Diabetes and Periodontal Disease

How is diabetes, or prediabetes, related to periodontal (gum) diseases?

One of the main risk factors for the development of periodontal disease is diabetes.   We now know that individuals with type II diabetes are three times more likely to develop periodontal disease.   Conversely, results from the National Health and Nutrition Examination Survey (NHANES) and its follow-up studies suggest that non-diabetic adults with periodontal disease develop type 2 diabetes more often than those without periodontal disease.

In 2003 the American Diabetes Association stated that periodontal disease is often found in people with diabetes.  However, there are millions of individuals who are unaware that they may be “prediabetic” (they have elevated blood sugar levels), and that this may be a contributing factor in their periodontal disease.   While diabetes and pre-diabetes occur in people of all ages and races, some groups have a higher risk for developing the disease than others.   Diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population.  This means they are also at increased risk for developing pre-diabetes.

What we now understand about diabetes and periodontal disease is that an elevation in inflammatory mediators in the gums is the cause for the close association between diabetes and increased incidence of periodontal diseases .  Bacteria thrive in the individual with elevated blood glucose, stimulating pro-inflammatory mediators, which leads to an overproduction of a bone destroying enzyme called collagenase.  It is well established that elevated levels of collagenase lead to the destruction of the periodontal ligament and bone supporting the teeth.

What you can do:

1) Get Tested

We highly recommend an HbA1c blood test for an accurate assessment of average glucose levels over time.  In our experience the simple fasting glucose test is not a good indicator of borderline or current diabetes.

Go to www.diabetes.org for more information

2) Learn More

A great comprehensive paper by water pik on diabetes

The two way connection

“Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.  Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.”  (American Academy of Periodontology)

Go to www.perio.org for more information abou the “mouth-body” connection, there are numerous articles on this topic.

3) Get definitive periodontal treatment

4)  Look into adjunctive medication which can help. How to help control chronic inflammation and destructive levels of collagenase enzymes created by elevated glucose levels and lack of good glycemic control.

Also Important to consider:

Prevention and proactive treatment of periodontal disease is fundamentally important in patients with diabetes because of the potential negative impact of untreated periodontitis on glycemic control and diabetic complications.  But as we have observed, one disease ‘feeds’ the other.  Addressing this two way connection is crucial to achieving periodontal health.  Host factors contributing to both periodontal disease and glycemic control must be defintively addressed if we are to expect success and remission of both diseases.

At PerioPeak Innovations we pinpoint and address all risk factors which may be contributing to your periodontal disease.  We pride ourselves in finding the cause – rather than just treating the effect.  Our mission is to provide comprehensive periodontal care,  empowering all of our clients for long term periodontal and overall health.

Find out how our advanced non-surgical approach for chronic periodontal disease can help to maintain optimal health.

Further important considerations with diabetes, periodontal disease, and cardiovascular disease:

Below is an exerpt from J. Periodontal 7/09 – The American Journal of Cardiology and Journal of Periodontology Editor’s Concensus:  Periodontitis and Artherosclerotic Cardiovascular Disease.

Metabolic Syndrome

Metabolic syndrome is diagnosed when 3 of the following features are present: (1) increased waist circumference(men ‡40 in [‡102 cm], women ‡35 in [‡88 cm]), (2) increased serum triglyceride level (150 mg/dl [1.7 mmol/L]) and/or drug treatment for elevated triglycerides (most commonly fibrates and nicotinic acid), (3) decreased serum HDL cholesterol level (men <40 mg/dl [1.03mmol/L], women <50 mg/dl [1.3 mmol/L]) and/or drug treatment for decreased serum HDL cholesterol, (4) elevated blood pressure (‡130mmHg systolic and/or ‡85mmHg diastolic) or antihypertensive drug treatment of patients with histories of hypertension, and (5) elevated fasting glucose (blood glucose ‡100 mg/dl) and/or drug treatment for hyperglycemia.


Patients with periodontitis meeting criteria for metabolic syndrome should be identified, and all risk factors for atherosclerotic CVD should be treated, beginning with lifestyle changes aimed at weight reduction. Metabolic syndrome is closely linked to insulin resistance and is a secondary target of lipid therapy because the risk factors for metabolic syndromeare highly concordant and, in aggregate, enhance the risk for atherosclerotic CVD at any serum level of LDL cholesterol.

Many patients with periodontitis meet criteria for the metabolic syndrome.  Because measures of systemic inflammation are a common feature of periodontitis and metabolic syndrome, it may be particularly important to identify patients who meet these criteria for CVD prevention strategies.  We highly recommend The Bale Doneen approach to early diagnosis, intervention, and prevention.

Find a provider near you www.baledoneenmethod.com