Diabetics To The Dentist!

Current research has shed some light on what may turn out to be a more serious connection between periodontal disease and diabetes, a caution that offers an important warning for diabetics who may be avoiding the dentist.

According to Anthony Iacopino, D.M.D., Ph.D, "It's generally accepted that 60- to 65% of the population has periodontal disease of some kind or another, but diabetic patients have an increased frequency beyond that. So you're probably talking about 85 to 90 percent of diabetics." Scary numbers when you consider that, as the American Diabetes Association Web site attests, "15.7 million Americans have diabetes. 10.3 million are currently diagnosed, but 5.4 million unfortunately are not, with approximately 798,000 new cases a year."

The connections between diabetes and periodontal disease are more or less understood. Diabetes can thicken the blood vessels, hindering the flow of oxygen and nourishment to the mouth. It can also slow down the blood's ability to carry away accumulated waste products. Such a reduction in circulation and waste removal can leave the gum and bone tissue more susceptible to infection. In addition, if diabetes is poorly controlled, high glucose levels in the fluids of the mouth may provide fertile ground for germs to grow and eventually bring about gum disease. But studies have also demonstrated that the possible cause-and-effect relationship between diabetes and periodontal disease might be approached from the reverse.

In a 1997 study published by the Journal of Periodontology, a group of 113 Pima Indians with both diabetes and periodontal disease were given periodontal treatment, which reduced both the inflammation in their gums and made their diabetes more manageable. This relationship between the diseases has encouraged questions in the medical field that are only recently being analyzed. New research presented at the April 2001 American Academy of Periodontology (AAP)/National Institute of Dental and Craniofacial Research (NIDCR) symposium in Bethesda, Md., attempted to show that chronic periodontal disease may, in turn, be a risk factor for diabetes.

"Periodontal disease causes pockets to form in the gums, allowing bacteria to enter," said Iacopino, a presenter at the symposium. "The bacteria can then enter the blood stream and activate immune cells. You can think of it as a self-destructive reaction. You have immune cells that are producing biological signals -- called cytokines -- that are destructive to many organ systems." Most importantly for diabetics, insulin production takes place in the pancreas, a region of the body where cytokines can be particularly destructive to beta cells. Once this happens, it may induce Type 2 diabetes, even in otherwise healthy individuals with no other risk factors for diabetes, he said. And even if you are a diabetic who practices regular blood-sugar control, that doesn't mean you're safe from complications. "Even for diabetes patients that are well-controlled, with serum glucose levels in the normal range, some still have many problems with periodontal disease. There seems to be more of a connection between the cholesterol and the triglyceride levels in those patients and their periodontal condition," Iacopino said. His research, which incorporated studies of blood profiles on both diabetic and non-diabetic patients with and without periodontal disease, noted a significant relationship between the levels of cholesterol and triglycerides and the severity of the patients' periodontal disease. In both diabetics and non-diabetics with periodontal disease, Iacopino found connections with the serum lipid levels that were not evident with the serum glucose at all. Such connections have spurred international interest in the subject. Researchers in Sweden analyzed diabetic patients with high glucose levels, as well as diabetic patients with high lipids levels, and their findings were congruous with Iacopino's -- patients with high lipid levels, not high glucose levels, had more incidences of periodontal disease. Iacopino said that the next step will be to perform clinical studies and, in fact, his research team will initiate the first phase of a group of studies in July at Marquette University's School of Dentistry. His group plans to study diabetic and non-diabetic patients, inserting omega3 fish oil supplements into their diets in an attempt to adjust their lipid levels more favorably. "We're going to be looking at how their bodies respond to that, what happens to their periodontal condition, and if periodontal treatment is more effective when patients are taking the lipid lowering supplements. And that's just the beginning," he said.

The goal is to observe patients over time and analyze what is happening to their diabetic conditions, to see whether they are developing diabetes to the same extent as patients that aren't being subjected to those t therapies and interventions. But clinical studies will face many bumps in the road. Iacopino said that it might be difficult to get such a study approved, because it involves ethical issues on whether researchers can simply watch someone develop diabetes.

According to Iacopino, it will be several years before there will be some kind of epidemiological survey or any other kind of clinical data that directly links the progression of periodontal disease to the development of diabetes. "All we can do right now is say that the connection makes sense. The science that supports it in different areas makes sense. The absolute proof is going to be that clinical study," he said. Iacopino advised that, for now, the best method diabetics can use to improve their quality of life and general oral health is to employ lipid-reduce therapies. Everything the doctor tells you to do that you don't want to -- eat a low-fat diet, exercise, take necessary medication -- will be well worth the effort. Especially for smokers, who should pay special attention to their oral health -- smoking increases the likelihood of developing a form of periodontal disease by five times. In addition, smokers with diabetes age 45 or older are 20 times more likely to get a form of periodontal disease than someone without these risk factors. So, for diabetics and non-diabetics alike, a trip to the periodontist is a trip worth taking.