Periodontal Disease and Diabetes

Overview

This Guidelines summary provides information for community pharmacy teams on periodontal (gum) disease and its links with diabetes. It offers guidance for communicating with people with diabetes on the risks of periodontal disease.

The information in this summary was taken from the British Society of Periodontology and Implant Dentistry’s Diabetes and gum disease fact sheet; the Diabetes and Primary Care article, Did you know that diabetes increases the risk of gum disease? by Dr Penny Hodge; and the NHS England and NHS Improvement commissioning standard document, Dental care for people with diabetes.

Reflecting on Your Learnings

Reflection is important for continuous learning and development, and a critical part of the revalidation process for UK healthcare professionals. Click here to access the Guidelines Reflection Record.

Periodontal Disease

Definition, Symptoms, and Causes

• Periodontal disease is the sixth most common disease in the world
• It affects the tissues supporting the teeth, including the bone
• The symptoms of the disease, which have an impact on quality of life, include receding, shrinking, and bleeding gums; loosening teeth; discomfort when chewing; and, eventually, tooth loss
• Periodontal disease is caused by dental plaque, a coating of bacteria on the teeth, which continuously collects around the gum margin
• Over half the UK population is affected by periodontal disease in varying degrees, and 10% suffer from the severe form, which is most likely to result in tooth loss
• Poorly managed blood glucose levels cause damage to the nerves, blood vessels, heart, kidneys, eyes, and feet
• The gums can also be affected. Reduced oxygen and nutrient levels, which occur in the gums as a result of damage to the blood vessels, make infection of the gums and the bone supporting the teeth more likely
• Poorly controlled blood glucose leads to changes in the inflammatory processes in the gums, which may accelerate gum tissue damage and destruction
• Severe periodontal disease can increase blood glucose levels both in people with diabetes and in those without the condition.

Periodontal Disease and Diabetes

• It is now clear that there is a bidirectional link between diabetes and periodontitis:
  • people with type 1 and type 2 diabetes are at greater risk of developing periodontitis and people with periodontitis are at greater risk of developing type 2 diabetes
  • effective treatment of periodontitis in people with type 2 diabetes can improve glycaemic control to an extent that can reduce the need for an additional prescribed medication, as well as to reduce systemic complications associated with increased glycaemia
• Successful gum treatment may improve control of diabetes.

Advice for Healthcare Professionals

Information for Community Pharmacy Teams When Communicating With People With Diabetes on the Risks of Periodontal Disease

• People with type 1 and type 2 diabetes need to access effective dental care and local pathways should be developed to support this
• The bidirectional link between diabetes and periodontitis is not currently well known and so it is vital that this is communicated to all stakeholders, including patients
• It is essential that the importance of good periodontal health is incorporated into the suite of self-care measures that people with diabetes already employ
• Keeping blood glucose levels low and stable can reduce the risk of gum disease, and looking after oral health could help to improve long-term outcomes in people living with diabetes
• Inform people with diabetes of the increased risk of gum disease and advise them to see their dental professional for regular check-ups, treatment, and regular maintenance
• Patients recently diagnosed with diabetes should share this information with their dentist and hygienist and request more careful annual monitoring of their gums
• Information on improving gum health should be part of overall diabetes management
• Encourage patients to be aware of signs/symptoms of gum disease, such as gums bleeding while brushing or eating, loose teeth, receding/shrinking gums, and halitosis (bad breath).