What special perio care do your patients with diabetes need?

Date: May 2021

Author: Louise Sinclair

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As of 2019, the International Diabetes Federation estimated that 463 million people worldwide suffer from diabetes, and a further 374 million suffer from pre-diabetes. These figures are projected to reach, respectively, 578 million and 454 million by 2030, and 700m and 548m by 2045. Given that diabetes is closely associated with periodontal disease, these figures highlight the importance of providing thorough periodontal care to patients with diabetes. Here, we discuss the latest research and recommendations to help you improve your patients’ oral and systemic health outcomes.

The relationship between diabetes and periodontal disease

It has long been established that diabetes can increase the risk for incidence and progression of periodontal disease, by as much 86% according to a 2018 meta-analysis published in Acta Diabetologica. That’s why periodontitis is often referred to as “the sixth complication of diabetes.”

The relationship between the two is bi-directional. Not only does diabetes increases the risk of periodontal disease, but periodontal disease can impair glycemic control and make diabetes more difficult to manage. This further increases the likelihood of oral and systemic complications in the patient, potentially trapping them in a spiral of deteriorating health.

The importance of periodontal care

Research has recently found that periodontitis and diabetes share common markers of systemic inflammation. In a recent study published in the Journal of Clinical Periodontology, researchers found that treating periodontitis reduced overall systemic inflammation in patients with type 2 diabetes. This, along with existing evidence that periodontal therapy improves blood glucose levels, suggests that periodontal care can improve both oral and systemic outcomes.

Cardiovascular disease is a principal complication of type 2 diabetes and is associated with higher mortality risk. In 2020, another group of researchers were the first to discover evidence that periodontal therapy could also improve certain aspects of cardiac function in patients with type 2 diabetes.

In another 2020 study, periodontal pocket formation and alveolar bone loss was observed in those with elevated blood glucose levels not considered high enough to meet the diagnostic threshold for diabetes, or even pre-diabetes. This suggests that by the time diabetes is diagnosed, the associated periodontal tissue destruction may have been underway for some time.

Altogether, the evidence underscores the benefits – and the urgency -- of pro-active periodontal care for patients with diabetes. The earlier periodontal disease is detected and treated, the better chance you have to help improve patients' oral and systemic health outcomes.

How to support patients with diabetes

Diabetes has a wide range of implications for overall health and requires significant adjustments to daily life. Just as the patient pays special attention to areas like nutrition, blood pressure, optical health and skin care, they should be made aware of the need to closely monitor their oral health.

Many patients are unaware of the connection between oral and systemic health, so education is a great place to start. Talk your patient through the diabetes-periodontal disease connection using non-technical language. It may help to use patient-focused educational aids like videos, models or slideshows, and provide take-home resources like these Diabetes and Your Oral Health brochures from the American Dental Association (ADA).

Oral hygiene coaching should focus on the importance of controlling plaque. Emphasize the need to use products specially formulated to fight plaque bacteria and guard against gingivitis, such as Colgate Total SF Toothpaste and Colgate Total 12 HR Pro-Shield Mouthwash. For patients with active gingival inflammation, chlorhexidine gluconate mouth rinse such Colgate PerioGard can be prescribed as a component of the professional treatment of gingivitis. Patients should also be educated and coached on interdental cleaning. If the patient has dental appliances, you can also emphasize the importance of thorough daily cleaning, and offer guidance on products and technique if necessary.

Finally, patients with diabetes should be educated on the importance of regular dental visits and periodontal screening. The loss of periodontal tissue is irreversible, so catching and managing periodontal disease in the early stages is essential for maintaining oral health.

Fortunately, patients with diabetes usually recognize the importance of self-care and are typically motivated to comply with healthcare advice. Providing them with recommendations and resources to improve both their oral and systemic health outcomes will help them see you as a trusted partner, building a strong and loyal patient-dentist relationship.