Gum disease affects more than mouth
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By George Malkemus  August 23, 2013 12:00 am

Gum disease, called periodontal disease, is a bacterial infection of the gums that affects more than just the mouth. Periodontal disease is often painless and usually develops slowly over many years, but it may progress in rapid destructive stages. The bacterial infection attacks the gums and bone that support the teeth and hold the teeth in the jaw. Gum disease is the major cause of tooth loss.

Periodontal disease plays a role in numerous disease conditions throughout the body, including heart disease, strokes, ulcers and adverse pregnancy outcomes such as low birth weight and preterm births. Diabetes is also affected and increased by periodontal disease, which alters blood sugar control in diabetics.

For many years, studies have shown people with diabetes, especially uncontrolled diabetes, have more gum disease than those without diabetes. Recent studies now show periodontal disease raises blood sugar levels in people with and without diabetes.

Bacteria that build up between the tooth and gum can enter into the bloodstream when gums bleed. These bacteria can travel throughout the body and cause serious health problems. Plus, periodontal disease is an inflammatory disease and affects other diseases that are affected by inflammation such as diabetes. Periodontal disease can be prevented with good oral health habits, such as brushing, flossing and regular professional cleanings.

Both diabetes and periodontal disease are chronic inflammatory diseases that have a major impact on the health of millions of people worldwide. Gum disease is rampant in our society. More than half of all U.S. citizens over the age of 30 have periodontal disease and more than 60 percent of Americans over the age of 60 are infected. Meanwhile, diabetes and obesity rates in North America have been increasing substantially over the last 20 years. There are more than 23 million diabetics in the United States alone and more than 170 million worldwide.

The word diabetes derives from the ancient Greek meaning “to pass through urine.” With the disease, abnormally high blood sugar glucose levels lead to high levels of glucose passing through to the urine. Glucose is the body’s primary energy source and is controlled by the hormone insulin produced in the pancreas. With diabetes, high blood glucose levels form because of diminished production of insulin. High blood glucose level is called hyperglycemia. Signs of diabetes include excessive urine production, extreme thirst, blurred vision, unexplained weight loss, tiredness and stupor like a drunken state. 

Both diabetes and gum disease are silent killers. Usually, both diseases are painless until advanced stages, which will lead to major problems. Often when diabetes is out of control with hyperglycemia, there are no symptoms. But high blood glucose levels can lead to serious problems over time, including kidney disease, blindness, foot problems, heart disease, stroke and nerve damage. Kidney disease can lead to kidney failure and the need for dialysis. Blood vessel damage in the eyes can lead to blindness. Heart disease can lead to death. In fact, heart disease is the number one cause of death in people with diabetes.

Neuropathy, particularly numbness of the feet is a common problem with diabetics. Nerve damage in the feet can lead to the need for amputation. My father, Gene, has had diabetes and taken insulin shots daily since 1993. He has numbness in his feet. Many years ago, he was changing into his golf shoes before a round of golf and could not find his shoehorn that he always used to put on his golf shoes. Finally, he gave up looking and forced his shoes on without the shoehorn. After walking to the sixth hole at Indian Valley Golf Course in Novato, something did not feel right, so he took off his shoe and found the shoehorn in the golf shoe. He never felt a thing. 

Diabetics are three to four times more likely to have periodontal disease because of their reduced immune and healing response. It is extremely important for diabetics to have excellent oral hygiene and regular professional cleanings. The presence of any gum infection can make it much more difficult for a diabetic to control his or her blood sugar. Diabetics without periodontal disease have shown six times better blood sugar control versus diabetics with gum disease. Studies have also shown that the elimination of gum disease can directly improve a person’s control over diabetes dramatically. 

Eliminating periodontal disease has definitely contributed to my father’s control of his diabetes. When I started practice on April 1, 1985, my father was my first patient. He had periodontal disease at that time, including a loose molar. With professional periodontal treatment, the gum tissue around that molar tightened up and he still has it today. He is meticulous with his oral hygiene and receives cleanings every three months.

A 1997 study of 113 Pima Indians in Arizona showed reducing their periodontal infection significantly improved their control of diabetic sugar levels. Pima Indians were known for their high number of diabetics and an increased proportion of periodontal disease. After intense treatment to reduce their gum disease, the study found vast improvement in their diabetes, with a reduction in the amount of insulin needed and, in some cases, complete removal from medications. 

Diabetics with gum disease have a greater risk for cardiovascular and kidney complications than diabetic patients without periodontal disease. In a study of more than 600 diabetic patients, the death rate was over 2.3 times higher from heart attacks, and 8.5 times higher from kidney disease in individuals with severe periodontal disease. 

My father has not had any gum disease since I started the practice in 1985, and he has not had any heart or kidney problems that are common with diabetics. In my next article, I will write about his experience after 40 years with diabetes.

Enjoy life and keep smiling. 

George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com. Visit Dr. Malkemus’ Web site at www.malkemus.com.

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