Diabetics have to watch what they eat, make sure they exercise, and, it turns out, they have to make sure they brush and floss with greater vigilance, too. There is a complex relationship between diabetes and gum disease that is “bi-directional” and too often part of a “vicious cycle” of health issues “in American Indians and Alaskan Natives where pre-diabetes and diabetes is so prevalent,” according to Dr. Maria Emanuel Ryan, a professor of oral biology and pathology and director of clinical research at Stony Brook University in Stony Brook, New York.
“The connection between gum disease and diabetes is related to the chronic inflammation that exists within both of these disease processes,” Dr. Ryan says. “The more advanced form of gum disease known as periodontitis is driven by bacterial infection and inflammation. Both infection and inflammation, hallmarks of gum disease, are known to cause insulin resistance, increasing the risk for developing diabetes and making it very difficult for someone with diabetes to gain control of their diabetes, or to get their blood sugar levels down.”
To help spread the word about the importance of oral health among people struggling with diabetes, Colgate Total has donated $100,000 to the American Diabetes Association’s Stop Diabetes program. The hope is that this cash will help the American Diabetes Association (ADA) inform more Americans about the crucial link between gum disease and diabetes. This link is particularly important in Indian Country, where, according to the ADA, American Indians and Alaskan Natives have a 2.2 times higher likelihood to have diabetes compared to white Americans. In addition, 95 percent of Natives who have diabetes have Type II diabetes, and 30 percent of Natives have pre-diabetes.
Dr. Ryan adds that, “Recent studies have indicated that the risk of developing diabetes is twice as likely in people with varying degrees of periodontitis followed over two decades." Periodontitis is the inflammation and infection of the tissue and bones surrounding the teeth. "Multiple studies, many conducted in Native American people, have demonstrated that periodontitis can worsen glycemic control in people with diabetes, increasing their risk for developing long term complications of diabetes such as cardiovascular disease and kidney disease, thereby increasing the risk for mortality,” she says. Growing public awareness of the connection between oral health and overall health will hopefully help reduce the risk of serious complications, including death, among people with diabetes.
Dr. Ryan says that gum disease is “the most common chronic inflammatory disease in the world,” perhaps because “it is often a silent disease with few signs and symptoms.” To maintain optimal oral health, home care, including brushing at least twice a day and flossing at least once a day, prevent this disease of the supporting structures of the teeth. Regular dental visits are especially important in the prevention of gum disease. Because there often aren’t any symptoms when gum disease is present, Dr. Ryan says an oral health care provider is often needed to insure “home care is adequate” and the gums are indeed healthy. If a person’s gums bleed when they floss or brush, they have red swollen gums, suffer from persistent bad breath and/or a bad taste in the mouth, suffer from shifting teeth; growing spaces between teeth; or loosening of teeth, then Dr. Ryan says immediate professional care is needed, as these may be signs of gum disease.
Unfortunately, throughout much of Indian Country, access to professional oral health care is limited. Dr. Ryan says, “I am fully aware of the access to dental care issues at Pine Ridge, and I believe that we can all help in making a difference. The School of Dental Medicine at Stony Brook University has an outreach program to the Pine Ridge Indian Reservation in South Dakota where they have been providing support for much needed dental services for the past ten years. Students, faculty and staff from our school spend two weeks every summer providing much needed dental care to members of the Lakota tribe at the Indian Health Center at Pine Ridge in a facility operated by the Indian Health Service. Several dental manufacturers generously donate supplies and equipment.” Dr. Ryan adds that many students, “ leave their summer experience knowing that so much more needs to be done to help out and based on the fulfilling experience of providing care to those who are truly in need and who lack access to care, many of our graduates continue to volunteer and provide services to those most in need.”
Despite these efforts, the Native American Oral Health Care Project, an ADA-sponsored initiative that seeks to collaborate with Indian tribes to improve oral health, reports that dental decay is 300 times more likely throughout Indian Country than it is in the general U.S. population. This statistic is even more alarming when the high diabetes rate among Natives is considered. “Studies have shown that untreated periodontal disease can make it more difficult to control diabetes so that no matter how much you watch your diet or whether you are good about taking your medications you may find that it gets harder and harder to keep your blood sugar levels down because the infection and inflammation in your mouth is causing insulin resistance, thwarting your efforts to gain control of your diabetes,” Dr. Ryan says.