A Dental Diabetes Link

Type 2 diabetes tied to poor dental and oral health in new South Korean study

(RxWiki News) Diabetes and dental health might not be the most obvious pair, but new research out of South Korea suggests that there might be a connection between the health of the mouth and the management of diabetes.

The researchers looked at the dental health of patients who had type 2 diabetes for a number of years.

The study showed a connection between poor oral health, longer diabetes duration and worse self-management of diabetes.

"Brush and floss your teeth everyday."

In type 2 diabetes, the body does not use the hormone insulin properly, resulting in high blood glucose (sugar) levels.

According to the study authors, who were led by Eun-Kyong Kim, of the Department of Preventive Dentistry at Kyungpook National University in Daegu, South Korea, there has been evidence that diabetes is a risk factor for some dental health issues, but the relationship is not fully understood.

Kim and team wanted to explore this topic further by looking at the dental health of 125 type 2 diabetes patients. The patients ranged in age from 33 to 75 years, and had an average age of 57.8 years old.

The patients had all been diagnosed with diabetes for over a year and did not have any other general health issues like heart disease, immune conditions or psychiatric disorders. 

In this study, the researchers focused on periodontal health, or the health of the tissues and bones surrounding and supporting the teeth.

The researchers assessed periodontal health through a number of measures, including the number of missing teeth and amount of gum bleeding. The researchers also relied on the Russell Periodontal Index, which measures gingivitis (inflammation of the gums) and bone loss of the teeth on a scale from zero to eight, and the Community Periodontal index, which looks at bleeding, plaque and the presence of pockets around the teeth on a scale from zero to four.

For both indexes, a lower score means a healthier mouth and a higher score means more periodontal health issues.

The participants were asked about their diabetes self-management, including topics like exercise, diet and the monitoring of blood sugar levels. Results from glycosylated hemoglobin (HbA1c) tests were also used to examine the participants' blood sugar levels.

Of the participants, 56.8 percent reported brushing their teeth twice a day (the most commonly reported frequency), and 72.8 percent reported that their self-perception of their own oral health was "unhealthy."

Most patients (59.2 percent) had lived with diabetes for between 6 and 9 years, and most (69.6 percent) had an HbA1c level above 7 percent — a score often signaling that the diabetes is not well controlled.

According to the authors of this study, the number of missing teeth and the amount of gum bleeding increased in the participants who had diabetes the longest and in the participants with the worst diabetes self-management scores. Participants who had diabetes longer and had HbA1c levels over 7 percent also scored higher on the Community Periodontal and Russell Periodontal indexes. 

For example, those who had diabetes for five years or less had an average of 3.14 missing teeth, while those who had diabetes for over 10 years had an average of 8.40 missing teeth. And those with an HbA1c level under 7 percent had an average of 3.79 missing teeth, compared to those with an HbA1c level of 7 percent or higher who had an average of 5.31 missing teeth.

Of the patients who had diabetes for five years or less, 28.8 percent scored zero, one or two on the Community Periodontal Index and 38.9 percent scored a four (the highest score on the scale, representing worse periodontal health). In comparison, only 12 percent of those who had diabetes for over 10 years scored a zero, one or two on the same index, while 80 percent scored a four. 

The researchers concluded that they found the duration of diabetes and management of the disease to be tied to periodontal health in these type 2 diabetes patients. "Therefore, we emphasize the role of blood glucose control and self-care practice of diabetes along with oral health education for management of oral health, which is exceptionally important for prevention of diabetes related complications and improvement of quality of life," Kim and team concluded.

"I’ve seen firsthand the effects of diabetes on my patients’ gum health," said Kevin Burgdorf, DDS, Dentist and owner of Dr. Kevin Burgdorf, DDS.

"Diabetics have a more difficult time fighting infections, and gum disease is just that: a chronic infection of the gums. But it’s a two way street: active gum disease can make it more difficult to control your diabetes. Unhealthy gums can cause an increase in blood sugar, so it is especially important for diabetics and those who are at a high risk of developing diabetes to see their dentist regularly," said Dr. Burgdorf.

He added, "And remember: only floss the teeth you want to keep!"

This was a fairly small study from a specific region. More research involving a diverse population is needed to confirm the findings and further explore the relationship between diabetes and dental health.

This study was published online in BMC Oral Health on November 7. No conflicts of interest were reported.

Review Date: 
November 11, 2013