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Dentists at the Front Line in Diabetes Epidemic

THURSDAY, Feb. 23, 2017 (HealthDay News) -- You'd probably be surprised if your dentist said you might have type 2 diabetes. But new research finds that severe gum disease may be a sign the illness is present and undiagnosed.

The study found that nearly one in five people with severe gum disease (periodontitis) had type 2 diabetes and didn't know it. The researchers said these findings suggest that the dentist's office may be a good place for a prediabetes or type 2 diabetes screening.

"Be aware that worsened oral health -- in particular, periodontitis -- can be a sign of an underlying [condition], such as diabetes," said study author Dr. Wijnand Teeuw. He's the chief of the periodontology clinic at the Academic Center for Dentistry Amsterdam in the Netherlands.

"Early diagnosis and treatment of both periodontitis and diabetes will benefit the patient by preventing further complications," Teeuw added.

Diabetes is a worldwide epidemic. In 2010, it was estimated that 285 million adults worldwide had diabetes. By 2030, that number is expected to rise to 552 million, according to the study authors. It's suspected that as many as one-third of people who have diabetes are unaware they have the disease.

Untreated, diabetes can lead to a number of serious complications, such as vision problems, serious kidney disease, heart trouble and infections that take a long time to heal, according to the American Diabetes Association.

Periodontitis -- an infection that causes inflammation of the gums and destruction of the bones that support the teeth -- is often considered a complication of diabetes, Teeuw said.

The current study included more than 300 people from a dental clinic in Amsterdam with varying levels of periodontitis or healthy gums. Approximately 125 had mild to moderate periodontitis and almost 80 had severe periodontitis. The rest had healthy gums.

The researchers tested blood sugar levels in all of the study participants using a test called hemoglobin A1c. This test provides an average of blood sugar levels over two to three months.

In people who had never been diagnosed with diabetes, the researchers found that 50 percent of the group with severe gum troubles had prediabetes, and 18 percent had type 2 diabetes. In the mild to moderate group, 48 percent were found to have prediabetes and 10 percent learned they had type 2 diabetes.

There were even significant numbers of people in the healthy gums group that had prediabetes -- 37 percent had prediabetes and 8.5 percent had type 2 diabetes, the study revealed.

Dr. Sally Cram, a periodontist and a spokeswoman for the American Dental Association, said she sees what the study found in her practice every day.

"I see quite a few patients who don't know they have diabetes, and when they don't respond normally to periodontal therapy, I have to say, 'Go to your doctor and get tested for diabetes,'" she said.

And, on the other side, she explained that people with uncontrolled diabetes often see improvement when their gum disease is under control.

"People with diabetes aren't as able to fight inflammation and infection," Cram explained.

Diabetes specialist Dr. Joel Zonszein said frequent or slow-to-heal infections are important signs of diabetes.

"People often come in with severe infections in the skin, and I think it's probably the same for infections in the mouth. People have been living for years with high blood sugar, and even if they go to the dentist, they don't get their blood sugar checked," Zonszein said.

"The relationship between diabetes and gum infections goes two ways. When you improve one, you also improve the other," he added. But it's not clear which comes first, and this study didn't prove a cause-and-effect relationship, only an association, Zonszein noted.

But the findings do show the importance of collaboration between health care providers, according to Zonszein, who is the director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.

Cram noted that basic prevention goes a long way toward preventing gum disease.

"Ninety-nine percent of dental problems and disease are preventable. Brush your teeth twice a day and floss once, and see your dentist periodically," she recommended.

Warning signs of gum disease include bleeding gums, receding gums, sensitive teeth, loose teeth, bad breath or a bad taste in the mouth.

The study was published online Feb. 22 in BMJ Open Diabetes Research & Care.

More information

Learn more about the connection between diabetes and oral health from the American Diabetes Association.

SOURCES: Wijnand Teeuw, D.D.S., M.Sc., chief, periodontology clinic, Academic Center for Dentistry Amsterdam, The Netherlands; Sally Cram, D.D.S., P.C., periodontist, Washington D.C., and spokeswoman, American Dental Association; Joel Zonszein, M.D., director, Clinical Diabetes Center, Montefiore Medical Center, New York City; Feb. 22, 2017, BMJ Open Diabetes Research & Care, online

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