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Improved oral health to reduce the risk of diabetes - Deborah Lyle

Concurrent with the prevalence of obesity and a rise in physical inactivity, around 422 million people worldwide now have diabetes. As one of the leading causes of death across the globe, The World Health Organisation (WHO) is calling for action to raise awareness and help reduce the risks of type 2 diabetes, improving access and the quality of care for people with all forms of diabetes.[1]

In the UK, the number of people with diabetes is increasing rapidly[2] and in order to stem this rise, readily available diabetes education with an emphasis on the prevention of type 2 diabetes is urgently needed. The other pressing issue is that an estimated 630,000 people in the UK have undiagnosed or untreated type 2 diabetes2 and the longer they live without intervention the worse their health outcomes are likely to be.

As dental professionals will be aware, diabetes occurs when the body is unable to efficiently metabolise glucose circulating in the blood stream due to either inadequate production or the impaired effectiveness of insulin.[3] If the body is unable to process the glucose in the blood and levels remain elevated for long periods (hyperglycaemia), permanent damage to parts of the body such as the eyes, nerves, kidneys and blood vessels can occur.[4] In addition, if blood sugar levels are poorly controlled salivary flow can decrease and encourage bacterial growth and/or dry mouth, which may lead to ulcers, soreness, halitosis, infections and tooth decay.[5] Uncontrolled diabetes can also impair the function of white blood cells and cause reduced blood flow around the body including the oral cavity, where the gingiva and teeth can become weak and more susceptible to infection.[6]

Over the last two decades, the profession has seen more and more evidence to suggest that diabetes heightens the chances of developing periodontal disease[7],[8] and increases periodontal destruction.[9] It seems that the link between these two chronic diseases is more complicated that we first thought, as a further study also reveals that periodontal infection can adversely impact glycaemic control[10],[11] making it more difficult for diabetic patients to control their blood glucose levels. In fact, a recent systematic review tentatively suggests that when periodontal treatment is maintained for at least three months it can improve the general health of type 2 diabetic patients by affecting glycaemic control.[12]

Of course, it is important that dental professionals understand diabetes in order to be able to adequately inform, advise, monitor and plan treatment for patients already with the condition and for those that may be at risk of developing it. As with most serious diseases, successful treatment to reduce the risk of complications depends on swift diagnosis – but, regrettably, it is possible for individuals to have abnormal blood glucose levels for some time and be fairly asymptomatic. Equally, it can sometimes be hard for people to notice the early symptoms of diabetes or they may simply disregard the warning signs and put them down to fatigue, stress or the side effects of medication. The dental practice, however, has been recognised as a suitable location for identifying patients with pre-diabetes and undiagnosed diabetes.

Research conducted in the last year has revealed that a considerable number of patients with severe gum disease have undiagnosed diabetes. A study at the University of Amsterdam confirmed that periodontitis is an early sign of diabetes and, therefore, could serve as a valuable risk indicator to help prevent more severe complications. [13] Similarly, as patients attend the practice routinely, practitioners are ideally placed to discuss diabetes. If a patient mentions dry mouth, ulcers or increased thirst, or indeed any of the other early signs or symptoms of diabetes such as feeling more tired than usual or using the bathroom a lot, losing weight without trying or blurred vision,[14] dental professionals should advise them to visit their GP for screening.

As well as making patients aware of the risks of diabetes and possibly helping to identify undiagnosed or untreated cases, dental professionals can also arm patients with the skills and guidance they require to make a positive impact on both their oral and general health. This includes offering dietary advice and helping them to enhance and maintain excellent oral health. Practitioners can also teach brushing techniques and recommend consistently effective adjuncts like the Waterpik® Water Flosser, which has been clinically proven to be twice as effective as dental floss for improving gingival health.[15] In fact, the Waterpik® Water Flosser can remove plaque biofilm from treated areas in just 3 seconds[16] and can significantly reduce gingivitis and bleeding for patients with diabetes.[17]

The escalation in the prevalence of diabetes is posing a challenge to all aspects of the healthcare system. However, with the promotion and education of patients to raise awareness of the risks of diabetes, as well as strategies to improve both general and oral health, patients could potentially live longer, happier lives with fewer complications.


For more information on Waterpik International, Inc. please visit www.waterpik.co.uk. Waterpik® products are available from Amazon, Costco UK and Superdrug stores across the UK and Ireland.



