed as a social problem that touches many sectors, including food, housing, commerce, transportation and the environment.”

Diabetes is also associated with higher dental costs, another factor that affects an individual's ability to receive care.

A recent questionnaire-based study in Denmark found that people with type 2 diabetes were more likely to rate their oral health as poor than those without diabetes, and that the risk of poor self-rated oral health increased with educational attainment. Decrease and increase. The highest educational attainment and disposable household income were indicators of higher socioeconomic status and a lower likelihood of rating their oral health as poor, again pointing to inequalities.

The authors concluded that “diabetes and dental care providers should engage in multidisciplinary collaboration across the healthcare sector to ensure consistent treatment and management of diabetes.”

But such cooperation is easier said than done. “One of the challenges is our fragmented health system, where oral health and medical care are separate,” Gabe said.

Malkani agreed that in most cases the two are separate. “When we deal with most complications of diabetes, such as those involving the heart, eyes, or kidneys, we can have interdisciplinary care—everyone across the spectrum of medical disciplines. If I refer an ophthalmology colleague or a cardiologist or Vascular surgeons, they can also be in the same network from an insurance perspective.

But for dental care, referrals are interprofessional, not interdisciplinary. “I have to make sure patients have a dentist because dentists are often not part of a health network, and if the patient doesn’t have dental insurance, cost and access can be a challenge.”

A recent systematic review of interprofessional education and interprofessional collaborative care in Australia found that more than one-third of health professionals “do not understand” the relationship between oral health and T2D. Additionally, only 30% of respondents reported ever referring patients for oral health assessment. There is little interprofessional collaborative care between medical and dental professionals when managing patients with type 2 diabetes.

Treat teeth

“We always talk to patients with T2D about the importance of getting eye exams, foot exams and kidney exams,” Malkani said. “But we also need to make sure they go to the dentist. Typically, people get their teeth cleaned twice a year. But if you have diabetes and poor oral health, you may need a cleaning every three months, and insurance will usually pay for it. cost.

Additionally, treating periodontitis can help control blood sugar, according to a two-way link. The authors of the 2022 update of the Cochrane review on treating periodontitis to control blood sugar write that they have “doubled the number of included studies and participants from the 2015 update” to 35 studies, randomizing 3249 Participants were randomly assigned to periodontal treatment or control groups. This “led to changes in our conclusions about the primary outcome of glycemic control and in our level of certainty in that conclusion.”

“We now have moderate-quality evidence that periodontal treatment using subgingival instrumentation significantly improves glycemic control in patients with periodontitis and diabetes compared with no treatment or usual care. Evaluating periodontal treatment versus no treatment Further trials of treatment/usual care are ongoing and are unlikely to change the overall conclusions drawn from this review.

“Dentists also have a responsibility,” Malkani added. “If they see someone with severe gum disease or cavities, especially someone who is younger, they need to tell that person to check their blood sugar to make sure they don't have T2D.”

In fact, a recent review found that T2D complications such as xerostomia and periodontal problems can adversely affect health and that “dentists can play an important role in raising awareness of these issues and improving the quality of life of patients with diabetes. effect.

key statistics

The Centers for Disease Control and Prevention highlights the following facts about diabetes and oral health:

  • Adults age 20 or older with diabetes are 40% more likely to have untreated tooth decay than similar adults without diabetes.
  • Approximately 60% of U.S. adults with diabetes have seen a doctor but not a dentist in the past year.
  • Expanding health care coverage for periodontal treatment for people with diabetes could save approximately $6,000 per person over a lifetime (2019 USD).
  • Compared with people without diabetes, adults aged 50 or older with diabetes were 46% more likely to have a functional dentition (fewer than 20 teeth) and severe tooth loss (fewer than 8 teeth). ) is 56% more likely.
  • Adults aged 50 or older with diabetes are more likely to have difficulty eating due to dental problems.
  • Annual dental costs for adults with diabetes are $77 (2017 USD) higher than those without diabetes. For the United States, this cost is equivalent to $1.9 billion.



Source link

Leave a Reply

Your email address will not be published. Required fields are marked *