July 2, 2020
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Gum disease and diabetes during the pandemic

By: George Malkemeus
May 8, 2020

During the COVID-19 pandemic, it is important to stay safe with ‘Shelter in Place.”  This includes good oral hygiene, particularly brushing and flossing.  Dental offices are currently closed during the pandemic for regular dental care, including teeth cleanings and periodontal care.  Only emergency care is available.  

Good oral hygiene is particularly important for the diabetic patient.  Both diabetes and periodontal disease are chronic inflammatory diseases, which weaken the immune response.  A strong immune response is necessary to fight COVID-19, as well as fighting other infections.   

Gum disease, called periodontal disease, is a bacterial infection of the gums. Periodontal disease is often painless, and usually develops slowly over many years, but 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 affects more than just the mouth. It 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.  

Numerous studies have shown that people with diabetes, especially uncontrolled diabetes, have more gum disease than those without diabetes.  Recent studies now show that 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 and flossing and regular professional cleanings.

Both diabetes and periodontal disease 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 over 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 over 23 million diabetics in the United States alone and over 170 million worldwide. 

The word diabetes derives from ancient Greek meaning “to pass through urine.”  With the disease, abnormally high glucose levels in the blood leads to high levels of glucose passing through kidneys into 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 due to diminished production of insulin. Having a higher than normal level blood glucose 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 had type 1 late onset diabetes and took insulin shots daily since age 47. He passed away earlier this year at age 94.  Since his early 50s, he had numbness in his feet. Over time his feet became totally numb, though he continued to walk when golfing into his early 80s.  Many years ago, he was changing into his golf shoes before a round of golf at Indian Valley Golf Course in Novato.  He was frustrated because he 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 nine holes, something did not feel quite right, so he took off his shoe and found the shoehorn in the golf shoe.  He never felt a thing due to his diabetic neuropathy.

Diabetics are 3-4 times more likely to have periodontal disease, due to 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 their diabetes. 

Eliminating periodontal disease 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 had the tooth when he died. He was meticulous with his oral hygiene and received cleanings every three months. Near the last month of his life, when he couldn’t get out of bed, I personal cleaned his teeth for him whenever I visited him at his home in Novato. He was particularly appreciative of being flossed, which he was not able to do anymore.  Flossing was a positive, pleasing, healthy habit that he had performed over the last 45 years of his life.  My father had a warm positive attitude right to the end. He will be missed.

So in conclusion, stay safe, keep your mouth clean, and stay positive like my father would through this difficult time! 

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@  Visit Dr. Malkemus’ Web site at