[1] World Health Organisation. 10 facts on diabetes. April 2016. http://www.who.int/features/factfiles/diabetes/en/ [Accessed 20th March 2017]

[2] Diabetes UK. Number of people with diabetes reaches over 4 million. January 2016. https://www.diabetes.org.uk/About_us/News/Number-of-people-with-diabetes-reaches-over-4-million/?gclid=COXU-J6E5dICFcUp0wodA3AGmQ [Accessed 20th March 2017]

[3] Disabled World. Diabetes: Types, symptoms and treatments. https://www.disabled-world.com/health/diabetes/ [Accessed 20th March 2017]

[4] NHS Choices. Hyperglycaemia (high blood sugar). http://www.nhs.uk/conditions/Hyperglycaemia/Pages/Introduction.aspx [Accessed 20th March 2017]

[5] Awatif Y et al. Oral Manifestations and Complications of Diabetes Mellitus. Sultan Qaboos Univ Med J. 2011 May; 11(2): 179–186. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3121021/ [Accessed 20th March 2017]


[6] Rajkumar D et al. Diabetes and periodontal disease. J Pharm Bioallied Sci. 2012 Aug; 4(Suppl 2): S280–S282. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3467897/ [Accessed 20th March 2017]

[7] Dr. Guglielmo Campus et al. Diabetes and Periodontal Disease: A Case-Control Study

 Journal of Periodontology March 2005, Vol. 76, No. 3, Pages 418-425 , DOI 10.1902/jop.2005.76.3.418 (doi:10.1902/jop.2005.76.3.418). http://www.joponline.org/doi/abs/10.1902/jop.2005.76.3.418 [Accessed 20th March 2017]

[8] Ira B Lamster et al. The relationship between oral health and diabetes mellitus. The Journal of the American Dental Association. October 2008, Volume 139, Supplement 5 Pages 19S-24S. http://jada.ada.org/article/S0002-8177(14)63883-6/fulltext [Accessed 20th March 2017]

[9] Mealey BL. Periodontal disease and diabetes. A two-way street. J Am Dent Assoc. 2006 Oct;137 Suppl:26S-31S. https://www.ncbi.nlm.nih.gov/pubmed/17012733 [Accessed 20th March 2017]

[10] Mealey BL. Diabetes and periodontal disease: two sides of a coin. Compend Contin Educ Dent. 2000 Nov;21(11):943-6, 948, 950. https://www.ncbi.nlm.nih.gov/pubmed/11968145 [20th March 2017]

[11] Taylor GW et al. Periodontal disease: associations with diabetes, glycemic control and complications. Oral Dis. 2008 Apr;14(3):191-203. https://www.ncbi.nlm.nih.gov/pubmed/18336370. [Accessed 20th March 2017]

[12] Teeuw W J et al. Effect of Periodontal Treatment on Glycemic Control of Diabetic Patients. A systematic review and meta- analysis. Diabetes Care. 2010 Feb; 33(2): 421–427. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809296/ [Accessed 20th March 2017]

[13] Teeuw W J et al. Periodontitis as a possible early sign of diabetes mellitus. BMJ Open Diabetes Research and Care 2017;5:e000326. doi:10.1136/bmjdrc-2016- 000326. http://drc.bmj.com/content/bmjdrc/5/1/e000326.full.pdf [Accessed 20th March 2017]

[14] Diabetes UK. What are the signs and symptoms of diabetes? https://www.diabetes.org.uk/Diabetes-the-basics/Diabetes-Symptoms/ [Accessed 20th March 2017]

[15] Rosema NAM et al. The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol 2011; 13(1):2-10. https://www.waterpik.co.uk/professional/clinical-research/dental-floss-vs-water-flossing-reduce-gingival-bleeding-rosema-2011/ [Accessed 20th March 2017]

[16] Gorur A et al. Biofilm removal with a dental water jet. Compend Contin Ed Dent 2009; 30 (Suppl 1):1 - 6. https://www.waterpik.co.uk/professional/clinical-research/water-flosser-removes-plaque-gorur-2009/ {Accessed 20th March 2017]

[17] Al-Mubarak S et al. Comparative evaluation of adjunctive oral irrigation in diabetics. J Clin Periodontol 2002; 29:295-300. https://www.waterpik.co.uk/professional/clinical-research/diabetes-patients-reduce-plaque-gingivitis-al-mubarak-2002/ [Accessed 20th March 2017]





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