The Important Connection Between Gum Disease and Diabetes – And Why We Should Be Treating Both Simultaneously

Did you know that your overall health has direct ties to the health of your teeth, gums, and saliva? There is a growing body of evidence demonstrating that improved oral heath can lead to greater overall wellness – and vice versa.

One connection that we’ve been exploring at the Forsyth Institute is the link between diabetes, type 2 diabetes – the most prevalent form of diabetes -  and gum disease. Over the past few decades, the global prevalence of diabetes has drastically increased and, according to the International Diabetes Federation, roughly 415 million adults worldwide currently have – a number that is expected to grow in the coming years. This global problem heavily impacts quality of life, lifespan, and overall healthcare costs.

What is little-known by many diabetes patients is the very real connection between diabetes and chronic periodontitis (CP), a severe form of gum disease, which can ultimately result in tooth loss. CP is often cited as a complication that can arise from diabetes, but what isn’t discussed as frequently is how this connection goes both ways. In our research and dental practice at the Forsyth Institute, we’re finding people with diabetes are not only more susceptible to serious gum disease, but that gum disease may also affect blood glucose control and contribute to the progression of diabetes.

Why Is CP and Diabetes a Two-Way Street?

According to American Diabetes Association, “people with diabetes are at an increased risk for serious gum disease because they are generally more susceptible to bacterial infection, and have a decreased ability to fight bacteria that invade the gums.” However, my research and that of others indicates that the increase in blood glucose resulting from gum disease may make it even more difficult for diabetic patients to control their blood sugar. Additionally, we found that periodontitis independently increases systemic inflammation that may have an impact on the control of diabetes and its complications, including cardiovascular disease. Therefore, we have reason to believe that patients could benefit from treating both diseases simultaneously, specifically by targeting the inflammatory responses that are characteristic of both CP and diabetes.

While acute inflammation serves a protective role against injury and infection, when prolonged and unresolved, it can impact other health problems such as obesity, cardiovascular diseases, arthritis, blindness, chronic kidney disease, and more, and can worsen the symptoms of CP and diabetes. Both CP and diabetes are characterized by increased inflammation and a disrupted immune response. However, despite these connections, treatments for patients with both diseases remain separate and do not deal with these common symptoms simultaneously.

In a study published by the American Society for Microbiology in the journal Infection and Immunity, it was demonstrated for the first time that “resolvins”, compounds naturally produced in the body from omega-3 fatty acids, have the potential to “shut off” chronic inflammation. In patients with diabetes, it is thought that CP influences the progression of diabetes through both inflammation and the diffusion of periodontal pathogens that contribute to insulin resistance, obesity and atheroma formation in arteries. Furthermore, periodontal infections can raise blood sugar, worsening control of diabetes and its complications. Based on this correlation between diabetes and CP, and evidence that resolvins play a crucial role in both diseases, an integrative approach that addresses the systemic inflammatory responses could go a long way towards improving outcomes and more importantly, preventing complications of unresolved inflammation in the body.

The main approach for treating diabetes is to control blood glucose levels and metabolic imbalances associated with hyperglycemia, and plaque control is the main approach for treating CP. While management of hyperglycemia in diabetes and pathogenic subgingival biofilms in CP are crucial for preventing disease progression and complications, resolving systemic inflammation is key to maintaining an effective immune response and restoring health, knowing that inflammation is what drives the alteration of tissues in both diseases.

Currently, there are few methods to treat the inflammation present in diabetes and CP. The first line of treatment for diabetes  targets increasing insulin sensitivity, but has little effect on inflammation.  Although still experimental, our new data suggest that natural control of inflammation with resolvins reduces inflammation in both type 2 diabetes and CP.  Resolvins also increase the efficiency of bacteria clearance reducing the bacterial load and pathogens in plaque. Our latest findings suggest that the bacteria in our gut may play important roles in obesity-related insulin resistance in diabetes and impact the composition of disease promoting bacteria in the mouth.  Investigating human-bacterial interactions along the digestive tract will shed new light on critical aspects of what drives disease onset and progression and how we can intervene to prevent it. Taken together, these findings suggest a new direction in the way we treat diabetes that could have a profound effect on the 415 million suffers of diabetes worldwide.

What else?

The connections between CP and diabetes are just the tip of the iceberg when it comes to the links between oral health and overall wellness, and we have a long way to go to deepen our understanding of our body and its complex interactions with our resident bacteria. In this case, and in many other instances, it boils down to understanding the inflammatory responses of our bodies systems, and recognizing that inflammation plays a key role in almost all disease. At the Forsyth Institute, we’re working day in and day out on the foundational research that will help to make these treatments and others a reality, with the ultimate goal of understanding health and wellness as a whole body, integrated system.

You can learn more about this research in our review paper published in Current Pharmaceutical Design, volume 22, issue 15.

 

By Corneliu Sima DMD, DSc, MSc, Dip. ABP

Assistant Clinical Investigator

The Forsyth Institute 

Thursday, January 26, 2017
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