Dental Treatment might lower Glucose Levels in Type 2 Diabetes

Newswise, May 2010 — Routine dental treatment can reduce blood glucose levels in people with type 2 diabetes who have preexisting gum disease.

Researchers analyzed seven studies of people ages 16 and older with either type 1 or type 2 diabetes who had periodontitis, a bacteria-caused disease that attacks the gums, tissue and bone that support the teeth.

After combining data for 244 patients from the three most pertinent studies, the researchers concluded that treating gum disease could have small but beneficial implications for people with type 2 or “adult-onset” diabetes.

“It would be wise to advise these patients of the relationship between treating periodontal disease and the possibility of lowering their blood sugar levels,” said Terry Simpson, lead author at the Edinburgh Dental Institute, in Scotland.

 “Additionally, an oral health assessment should be recommended as part of their routine diabetes management.”

There was not enough available evidence to support similar benefits for people with type 1 diabetes.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research.

Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The reviewers caution that the possible benefits come from only three small studies. Larger, randomized trials are necessary to further study periodontal treatment and outcomes.

Simpson said most dentists as well as doctors are unaware of the possible link between periodontal disease and diabetes.

“Among those who are aware of the connection some may be skeptical about the link,” said Simpson, who is a general dental practitioner.

“Diabetes is on the rise and we are seeing more people with perio problems. Most periodontists are aware of the relationship between diabetes and perio disease,” said Sally Cram, D.D.S., a consumer advisor for the American Dental Association and a periodontist practicing in Washington, D.C.

“Some physicians are aware of the association, but they don’t always explain it to the patient. However, I am seeing more referrals from physicians who tell patients to see a periodontist and get their gum health under control.”

Diane Elson, M.D., a clinical professor of medicine in the endocrinology division of the University of Wisconsin School of Medicine and Public Health, said, “We are trying to increase awareness of the relationship between diabetes control and periodontal disease. In addition to the effects on glycemic control, periodontal disease is also linked to cardiovascular disease — the leading cause of death in people with diabetes.”

Controlling blood glucose levels is critical for people with diabetes. Glucose is a sugar that comes from food, but the body also forms and stores glucose.

If blood glucose levels are too high, the patient might face complications. If these levels are high routinely, that person could be at risk for heart disease, stroke, kidney disease and other health problems.

“Treatment can reduce the amount of bacteria and inflamed tissue in the gums,” Simpson said “The presence of bacteria and inflamed tissue is thought to produce chemical changes which affect the action of insulin and in turn raises the circulating levels of sugar in the blood stream.

"By resolving this with periodontal treatment, the patient might experience a lower blood sugar level over a period of time.”

Cram said, “I have seen several patients who have no idea they are diabetic, but after seeing how poorly they respond to therapy, I have recommended they be tested for diabetes. Once we get the diabetes under control, we are only then able to make progress in getting the perio disease under control.”

Simpson said that those who are responsible for health policy and promotion might want to increase awareness of the connection between periodontal disease therapy and diabetes control.

“Treatment for periodontal disease is well-established and widely available in many developed countries,” he said. “When diabetes support networks are planned it is important that health care professionals and patients become aware of this association.”

Elson agreed but added, “While we encourage patients to seek regular dental care, it is not always a priority unless there is obvious advanced disease. Lack of dental insurance is often a barrier to care.”

Cram said the take-home message is simple: “If you are diabetic and having trouble controlling your blood glucose, have a dental check-up to see if your gums might be part of the issue.”

The Cochrane Library (http://www.thecochranelibrary.com) contains high quality health care information, including Systematic Reviews from The Cochrane Collaboration.

These reviews bring together research on the effects of health care and are considered the gold standard for determining the relative effectiveness of different interventions.

The Cochrane Collaboration (http://www.cochrane.org) is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.

Simpson TC, et al. Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database of Systematic Reviews. Issue 5, 2010.