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Diabetes mellitus (DM) is a major global health issue, affecting over 460 million adults worldwide, with projections of continued growth. Beyond its impact on blood sugar, diabetes is closely linked to oral health problems, particularly periodontal (gum) and peri-implant (around dental implants) diseases. Recent research clarifies that these connections are not only strong but often bidirectional, meaning diabetes can worsen oral disease.
Multiple studies confirm that people with diabetes are at significantly higher risk for periodontal and peri-implant diseases. The risk is not just about having diabetes but is closely related to how well blood sugar is controlled. Chronic high blood sugar, measured by HbA1c, is a more significant risk factor than the specific type of diabetes. Poor glycemic control leads to more severe gum disease, increased bone loss, and higher rates of tooth loss and implant complications.
The relationship between diabetes and oral disease is two-way: diabetes increases the risk and severity of gum and implant disease, while gum disease can make diabetes harder to control. Treating gum disease has been shown to improve blood sugar levels, with interventions like deep cleaning reducing HbA1c by about 0.4% for several months.
High blood sugar in diabetes leads to the formation of advanced glycation end products (AGEs), which promote inflammation and tissue damage. AGEs interact with receptors in the body, triggering the release of inflammatory molecules and reactive oxygen species. This environment makes the gums more susceptible to infection and less able to heal. The immune system in people with diabetes is also less effective at fighting bacteria in the mouth, resulting in more severe and persistent infections.
The evidence is clear: diabetes and periodontal/peri-implant diseases are bidirectionally associated, and this relationship appears to be causal, especially when diabetes is the primary factor. Chronic hyperglycemia is the main driver of oral disease severity, regardless of diabetes type. Patients with poor glycemic control consistently show worse periodontal outcomes, higher tooth loss rates, and increased peri-implantitis risk.
Beyond inflammation, changes in the oral microbiome likely contribute to disease progression, but the exact mechanisms are still being studied. Another critical gap is the lack of coordination between medical and dental professionals. Physicians often overlook oral health screening, while dentists may miss opportunities to identify undiagnosed diabetes.
| Role | Key Actions |
|---|---|
| Physicians | Screen for gum disease; educate patients on the oral-diabetes link |
| Dentists | Test HbA1c in high-risk periodontal cases; advocate for metabolic health |
Managing both diabetes and oral health together is essential. Good blood sugar control and good oral hygiene are necessary to prevent complications. Treating gum disease can help improve diabetes management and reduce systemic complications. Closing the gap between medical and dental care is the next critical step in addressing this dual health burden. This approach not only preserves teeth but also improves overall health outcomes for people with diabetes.
Enteghad S, Shirban F, Nikbakht MH, Bagherniya M, Sahebkar A. Relationship Between Diabetes Mellitus and Periodontal/Peri-Implant Disease: A Contemporaneous Review. Int Dent J. 2024 Jun;74(3):426-445. doi: 10.1016/j.identj.2024.03.010. Epub 2024 Apr 12. PMID: 38614881; PMCID: PMC11123523.
