DIABETES AND PERIODONTAL DISEASE:

 DIABETES AND PERIODONTAL DISEASE:

Establishing the connection

The character and epidemic proportions that diabetes has reached worldwide are known to all. On the other hand, it is established that periodontal disease is the most common infection in humans.

Relationship: diabetes and periodontal disease

The relationship between diabetes and periodontal disease is well established. Periodontal infection represents a complication that alters the systemic physiology in diabetic patients since it can go beyond being a localized infection. The severity and chronicity of the disease result in the rupture of the gingival tissue and, even, of the bone.

The relationship between diabetes and periodontal disease is a good example to understand a systemic disease that predisposes an oral pathology that, once established, exacerbates the progression of systemic disease. This is even more serious and complex when diabetes is not controlled. The reason for all this lies in the accumulation of advanced glycation end products (AGEs: “advanced glycation end products”) and an exaggerated response at the gingival level. Bacterial products, such as endotoxins and lipopolysaccharides, also play an important role in the spread of the inflammatory response. Porphyromonas gingivalis and monocytic cells play an important active role in this. Porphyromonas gingivalis are gram-positive coccobacilli, highly prevalent in both chronic and aggressive periodontitis and rarely seen in a healthy periodontium.

Periodontitis and cardiovascular disease in patients with diabetes

Different studies have associated periodontal disease with coronary atherosclerosis and bacterial DNA has been found in atherosclerotic plaques. It is presumed that this could be due to the increase in inflammatory cytokines that, in turn, affect the coronary endothelium at an earlier age.

Prevention and therapeutic recommendations

Gingivitis, which is characterized by inflammation of the gums, precedes periodontitis and must be treated in time. There may be halitosis and a bad taste in the mouth, slight bleeding when brushing the teeth, and even recession of the gum root. Treatment consists of brushing at least 2 times a day, flossing, and visiting the dentist for cleaning at least every 6 months. Additionally, rinses (Listerine, Peridex, and rinses containing triclosan, approved by the American Dental Association Council on Dental Therapeutics) can be used. If the infection is advanced, antibiotics such as amoxicillin and / or clindamycin should be used, in case of allergy to penicillins.

In the event that the antibiotics are not enough and the disease progresses - together with the uncontrolled diabetes - a deeper dental surgery may be necessary, to be performed by a dental subspecialist. Proper management of this problem is important as this can lead to tooth loss and bone infection, and develop into a dental catastrophe.

Commentary

Due to the frequency of this problem, it is important that we recommend to patients with diabetes that, in addition to having good control of diabetes by keeping their glycosylated hemoglobin (HgA1c) below 7.0, it is very important to maintain good oral hygiene, minimize the intake of simple sugars - especially before going to bed - and brush your teeth at least twice a day.