Thursday, 23 February 2017

Gum Disease: Periodontitis Could Be An Early Sign Of Diabetes


Severe gum diseases known as periodontitis could show sufferers have type 2 diabetes.

But dentists could help screen those at risk with a simple finger pin-prick to detect blood sugar levels.

University of Amsterdam researchers said the test would be cost effective in spotting those with pre-diabetes where blood sugar levels above the normal range, but not high enough to be diagnosed as having diabetes.

It could also help stop people losing their teeth - a common problem in periodontitis sufferers.

Diabetes is difficult to detect and it is estimated a third of people who have it are undiagnosed.

More than one in 16 Britons have diagnosed or undiagnosed diabetes - nine out of ten with type 2.

It affects an estimated 3.9 million people with numbers increasing.

Dr Wijnand Teeuw of the University of Amsterdam said: "The early diagnosis and intervention of (pre)diabetes prevent the common microvascular and macrovascular complications and are cost-effective.

"Therefore, risk indicators for (pre)diabetes screening are needed and proposed.

"In this respect, the onset of several oral pathologies might be indicative of metabolic dysregulation.

"Several studies demonstrate the association between diabetes and oral diseases.

"The most commonly observed chronic oral disease is periodontitis.

"The severe form of this condition occurs in an estimated 10 to 15 per cent of the population, and the prevalence is twice as high in subjects over 50 years of age.

"Many studies have demonstrated that diabetes mellitus severely exacerbates the onset, progression, and severity of periodontitis.

"The prevalence of periodontitis in patients with diabetes is estimated to be two or even three times higher than in an otherwise healthy population.

"In addition, periodontitis is strongly associated with uncontrolled diabetes mellitus.

"This is because subjects with diabetes, particularly subjects with uncontrolled diabetes, are more susceptible to infections and impaired wound healing; therefore, periodontitis is considered to be a complication of diabetes mellitus.

"With this knowledge, it has been suggested that dentists could help screen for (pre)diabetes.

"The majority of dental practices are not equipped for blood biochemistry.

"The measurements of glycated hemoglobin (HbA1c) using dry blood spots may be a conservative way to screen for diabetes in patients with periodontitis."


The study published in the journal BMJ Open Diabetes Research & Care analysed 313 predominantly middle-aged people attending a university dental clinic.

Of these, 109 had no gum disease, 126 had mild to moderate gum disease and in 78 it was severe, affecting the supporting structures of the teeth.

Those with severe gum disease were more overweight with an average BMI of over 27 but other risk factors for diabetes, including high blood pressure and high cholesterol levels, were similar among all three groups.

And people with mild to moderate gum disease also had more relatives with diabetes than those with no or severe gum disease.

Just under three per cent of those with no gum disease had already been diagnosed with type 2 diabetes.

This was also the case for four per cent of those with mild to moderate gum disease, and for nearly eight per cent of those with the severe form.

An HbA1C value of 39-47 mmol/l is considered to indicate 'pre-diabetes' while values above that indicate diabetes.

Blood tests found HbA1C values were highest in those with the most severe form of gum disease.

Their average HbA1C value was 45 mmol/l, compared with 43 mmol/l in those with mild to moderate gum disease and 39 mmol/l in those with no gum disease.

Previously undiagnosed cases of diabetes were found in all three groups: 8.5 per cent of those with no gum disease; just under 10 per cent of those with mild to moderate gum disease; and nearly one in five (18 per cent) of those with the severe form.

Dr Teeuw concluded: "On average, patients with periodontitis showed higher HbA1c plasma levels compared with individuals without periodontitis.

"Among the subjects with severe periodontitis whose metabolic status was unknown, 18 per cent of suspected new diabetes cases were identified.

"Here, we show that periodontitis is an early sign of diabetes mellitus and may therefore serve as a valuable risk indicator.

"A dental office that treats patients with periodontitis is a suitable location for screening for diabetes by a simple finger stick and validated HbA1c dry spot analysis."



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