A research group at Osaka University discovered that intensive diabetes treatment can improve the inflammatory state of periodontal disease.
Recent research published in Diabetes, Obesity, and Metabolism has shown that intensive diabetes treatment can positively impact periodontal health. This demonstrates that periodontal inflammation can be improved through intensive diabetes treatment despite the known link between diabetes and periodontal disease.
It is widely believed that diabetes and periodontal disease are interrelated. While it has been shown that treating periodontal disease improves blood glucose control, the effect of diabetes treatment on periodontal disease has remained largely unknown.
A collaborative research team from Osaka University conducted a two-week intensive diabetes treatment study with 29 type 2 diabetes patients. The results showed improvements in blood sugar control and periodontal health indicators. Patients who showed significant periodontal improvement also had higher pre-treatment C-peptide levels, suggesting better insulin secretion and less severe diabetic neuropathy and peripheral vascular disorders.
“These research findings are expected to advance our understanding of the relationship between diabetes and periodontal disease,” says senior author Masae Kuboniwa. “Improving periodontal disease in diabetic patients requires both periodontal treatment and early diabetes management. Promoting collaboration between medical and dental care from the early stages of diabetes can significantly prevent the onset and progression of periodontal disease in diabetic patients.”
A University of Birmingham-led study shows an increased risk of patients developing illnesses including mental ill-health and heart conditions if they have a GP-inputted medical history of periodontal (gum) disease
Experts carried out a first of its kind study of the GP records of 64,379 patients who had a GP-inputted recorded history of periodontal disease, including gingivitis and periodontitis (the condition that occurs if gum disease is left untreated and can lead to tooth loss). Of these, 60,995 had gingivitis and 3,384 had periodontitis. These patients’ records were compared to those of 251,161 patients who had no record of periodontal disease. Across the cohorts, the average age was 44 years and 43% were male, while 30% were smokers. Body Mass Index (BMI), ethnicity and deprivation levels were also similar across the groups.
The researchers examined the data to establish how many of the patients with and without periodontal disease go on to develop cardiovascular disease (e.g., heart failure, stroke, vascular dementia), cardiometabolic disorders (e.g., high blood pressure, Type 2 diabetes), autoimmune conditions (e.g., arthritis, Type 1 diabetes, psoriasis), and mental ill-health (e.g., depression, anxiety and serious mental illness) over an average follow-up of around three years.
From the research, published today in journal BMJ Open, the team discovered that those patients with a recorded history of periodontal disease at the start of the study were more likely to go on and be diagnosed with one of these additional conditions over an average of three years, compared to those in the cohort without periodontal disease at the beginning of the research. The results of the study showed, in patients with a recorded history of periodontal disease at the start of the study, the increased risk of developing mental ill-health was 37%, while the risk of developing autoimmune disease was increased by 33%, and the risk of developing cardiovascular disease was raised by 18%, while the risk of having a cardiometabolic disorder was increased by 7% (with the increased risk much higher for Type 2 diabetes at 26%).
Current advice from the America Dental Association tells you that if your gums bleed, make sure you are brushing and flossing twice a day because it could be a sign of gingivitis, an early stage of periodontal disease. And that might be true. So if you are concerned, see your dentist. However, a new University of Washington study suggests you should also check your intake of vitamin C.
“When you see your gums bleed, the first thing you should think about is not, I should brush more. You should try to figure out why your gums are bleeding. And vitamin C deficiency is one possible reason,” said the study’s lead author Philippe Hujoel, a practicing dentist and professor of oral health sciences in the UW School of Dentistry.
Hujoel’s study, published Feb. 1 in Nutrition Reviews, analyzed published studies of 15 clinical trials in six countries, involving 1,140 predominantly healthy participants, and data from 8,210 U.S. residents surveyed in the Centers for Disease Control and Prevention’s Health and Nutrition Examination Survey. The results showed that bleeding of the gums on gentle probing, or gingival bleeding tendency, and also bleeding in the eye, or retinal hemorrhaging, were associated with low vitamin C levels in the bloodstream. And, the researchers found that increasing daily intake of vitamin C in those people with low vitamin C plasma levels helped to reverse these bleeding issues.
Of potential relevance, says Hujoel, who is also an adjunct professor of epidemiology in the UW School of Public Health, both a gum bleeding tendency and retinal bleeding could be a sign of general trouble in one’s microvascular system, of a microvascular bleeding tendency in the brain, heart and kidneys.
