As the prevalence of diabetes grows in the United States and elsewhere, health care providers including dental providers are striving to help patients prevent and manage the effects of the disease. With regard to oral health, these effects can be significant. Xerostomia (dry mouth), recurrent oral candidal infections, and increased risk of postoperative infection after surgical dental procedures such as extractions are all more common among patients with diabetes. It is yet unclear whether people with diabetes experience more caries (tooth decay); however, diminished salivary flow and xerostomia-inducing medications (e.g., anti-hypertensive agents) are both important risk factors and may play a role.
Most notably, type 2 diabetes and periodontal disease are strongly correlated in the scientific literature, with some going so far as to call periodontal disease the sixth major complication of diabetes after retinopathy, nephropathy, neuropathy, cardiovascular disease (CVD), and poor wound healing. In moderate and advanced stages, there is a progressive destruction of connective tissue of the periodontium, including ligaments and bone that hold teeth in place. People with type 2 diabetes are more susceptible to periodontal disease than those without diabetes, and their disease is more likely to result in tooth loss.
Also of concern is persistent inflammation associated with chronic periodontitis and the deleterious impact of inflammatory mediators on metabolic control. Unmanaged diabetes is a primary risk factor for the progression of periodontal disease, and unmanaged periodontal disease appears to contribute to elevated blood glucose. The cycle can seem rather hopeless, but more optimistically, recent studies suggest that management of periodontal disease with nonsurgical treatment may actually help contribute to the management of glycemic control.
The link between oral and systemic health is firmly established, and in the case of diabetes, the best evidence.