When diabetics have their regular check-up, they are screened for problems that diabetes mellitus could cause to the eyes, kidneys, heart, the brain and the peripheral vascular system. Well, add one more: dental problem. Efforts to create awareness on end-organ damage gets restricted mostly to loss of vision, kidney failure, heart attack, stroke and loss of sensation as blood flow thins out in the limbs. All these are a one-way affair, wherein uncontrolled diabetes inflicts damage—sometimes irreversible—to vital organs. But, gum diseases and diabetes feed on each other.
If you are diabetic and have a gum disease such as periodontitis, diabetes aggravates it, and the gum disease impacts the other way round too. A mouth ulcer or an abscess in the mouth is bound to raise the reading by 30 to 40 points, diabetologists point out. “Nowadays, we ask diabetics, both new and old cases, to undergo a dental evaluation for periodontitis,” says Calicut Diabetes Forum secretary S.K Suresh Kumar. “We found that after periodontitis is treated and the inflammation in gums removed, the blood sugar level drops,” he said.
“Sometimes, we may miss it (the gum disease factor) when a hyperglycaemia patient comes for evaluation. The focus might have been on other factors that could cause damage to other organs. In order to avoid this, oral health evaluation is being made an integral part of diabetes management,” he said.
“Overall, 10 per cent to 15 per cent of adults have periodontitis. Diabetics have three times greater chance of getting this disease,” he says.
Nutritional deficiency is said to add to the factors that cause periodontitis, the diabetologist explains. Diabetics do not have the normal nutritional level as they have to give up various food items in order to keep their glycaemic level normal. Periodontitis can set in when immunity is low. Chronic destructive periodontitis is a persistent condition of weak gums whose minute retraction allows access for plaque and bacteria to eat away at the root of the dental structure. Left untreated and with poor oral hygiene, the situation worsens to loss of bone and the tooth.
A gum flap surgery has to be done in extreme cases by retracting the gum and cleaning the teeth up to the root. “In diabetics, there are two theories that suggest what causes the problem. One is that anti-diabetic drugs reduce production of saliva, which has the ability to flush bacteria out. The other is high glucose level in saliva that helps bacteria thrive,” says Dr. Suresh Kumar.
If the diabetic is also a smoker, it is a time-bomb planted in the mouth.
(Reporting by K.V. Prasad)