Diabetes and Your Gums: The Troubling Link Between the Disease and Periodontitis

Daniela Gurpegui Abud, D.D.S., Assistant Clinical Practice Leader and Assistant Professor of Dental Medicine

November 25, 2020
Dr. Daniela Gurpegui Abud

In 2019, it was reported that 34.2 million Americans - just over 1 in 10 - have diabetes. Those diagnosed are often counseled by their general practitioners, and endocrinologists, on how to manage glucose levels, practice healthy habits, and how to be prepared for emergencies. But according to TCDM Associate Professor of Dental Medicine and Assistant Clinical Practice Leader at Touro Dental Health Dr. Daniela Gurpegui Abud, there is another important health risk they should be aware of -- one that could cause permanent damage to your smile.

Periodontitis is a gum disease that damages the soft and hard tissue and, without treatment, can destroy the bone that supports your teeth.  Though considered common - estimates of 3 million cases per year of periodontitis are reported - the damage of bone loss caused by periodontitis is irreversible and as such, a problem that Dr. Gurpegui Abud says all people, and diabetics in particular, should be aware of.

As both a periodontist, and a recently diagnosed Type 1 diabetic, Dr. Gurpegui Abud says most of her patients are not aware of the association between diabetes and periodontitis, until she prompts the question, ‘how are you managing your diabetes?’

“‘Diabetes,’ they ask. ‘What does that have to do with my teeth?’ And I tell them. ‘Well, a lot. They affect each other,’” says Dr. Gurpegui Abud.

“I was in my last year of my Periodontics training when I was diagnosed with Type 1 diabetes. The first thing I asked was, ‘aren’t I too old to have Type 1?’ And that was the first misconception I learned from.”

Firstly, to understand this link, it’s important to note that both diseases have something in common - the key words here are systemic inflammation.

Diabetes is related to systemic inflammation, and so is periodontal disease, so these comorbidities increase the risk for each other. In patients with periodontitis, diabetes is associated with elevated cytokines and other mediators in fluids of the mouth, proving to cause that increased inflammation. In turn, in patients with diabetes, hyperglycemia triggers increase oxidative stress that also affects the mouth, which could lead to worsening of the periodontal disease.

A person experiencing gums that bleed or are swollen, a bad taste in their mouth, bad breath, loose teeth, or high amounts of tartar may be suffering symptoms of periodontitis. The trouble, according to Dr. Gurpegui Abud, is that you can also have periodontitis and have no symptoms at all.

“That’s why it’s necessary to focus on your oral health regardless,” Dr. Gurpegui says. “But for anyone diagnosed with diabetes, it’s even more important to make an appointment with your dentist, especially if you’ve been affected by any of the symptoms.”

To determine if you have periodontitis a dentist will perform a clinical examination measuring the ‘pockets,’ or distance between the gum line and your bone, and will analyze your x-rays. 

Left untreated, periodontitis can lead to permanent effects such as tooth loss altogether. But, according to Dr. Gurpegui Abud, there are ways to be proactive in the fight against periodontitis.

“A lot of people think they need an expensive toothbrush to get the job done. It’s not necessarily about having better tools. The best tool depends on what is best for the patient. An electric toothbrush is better for those who have less dexterity, or superficial staining on their teeth, but that doesn’t mean if you're using a manual toothbrush, you can’t be efficient with your oral health.”

So, what can you do to prevent periodontitis?

“First, if you have any of the symptoms related with gum disease, or have been diagnosed with diabetes, see your dentist for a checkup and be sure to schedule regular cleanings, according to what your dentist has suggested.” says Dr. Gurpegui Abud, who suggests patients diagnosed with periodontal disease should get 4 cleanings a year, once every 3 months. “Secondly, brush twice a day, for two minutes each session and make sure to ask your dentist to show you how to brush your teeth, there is a specific technique you should use.”

Lastly, she suggests flossing or using an interdental brush every day and making sure to clean your tongue every time you brush your teeth.

“There is an undeniable link between your overall health and your oral health,” shares Dr. Gurpegui Abud. “Ensuring that you are taking these preventative measures on your own, in addition to communicating with your dentist any questions or concerns you may have has the potential to make a huge impact on your overall quality of life.”