The study does not imply that successful reversing of an increased gingival bleeding tendency with vitamin C will prevent strokes or other serious health outcomes, Hujoel stresses. However, the results do suggest that vitamin C recommendations designed primarily to protect against scurvy — a deadly disease caused by extremely low vitamin C levels — are too low, and that such a low vitamin C intake can lead to a bleeding tendency, which should not be treated with dental floss.
Consequently, Hujoel does recommend people attempt to keep an eye on their vitamin C intake through incorporation of non-processed foods such as kale, peppers or kiwis into your diet, and if you can’t find palatable foods rich in vitamin C to consider a supplement of about 100 to 200 milligrams a day.
If someone is on a specialized diet, such as a paleo diet, it’s important that they take a look at their vitamin C intake, Hujoel said. “Vitamin C-rich fruits such as kiwis or oranges are rich in sugar and thus typically eliminated from a low-carb diet.”
This avoidance may lead to a vitamin C intake that is too low and is associated with an increased bleeding tendency. People who exclusively eat lean meats and avoid offal, the vitamin-rich organ meats, may be at a particularly high risk for a low vitamin C intake.
The association between gum bleeding and vitamin C levels was recognized more than 30 years ago. In fact, two studies co-authored by former dean of the UW School of Dentistry Paul Robertson (published in 1986 and 1991) identified gum bleeding as a biological marker for vitamin C levels.
However, this connection somehow got lost in dental conversations around bleeding gums.
“There was a time in the past when gingival bleeding was more generally considered to be a potential marker for a lack of vitamin C. But over time, that’s been drowned out or marginalized by this overattention to treating the symptom of bleeding with brushing or flossing, rather than treating the cause,” Hujoel said.
Hujoel’s literature review also determined that “retinal hemorrhaging and cerebral strokes are associated with increased gingival bleeding tendency, and that (vitamin C) supplementation reverses the retinal bleeding associated with low (vitamin C) plasma levels.”
So, missing the possible connection between gum bleeding and low levels of vitamin C has the potential to have serious health consequences.
The study authors write: “A default prescription of oral hygiene and other periodontal interventions to ‘treat’ microvascular pathologies, even if partially effective in reversing gingival bleeding as suggested in this meta-analysis, is risky because it does not address any potential morbidity and mortality associated with the systemic microvascular-related pathologies.”
Rates of both periodontal disease and cardiovascular disease are elevated in individuals with rheumatoid arthritis. New research published in Arthritis & Rheumatology suggests that immune responses to certain bacteria that cause periodontal disease may play a role in patients’ higher cardiovascular disease risk.
Among 197 patients with rheumatoid arthritis, those with antibody responses to common periodontal pathogens were more likely to also show signs of atherosclerosis.
“Evidence of exposure to a particular periodontal pathogen called Aggregatibacter actinomycetemcomitans had the strongest associations with atherosclerosis in the patients with rheumatoid arthritis that we studied,” said lead author Jon T. Giles, MD MPH, of Columbia University. “Moreover, it was associated with measures of coronary, carotid, and peripheral atherosclerosis, over and above other risk factors for atherosclerosis. Further studies are needed to determine if eliminating exposure to this pathogen might modify the increase in cardiovascular disease known to be part of rheumatoid arthritis.”
The Mail Online reports that brushing your teeth 3 times a day could ward off diabetes.
The report is prompted by a South Korean study that collected data from a health insurance system on the dental health and frequency of check-ups for over 180,000 people. It then linked this with records of raised blood sugar or prescriptions for diabetes drugs over an average 10-year follow-up.
The study found that having gum disease or a greater number of missing teeth was linked with increased chance of developing diabetes. Meanwhile increased teeth brushing – here defined as 3 or more times per day – was linked with 8% decreased risk of diabetes. (The study did not specify type of diabetes, but we can presume this is type 2 as the rarer type 1 is very unlikely to develop in older adults).
These findings do not prove that increased tooth brushing and tooth decay are themselves directly linked with diabetes. What is more likely is that other health and lifestyle factors associated with dental health are also associated with risk of diabetes. For example, people who consume more sugar may be more likely to have dental problems and diabetes. Similarly people more concerned for their dental health may be more likely to follow other positive health and lifestyle behaviours.
This is also a specific Korean population who may not be representative of the UK.
Following a healthy diet low in sugar and saturated fat, taking regular physical activity and maintaining a healthy weight are far more beneficial in reducing risk of type 2 diabetes.
