From insight to action: Tackling diabetes and gum disease together

Initiated by the World Health Organization (WHO), World Health Day is internationally recognised on 7 Apr. The theme for this year, “My health, my right,” underscores the importance of health equity. Nina Garlo speaks with Prof Timo Sorsa and Dr Tommi Pätilä on the links between diabetes and gum disease.

diabetes gum disease
(Image: rawpixel.com/ Freepik)

Diabetes and gum disease intertwine, potentially worsening each other. Neglecting dental care in diabetes management escalates health risks and costs. Fortunately, advancements in dental technology are enabling faster diagnostics and tailored interventions, promising substantial benefits for both patients and society.

Diabetes and gum disease emerge as two prevailing global health challenges demanding urgent attention. With approximately half of the world’s population grappling with gum inflammation, diabetes presents itself as a significant and mounting concern, affecting nearly half a billion people worldwide.1,2

Understanding the crucial link

Diabetes impacts individual health and well-being but also imposes a considerable economic strain on societies. So, where does the close connection between the two illnesses stem from, and how can knowledge of the existing correlation help scientists provide future breakthroughs in diagnosing and treating both conditions?

Research shows that individuals with diabetes often exhibit increased systemic inflammatory markers, such as aMMP-8 found in their gingival tissues and oral fluids. Elevated long-term blood sugar levels, a condition known as hyperglycemia, contribute to heightened oxidative stress, inflammation, and apoptosis, i.e. programmed cell death, in the body. Concurrently, heightened inflammatory markers associated with periodontitis can exacerbate diabetes and compromise its management.3-11

Studies reveal that periodontitis, a chronic inflammatory disease of the supporting tissues of the teeth, progresses more rapidly and destructively in individuals with uncontrolled diabetes or those who have not yet been diagnosed. Periodontitis can also complicate diabetes management and increase treatment costs. Conversely, a healthy periodontium can balance diabetes and support its management.

According to Timo Sorsa, Professor of Oral and Maxillofacial Diseases at the University of Helsinki, the role of adipokines has also been considered when investigating the connection between diabetes and periodontitis.

Adipokines are signaling molecules secreted by adipose tissue that regulate various physiological processes, including metabolism, inflammation, and immune function. These proteins can predispose to both periodontitis and diabetes, especially in overweight or diabetic individuals.

The relationship between periodontitis and diabetes has similarly been explained by immune response dysfunctions.12-14 Diabetics, especially those with severe periodontitis, have been found to have dysfunctions in immune cell activity, which can increase tissue damage and inflammation.

Different forms of diabetes, such as type I and II diabetes, as well as gestational diabetes, affect the risk and progression of periodontitis differently. Type II diabetics have a higher risk of developing periodontitis, and good glycemic control is a key factor in managing this risk. Type I diabetics also have higher risks of developing periodontitis, and gestational diabetes can affect both maternal and fetal health.

According to research, periodontitis may even double the risk of developing gestational diabetes. The mechanism by which periodontitis influences gestational diabetes is not, however, fully understood. Elevated levels of inflammatory mediators in the bloodstream due to gum inflammation, combined with gestational diabetes, may serve as a basis for systemic, chronic inflammation.15-16

Prof Timo Sorsa and Dr Tommi Pätilä
From left: Prof Timo Sorsa and Dr Tommi Pätilä

Light-activated technology for a healthier mouth and body

Dr Tommi Pätilä, a cardiac and transplant surgeon at the New Children’s Hospital at HUS, notes that the treatment of periodontitis in diabetics demands special attention and close collaboration with healthcare professionals.

Dr Pätilä emphasises the importance for diabetics to maintain good blood sugar levels, which can foster the healing of periodontitis and mitigate the risk of inflammation. Effective control of diabetic blood glucose levels is crucial, as elevated levels can impede periodontal healing and heighten infection risks.

“Treating periodontal disease in people with diabetes necessitates special attention due to diabetes potentially impacting oral health and impeding the healing of gum disease. While treatment for severe gum disease initiates similarly to other patients, individuals with diabetes require closer monitoring and collaboration with health professionals,” Dr Pätilä said.

In some cases, antibiotic treatment may also be necessary, and surgical procedures may be more intricate for people with diabetes compared to those without the condition. A healthy diet and regular exercise are also essential components of diabetes management, which also contribute to the success of periodontal disease treatment.

Overall health starts with a healthy mouth

Maintaining good oral hygiene and scheduling regular dental check-ups are imperative for individuals with diabetes.

Overall health starts with a healthy mouth. It is therefore important to regularly clean the mouth thoroughly, Dr Pätilä highlighted. He is one of the Finnish scientists behind the development of the new light-activated oral health-enhancing Lumoral device, which is now available in 16 countries globally.

Lumoral is an innovative personal healthcare device designed to remove 99.9% of harmful oral bacteria while preserving the healthy mouth flora. Traditional oral hygiene methods can only remove approximately 60% of bacteria, leaving behind a significant risk of oral health issues.

Lumoral’s advanced technology utilises colour molecules in its Lumorinse mouth rinse, which adhere to harmful oral bacteria attached to teeth surfaces and gum tissue in the mouth. Subsequently, the light emitted by the mouthpiece reacts with the green sensitizer, effectively breaking down the cell membrane of bacteria and destroying them both from inside and outside. This method ensures the eradication of harmful bacteria without the risk of resistance development.7, 18-21

Because 95% of dental diseases are caused by bacteria in the plaque, regularly eliminating dental plaque improves dental hygiene as well as prevents and treats dental and gum disease.

