Diabetes and Periodontitis

Introduction:

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 sugar. 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 during pregnancy.

What Is Periodontitis?

Periodontitis is a condition where periodontal health is compromised. 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 poor immune systems. Their antibodies cannot fight against the body's immune system. The abnormal levels of sugar are making a person more susceptible to infections followed by the destruction of the periodontal tissues. The essential complication of diabetes is periodontitis and periodontal abscess. The ratio of periodontitis in diabetic and non-diabetic patients is 59.6 percent to 39 percent. The other complications of diabetes are

• Local gingival irritation.

• More significant alveolar bone loss.

• Gingival bleeding.

• Tooth mobility increases, and it might result in tooth loss.

What Are the Other Causes of Periodontitis?

The development of periodontitis starts with a condition known as plaque (the sticky layer that is composed mainly of bacteria) and calculus.

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

• Plaque matures to form calculus below the gum line into tartar, which is known as calculus. Tartar is frequently filled with bacteria and is very difficult to remove with normal brushing. These calculi have a tendency to destruct the periodontal health of the patients.

• Brushing and flossing can help to remove tartar. However professional dental cleaning is required to remove the plaque which causes gingivitis. 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.

• Periodontitis, which is a condition where pockets of pathogens, plaque, and tartar eventually form between the teeth and gums, can be brought on by gingival inflammation. subsequently, additional pathogenic organisms begin to accumulate in these pockets. If left untreated, these deep infections result in bone and tissue loss, which may result in the loss of one or more teeth. Also, ongoing chronic inflammation can cause strain on the concerned individual's immune system. However, 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 get mobilized. This is considered to be an advanced stage of gingival disease. Mainly adults who belong to the age group of the 50s to 60s are more prone to gingival disease. 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.

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.

What Are the Diagnostic Criteria for Periodontal Diseases?

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 periodontal disease progresses gradually, the pockets get deeper.

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. However, 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. In the treatment of advanced periodontitis, many surgical approaches are used, which also include

• Osseous Surgery - The removal of pathogens that exist within pockets is accomplished through osseous surgery, commonly referred to as pocket reduction surgery.

• Open Flap Debridement - In this procedure the gingiva is cut to allow access for scaling and root planning while also exposing the teeth's supporting alveolar bone and root surfaces.

• Tissue Regeneration - The process of renewal and growth used to treat or replace diseased or damaged tissue is known as tissue regeneration.

• Bone Grafting - A surgical procedure called bone grafting restores missing bone.

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.

How to Prevent Periodontitis?

• Advice to brush the teeth with a suitable toothbrush and toothpaste at least twice a day.

• The use of interdental flossers helps in cleaning the teeth in between, 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.

• Additional care is needed when cleaning around the uneven surfaces of teeth.

• The use of an antibacterial mouthwash after brushing bits helps in preventing bacteria from growing and reduces any inflammatory reaction in the mouth.

Conclusion:

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 to evaluate gum and teeth health followed by appropriate treatment.