Periodontal diseases affect the soft tissues and bone that support the teeth. "Gingivitis," or inflamed gums, is the early form of periodontal disease. If left unchecked, gingivitis can progress to a more severe condition called "periodontitis." This infection, caused by harmful bacteria, eventually destroys the bone and ligament which hold the teeth in place. Sound teeth may become loose and, if untreated, can be lost.
Who Is Affected By Periodontal Disease?
For people with diabetes mellitus, periodontitis can be a major complication of their disease. Periodontal infection can upset blood sugar control, and loose or missing teeth can make eating the right foods difficult.
What Causes Periodontal Disease?
Dental plaque plays a major role in the development of gingivitis and other periodontal diseases. Plaque, a sticky film containing millions of bacteria, attaches to the teeth. Only certain types of bacteria, however, are suspected of causing gum disease. Dental scientists are studying these and other harmful organisms to determine the exact roles they play in periodontal problems.
Other factors that contribute to gum diseases include poor nutrition, inherited defects in infection-fighting cells, hormonal changes in pregnancy, and certain diseases such a diabetes mellitus.
Periodontal diseases are a problem for many Americans. In fact, the majority of the United States population above the age of 40 probably has some form of the disease, ranging from mild gum inflammation to severe periodontal infection. Although most of the damage from gum disease occurs after the age of 35, dental scientists believe that the disorder has its beginnings in youth. Most United States school children have gingivitis, and some even have the more destructive form of periodontal disease.
Recent studies show that persons with diabetes, especially those whose blood sugar levels are poorly controlled, are at higher risk of developing gum infections. Because of diabetes, periodontal disease is often more frequent and more severe, and tends to appear at an earlier age than in nondiabetics.
Diabetes & Susceptibility To Gum Disease
Thickening of Blood Vessels
Changes in blood vessels, an early complication of diabetes, may be part of the reason for increased susceptibility to gum disorders. Blood vessels deliver oxygen and nourishment to all body tissues, including those in the mouth, and carry away waste products made by the cells. Diabetes causes blood vessels to thicken, slowing down the flow of vital nutrients and the removal of harmful wastes. This can weaken the resistance of gum and bone tissue to infection.
Many kinds of bacteria thrive on sugars, including glucose. When diabetes is poorly controlled, high glucose levels in mouth fluids may encourage the growth of harmful germs and set the stage for gum inflammation.
Diabetic control, particularly in adults with noninsulin-dependent diabetes mellitus (NIDDM), also appears to play a role in their susceptibility to gum disorders. In those with poor diabetic control, periodontal disease is more prevalent, more severe, and causes more tooth loss than in nondiabetics of the same age.
In children with insulin-dependent diabetes mellitus (IDDM), gingivitis becomes more frequent and more severe as they approach puberty. As many as 20 percent of 11 to 18-year-olds with IDDM have some form of periodontitis. When IDDM is uncontrolled, it is not unusual to find severe periodontal disease and abscesses (acute infections in the tooth or gum) in young people and adults.
How Periodontal Disease Develops
Gingivitis, the first stage of periodontal disease, is commonly caused by poor brushing and flossing habits that allow plaque to accumulate on teeth near the gums. At first, there is mild inflammation - slight redness and swelling of the gum tissue around one or more of the teeth. Later, these symptoms worsen, and the gums tend to bleed easily. Bleeding while toothbrushing is one of the earliest signs of gum disease. During these changes, the gums may - or may not - be tender and sensitive. Because not everyone develops symptoms, there may be no warning that disease is present.
Gingivitis can be controlled with regular cleanings by the dentist and good daily home care. If untreated, the condition may progress to destructive periodontitis. Over time, the plaque hardens into "calculus" and extends from the gum line down along the tooth root. The gums gradually detach from the teeth, forming pockets that may progress to one-half inch or more in depth. Pockets tend to occur between teeth where the toothbrush cannot reach.
As the infection spreads, these pockets may fill with pus and cause bad breath. Eventually, the ligaments that fasten the teeth to the bone are destroyed, and much of the bone socket slowly disintegrates. The tooth loosens and may be lost.
The pattern of periodontal disease is complicated and not yet well understood. One tooth may be affected, or several. A tooth may be lost to disease, while its neighbor remains healthy. Active destruction of connecting tissues or bone may be going on at one site at the same time that other diseased sites are healing. It is important to remember that much of this destructive process can take place with little or no discomfort. You cannot always tell that periodontal disease is developing.
"Periodontal Disease & Diabetes: A Guide For Patients," Brochure, NIH publication #87-2946, National Institute of Dental & Craniofacial Research
Periodontal Disease & Diabetes
What is Plaque?
Source: Your Health Encyclopedia, 4-rd Edition, 2002
Last Revised at December 4, 2007 by Harutyun Medina, M.D.