“If we want to improve the results of dental care treatments, we need to focus on removing the plaque that is left on the teeth after brushing them,” said Prof Sorsa.

Dr Pätilä concluded: “Close collaboration between dentists and diabetes specialists is essential in the management and prevention of periodontitis and diabetes. Using an antibacterial light-activated method as an adjunct therapy when treating gum disease makes the treatment a lot more efficient than before.”

References

1. https://www.who.int/health-topics/diabetes?gad_source=1&gclid=CjwKCAjwwr6wBhBcEiwAfMEQswz2pRMAger7w_8jbQUxhA16BWX9ZRQD3kEr9zK1dgtgSjx6ZSQidRoC_-wQAvD_BwE#tab=tab_1

2. Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci (Qassim). 2017 Apr-Jun;11(2):72-80. PMID: 28539867; PMCID: PMC5426403.

3. Chee B, Park B, Bartold PM. Periodontitis and type II diabetes: a two-way relationship. Int J Evid Based Healthc. 2013;11(4):317-29.

4. Ryan ME, Ramamurthy NS, Sorsa T, Golub LM. MMP-mediated events in diabetes. Ann N Y Acad Sci. 1999;878:311-34.

5. Sorsa T, Ingman T, Suomalainen K, Halinen S, Saari H, Konttinen YT, et al. Cellular source and tetracycline-inhibition of gingival crevicular fluid collagenase of patients with labile diabetes mellitus. J Clin Periodontol. 1992;19(2):146-9.

6. Safkan-Seppala B, Sorsa T, Tervahartiala T, Beklen A, Konttinen YT. Collagenases in gingival crevicular fluid in type 1 diabetes mellitus. J Periodontol. 2006;77(2):189-94.

7. Brownlee M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes. 2005;54(6):1615-25.

8. Dandona P, Aljada A, Bandyopadhyay A. Inflammation: the link between insulin resistance, obesity and diabetes. Trends Immunol. 2004;25(1):4-7.

9. Hotamisligil GS. Molecular mechanisms of insulin resistance and the role of the adipocyte. Int J Obes Relat Metab Disord. 2000;24 Suppl 4:S23-7.

10. Rotter V, Nagaev I, Smith U. Interleukin-6 (IL-6) induces insulin resistance in 3T3-L1 adipocytes and is, like IL-8 and tumor necrosis factor-alpha, overexpressed in human fat cells from insulin-resistant subjects. J Biol Chem. 2003;278(46):45777-84.

11. Heikkila P, Niskanen L, But A, Sorsa T, Haukka J. Oral health associated with incident diabetes but not other chronic diseases: A register-based cohort study. Front Oral Health. 2022;3:956072.

12. Lauhio A, Farkkila E, Pietilainen KH, Astrom P, Winkelmann A, Tervahartiala T, et al. Association of MMP-8 with obesity, smoking and insulin resistance. Eur J Clin Invest. 2016;46(9):757-65.

13. Naguib G, Al-Mashat H, Desta T, Graves DT. Diabetes prolongs the inflammatory response to a bacterial stimulus through cytokine dysregulation. J Invest Dermatol. 2004;123(1):87-92.

14. D’Aiuto F, Parkar M, Andreou G, Suvan J, Brett PM, Ready D, et al. Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers. J Dent Res. 2004;83(2):156-60.

15. Lalla E, Cheng B, Lal S, Kaplan S, Softness B, Greenberg E, et al. Diabetes mellitus promotes periodontal destruction in children. J Clin Periodontol. 2007;34(4):294-8.

16. Chaparro A, Realini O, Hernandez M, Albers D, Weber L, Ramirez V, et al. Early pregnancy levels of gingival crevicular fluid matrix metalloproteinases-8 and -9 are associated with the severity of periodontitis and the development of gestational diabetes mellitus. J Periodontol. 2021;92(2):205-15.

17. Tsai C, Hayes C, Taylor GW. Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population. Community Dent Oral Epidemiol. 2002 Jun;30(3):182-92. doi: 10.1034/j.1600-0528.2002.300304.x. PMID: 12000341.

18. Jao Y, Ding SJ, Chen CC. Antimicrobial photodynamic therapy for the treatment of oral infections: A systematic review. J Dent Sci. 2023 Oct;18(4):1453-1466. doi: 10.1016/j.jds.2023.07.002. Epub 2023 Jul 11. PMID: 37799910; PMCID: PMC10548011.

19. Pakarinen S, Saarela RKT, Välimaa H, et al. Home-applied dual-light photodynamic therapy in the treatment of stable chronic periodontitis HOPE-CP)—three-month interim results. Dent J (Basel). 2022;10(11):206. doi:10.3390/dj10110206

20. Nikinmaa S, Alapulli H, Auvinen P, et al. Dual-light photodynamic therapy administered daily provides a sustained antibacterial effect on biofilm and prevents Streptococcus mutans adaptation. PLoS One. 2020;15(5):e0232775. doi:10.1371/journal.pone.0232775

21. Nikinmaa S, Moilanen N, Sorsa T, et al. Indocyanine green-assisted and LED-light-activated antibacterial photodynamic therapy reduces dental plaque. Dent J (Basel). 2021;9(5):52. doi:10.3390/dj9050052

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