However, good dental health is also important as it can help prevent gum disease.
Where did the story come from?
The study was carried out by researchers from the Ewha Womans University College of Medicine, Catholic University of Korea and Asian Medical Center, all in Seoul, South Korea. Funding was provided by the National Research Foundation of Korea and the Ministry of Education. The study was published in the journal Diabetologia and is freely available to access online.
The Mail coverage is slightly exaggerated in reporting a 14% decreased risk, which was from one small subgroup analysis in this study. The main finding was a less dramatic 8% decreased risk.
What kind of research was this?
This was a cohort study using data collected for a sample of the South Korean population in a National Health Insurance System (NHIS) database.
This study design can look at links between earlier exposures (such as dental health) and later outcomes (such as diabetes) but cannot prove cause and effect, because it is difficult to remove the influence of all the various health and lifestyle factors that may be involved in the links.
What did the research involve?
Almost all of the South Korean population are covered by the NHIS, which requires them to have a medical examination every 2 years. In 2015 researchers formed an NHIS Health Screening Cohort database (NHIS-HEALS), to gather information collected for a random sample of 541,866 people.
The 2-yearly medical examinations included health and lifestyle questionnaires, height and weight, and laboratory tests. Oral health was assessed by questionnaires on dental symptoms, frequency of dental checks and oral hygiene. Diagnosis of gum disease was also recorded in the database.
The researchers looked at data collected for people between 2003 and 2006 who did not have a diagnosis of diabetes. The definition of diabetes used in the study was having at least one fasting glucose sample of greater than 7mmol/l or prescription for diabetes drugs. After excluding those without information on dental health and with a previous diagnosis of diabetes they had a sample of 188,013 people.
They looked at follow-up to 2015 for these people (average 10 years) to see if anyone later developed diabetes according to this definition.
The researchers looked at the link with dental health taking account of variables including:
body mass index (BMI)
socioeconomic status
smoking and alcohol
physical activity (defined as performing at least 20 minutes of strenuous exercise once a week)
high blood pressure or cholesterol
kidney disease
cancer
What were the basic results?
The average age of people in the database was 53 years and 58% were men. Gum disease was recorded for 17.5%. A quarter reported visiting a dentist for professional cleaning once a year, and 42.6% reported brushing their teeth 3 or more times per day.
Over 10 years, 16% had a new diagnosis of diabetes.
In analyses adjusted for all confounding factors, the presence of gum disease was associated with a 9% increased risk of diabetes (hazard ratio 1.09, 95% CI 1.07 to 1.12).
Having 15 or more missing teeth was linked with 21% increased risk (HR 1.21, 95% CI 1.09 to 1.33).
Meanwhile, brushing teeth 3 or more times a day was linked with 8% decreased risk of diabetes (HR 0.92, 95% CI 0.89 to 0.95).
How did the researchers interpret the results?
The researchers conclude that frequency of tooth brushing was linked with decreased risk of diabetes and gum disease, and greater number of missing teeth with increased risk.
Conclusion
This is a novel analysis to have looked at the link between dental health and risk of diabetes, but it does not prove that one has directly caused the other.
There’s a high possibility that other health and lifestyle factors are linked with both chance of poor dental health, and chance of diabetes, and this is underlying the links. The researchers have tried to account for several factors, but it’s difficult to fully remove their influence while others may be having an effect. For example, the study has not assessed diet. People eating a high-sugar diet may have poorer dental health and higher chance of developing diabetes. Likewise people following a healthier lifestyle in general may take better care of their dental health.
The risk associations were very small – a relative risk increase (or decrease) of only a few per cent. So even if there is any direct link, this perhaps shows that other factors such as weight, diet and physical activity – and those we cannot change like family history – may have far greater influence on any individual’s risk.
Other limitations include the restricted level of information available in the database. For example, one of the criteria for diagnosing diabetes was a one-off blood glucose measurement above 7.0mmol/l. You’d normally expect this to be repeated to confirm a diagnosis.
Also being a specific South Korean population, they may have many different health and lifestyle characteristics and baseline risk of diabetes (which is more common in Asian populations). Therefore the results may not be directly applicable to the UK.
Dentists in the UK also generally advise that you brush your teeth for 2 minutes twice a day, morning and night. The findings of this study do not seem to provide a strong basis on which to change this recommendation.
The best way to reduce your risk of diabetes is to follow a healthy diet, low in sugar and saturated fat, take regular physical activity and maintain a healthy weight.
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