Oral Health and Diabetes: A Bidirectional Connection

Taylor Gowans

Sephora Djomo Ngwamou

Manisha Sharvananthan

(Dubov)

Introduction: 

Dental services can be valuable in the identification of many systemic diseases. Diabetes mellitus is an example of a systemic disease that is often screened for and identified by dental healthcare professionals, which can be vital for patients’ diagnosis and treatment (Yonel et al. 87). Diabetes mellitus impacts different areas of the body, including oral health (Aldosari et al. 87). This condition is characterized by hyperglycemia (high blood glucose levels) due to a deficiency of insulin secretion and/or resistance to insulin (Rohani 485). Hyperglycemia leads to complications within the oral cavity, such as periodontal disease, as well as other adverse oral health outcomes (Rohani 485). For example, studies have shown that patients with diabetes mellitus experience more cavities and root canals than those without the disease, however, they typically do not partake in extra care (Aldosari et al.). Therefore, the lack of access to adequate dental care can not only contribute to negative oral health effects, but negative systemic health effects as well. 

Oral Healthcare in the Diagnosis of Diabetes Mellitus: 

Dental healthcare practitioners play a key role in the identification of diabetes mellitus and studies have shown that patients find this screening important to their care, especially in the early stages of the disease (Yonel et al. 87). Roughly 25% of diabetes cases in the United States are undiagnosed. Studies have shown that in those aged 65 and older, in which undiagnosis increases, 58% of individuals regularly visit the dentist, while only 37% regularly visit a primary care physician, demonstrating the importance of diabetes diagnostic assessments in the dental field (Elangovan et al. 188). The diagnostic process takes the form of a symptom assessment (“Diabetes”). Symptoms for diabetes that a dentist can find include: gum disease, tooth decay, dry mouth, fungal infections, lesions in the mouth, loss of taste, infection and/or delayed healing (“Diabetes”). Periodontal assessments are also valuable in the diagnostic process, as this is how a dentist may discover gum disease and other types of diabetes-related infections (Bjelland et al. 202). If a dentist notices any side effects, they will refer the patient to a specialist for further assessment. Due to the nature of the disease, diabetic patients may require a different level or type of oral care (Tomar and Lester 1505). For example, more frequent dental visits, the use of various medications, and other specialized dental treatments may be required (Vernillo 134). By including this type of screening in dental practices, patients not only get the care they need, but also get a direct referral to a healthcare practitioner for further systemic care. Thus, a lack of access to dental care can lead to harmful health outcomes.  

The Bidirectional Relationship Between Periodontal Disease and Diabetes:

Oral health disparities play a significant role in the incidence and prevalence of diabetes, wherein limited access to dental care can contribute to poor oral health and diabetes (Ghanem and Nagy 2). Notably, individuals from underserved communities often experience periodontitis, which is linked to chronic inflammation and insulin resistance (Preshaw et al. 22). This connection mediates a two-way relationship between periodontitis and diabetes, as type 2 diabetes presents as insulin resistance (Preshaw et al. 22). Accordingly, people with diabetes are more susceptible to periodontitis, as evident by the prevalence of periodontitis in this population (Matthews 162). In fact, individuals with diabetes have a 70% higher chance of developing periodontitis, further underscoring the strong link between the two conditions (Alwithanani 57). The bidirectional relationship also indicates that untreated periodontitis can lead to worsening glycemic control and an increased risk of diabetes-related complications (Preshaw et al. 22-3). Given this relationship, the lack of proper dental care disproportionately affects individuals with limited medical care and exacerbates diabetic symptom progression, contributing to a cycle that worsens both health conditions (Northridge et al. 6-12; Zhang et al. 903). Disparities in access to dental care, including geographical barriers and financial limitations, can be compounded with poor oral health literacy, leading to delayed treatment and inadequate oral hygiene practices (Muirhead et al. 298-302). Furthermore, while food choices play a significant role in the management of diabetes, underserved individuals in lower-income communities may suffer from food insecurity, leading to poor food choices (Gucciardi et al. 326). Limited access to affordable and nutritious foods often results in a reliance on inexpensive diets high in processed carbohydrates and sugars (Gucciardi et al. 326-7). This not only worsens blood sugar control, which is integral to diabetes management, but also promotes oral bacteria growth, contributing to periodontal disease (Bonsembiante et al. 3344; Martinon et al. 197). Thus, addressing the systemic factors that contribute to oral health disparities in underserved communities, including access to dental care, food insecurity, and oral health literacy, is crucial to breaking the cycle between poor oral health and diabetes outcomes.

How Dental Care Through An Integrated Healthcare Team Could Improve Health Outcomes in Diabetic Patients:

As previously mentioned, dentists play an important role in minimizing the morbidity and mortality linked with diabetes by referring patients with periodontal disease to a physician for further evaluation (Zhang et al.1-9). Hence, it is important that greater efforts are made to increase dental access in underserved communities and spread awareness regarding the importance of maintaining optimal oral health (Zhang et al. 1-9). Public health campaigns could be used to increase public knowledge about the link between oral and systemic health, to encourage individuals to proactively seek dental care, ultimately mitigating the burden of preventable complications. Systemic barriers in accessing dental care for patients with diabetes and periodontal disease can be addressed by expanding community-based dental health clinic infrastructure in underserved areas (Glurich et al. 531-41). These clinics would consist of trained health care professionals (e.g., dentists and doctors) that understand the complex interplay between diabetes and periodontal disease. Considering that periodontal disease manifests from a lack of dental care, and exacerbates diabetes progression, a cross-disciplinary integrated care delivery model combining medicine and dentistry could improve the management of both conditions (Jones et al. 21-9).  For example, the dissemination of information could be quicker in an integrated team because all the providers would have access to the same comprehensive electronic information system (Jones et al. 21-9). As a result, patients diagnosed with periodontal disease would be expected to have a higher chance of receiving timely treatment in the case that they are also diagnosed with diabetes (Jones et al. 21-9).  

Conclusion: 

To conclude, it is important to note the connection between oral and systemic health, especially in the context of diabetes. The presence of a bi-directional link between periodontal disease and diabetes can lead to a worsening of both conditions, with individuals in underserved communities facing disproportionate risks due to limited dental care, poor oral health literacy, and food insecurity. These overlapping factors contribute to a cycle that exacerbates inflammation, insulin resistance, and poor glycemic control. Integrating a diagnostic process in dental exams can be vital for early intervention and allow for an introduction into collaborative healthcare. Collaborative healthcare can be a vital tool for bridging the gap between these two levels of healthcare and allowing for a more comprehensive examination at the dental office (Genco et al. 57).  Screening for, and diagnosing diabetes during dental exams, has been proven to be a feasible and helpful step towards collaborative healthcare and has proven to be important and meaningful to patients (Genco et al. 57). By including this type of care globally, the incidence of periodontal disease, cavities, root canals and other negative oral health outcomes associated with diabetes may diminish, and patients have the opportunity to get appropriate and targeted dental care for their condition.

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