Overview:

Blood is an important component of the body. All the electrolytes and sugars have to be maintained in the ideal amounts for healthy living. Conditions like chronic diabetes will lead to systemic problems. These systemic issues will be visible in the oral cavity too. Any oral lesions in a diabetic patient should be considered seriously.

What is Diabetes?

Diabetes is a condition where there is an increased level of blood sugars. It is of three types. They are type 1, type 2, and gestational diabetes. Type 1 most frequently occurs in children. Type 2 is common in older people. The other type is gestational diabetes, which occurs in pregnancy.

What is Periodontitis?

Periodontitis is a condition where there is poor periodontal health. This includes the following:

Inflammation in the gums.
Severe inflammation will result in the loosening of the teeth.
Bleeding of the gums that are accompanied by pain.

Why Does Periodontitis Occur in Diabetic Patients?

Diabetes and oral health are always interlinked. Diabetic patients have a poor immune system. Their antibodies cannot fight against the body's immune system. This weakened condition of the body makes an individual more prone to dental conditions. The abnormal levels of sugar are making a person more susceptible to infections. When an individual becomes more prone to infections, then the destruction of the periodontal tissues will be noted, and in some patients, calcified structures could be noted in on the blood vessels that are present in the gingiva. In a few other patients, color changes in the gingiva are also seen.

The essential complication of diabetes is periodontitis and periodontal abscess. The ratio of periodontitis in diabetic and non-diabetic patients is 59.6%:39%. This difference is a notable one, and the diabetic patients also face other complications such as:

Local gingival irritation.
More significant alveolar bone loss.
Gingival bleeding.
Tooth mobility increases, and it might result in tooth loss.
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What Are the other Causes Of Periodontitis?

The development of periodontitis starts with a condition known as plaque in most people. It is a sticky layer that is composed mainly of bacteria.

Plaque forms on a person's teeth when bacteria starts to interact with starches and sugars that are present in the food in their mouth. Brushing your teeth twice a day and flossing one time a day can help in the removal of plaque. However, plaque re-forms quickly.

Plaque can become hard below your gum line into tartar, which is known as calculus. Tartar is frequently filled with bacteria, and it's very difficult to remove. If plaque and tartar stay permanently on a person's teeth for a longer period of time, it may cause more damage to your teeth. Brushing and flossing can help to remove tartar. You might also need professional dental cleaning to remove it.

Plaque can cause gingivitis in some patients. Gingivitis can be defined as irritation and inflammation of the part of the gum tissue, which is seen around the base of the teeth. Professional treatment and good hygienic oral care may help in reversing gingivitis.

Gingival inflammation can cause periodontitis, eventually causing pockets to develop between your gums and teeth that fill with plaque, tartar, and bacteria. Later, these pockets get filled with more bacteria. These deep infections cause a loss of tissue and bone if not treated, leading to losing one or more teeth. Also, ongoing chronic inflammation can cause strain on the concerned individual's immune system.

The saliva present in the oral cavity acts as a self-cleanser and will try to remove the plaque. The deposition of the plaque and calculus will happen at a higher rate in diabetic patients.

What Is the Epidemiology of Periodontitis?

The immune system steps to fight the toxins, breaking down the bone and tissue that connect the teeth to the gums. Later, the teeth will have to be removed. This is considered to be an advanced stage of gingival diseases. Mainly adults who belong to the age group of the 50s to 60s are easily affected. The condition has now started to decline worldwide gradually.

What Are the Risk Factors of Periodontal Disease?

The risk factors of periodontal diseases are:

Age.
Smoking or tobacco use.
Genetics.
Stress.
Medications.
Clenching or grinding your teeth.
Other systemic diseases.
Poor nutrition
Obesity.

It is advised for diabetic people to look after these risk factors as they are the people who should be extra careful.

What Are the Symptoms Of Periodontitis?

The symptoms of periodontitis are:

Bad breath.
Red or swollen gums.
Tender or bleeding gums.
Pain during chewing.
Lose teeth.
Sensitive teeth.
Receding gums.
Longer appearing teeth.

How is Periodontitis Diagnosed?

Periodontal disease is diagnosed by using a thorough and focused periodontal examination. This examination is very frequently a part of a regular dental checkup. A periodontal probe is a small dental instrument that is gently used to measure the sulcus depth. A healthy sulcus measures a depth of three millimeters or less and does not bleed. The periodontal probe helps in the identification of pockets that are deeper than three millimeters. However, as the periodontal disease progresses gradually, the pockets get deeper.

How Is Periodontal Disease Treated in Diabetic Patients?

Diabetic patients should always have glycemic control. The prognosis is good for patients who have control over the levels of blood sugar. Treatment is primarily performed and aimed at removing the plaque and bacterial deposits on the affected person's teeth and gums.

It is best to always approach a dentist, and he or she will give you proper guidance on how to reduce the number of bacteria in your mouth. This will help in maintaining your teeth and gums clean. Even dentists will give you advice about the method of using toothbrushes and dental floss properly. They may also recommend other oral hygiene products like a water pick or mouthwash.

Below mentioned are the few steps of treatment.

Brush your teeth twice a day with fluoride toothpaste.
It is necessary to get your blood sugar level checked once or twice a month.
Using an electric brush is very useful.
Floss at least once a day. It helps in removing plaques.
Have a dental checkup at least twice a year for a professional cleaning.
Stop smoking and avoid chewing tobacco.

How Is The Surgery Performed For Periodontal Disease?

Before performing surgery for diabetic patients, a routine blood examination will be required to assess the levels of glucose. An additional evaluation of the bleeding time and clotting time would be required for a successful surgical procedure.

Suppose non-surgical therapy is found to be unsuccessful in managing the signs of disease activity. In that case, periodontal surgery may be suggested to stop successive bone loss and regenerate lost bone where possible. For the treatment of advanced periodontitis, many surgical approaches are used, which also includes osseous surgery and open flap debridement, as well as suggested tissue regeneration and bone grafting. The primary aim of periodontal surgery is definitive calculus removal and surgical management of the bony irregularities, which have resulted from the disease itself. It also aims to reduce pockets as much as possible. Specific procedures are not recommended for diabetic patients. You should coordinate with your dentist for proper treatment planning.

What Are the Home Remedies?

Always brush your teeth with a suitable toothbrush and toothpaste at least twice a day. You can even consider using an electric toothbrush, which may be more effective.
Use interdental flossers to clean between the teeth, especially in the spaces that the brush cannot reach. Dental floss can usually clean only the small gaps, but a dental brush is required for a larger space.
Extra care is needed when cleaning around the uneven surfaces of teeth.
Use an antibacterial mouthwash once you complete brushing. This can help in the prevention of bacteria from growing and reduce any inflammatory reaction in the mouth.

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