The mouth is the window into the health and wellbeing of the body. Systemic diseases may often begin showing signs in the mouth, Coeliac and Crohns disease often manifest as aphthous ulcers. Most notably periodontal disease with its prevalence in the American population has a direct correlation to diabetes and cardiovascular disease. The effects of periodontitis on the risks for systemic diseases makes it essential that all clinicians encourage patients to seek periodic exams and maintenance of their oral health.

Periodontitis, also known as gum disease, is a chronic inflammatory disease of the mouth that involves the gingiva, teeth, and supporting bone. Clinically defined as the loss of connective tissue attachment to the teeth and alveolar bone loss. A recent CDC report1 estimates that 42 percent of U.S. adults age 30 years or over with one or more teeth have periodontitis, the condition is more common in men than women and increases with age, 70.1 percent of adults 65 years and older have periodontal disease1. At first, it’s silent, practically invisible and sometimes even a painless disease, but once periodontal disease strikes it’s only a matter of time until it makes its presence known with uncomfortable, unsightly and quite possibly irreparable side effects.

Periodontal disease is the major cause of tooth loss in adults and caused by bacterial biofilm that forms constantly on teeth. The biofilm turns into plaque if not removed this plaque hardens into calculus along and under your gums. The clinical signs of periodontitis2 include swelling, redness, and bleeding from the gums, sensitive gums, spacing between teeth, loose teeth, changes in occlusion, halitosis, and exposure of root surfaces through the loss of bone around the teeth. The disease can present locally, involving a few teeth, or be more generalized.

Patients with diabetes (both type 1 and type 2) are at an increased risk of developing periodontitis3. Periodontitis has been referred to as the sixth complication of diabetes2and is often more generalized in patients with diabetes. Several studies found a higher prevalence of periodontal disease among diabetic patients than among healthy controls2. The risk increases as glycemic control worsens and evidence of loss of tooth support, often seen as spreading of teeth resulting in diastemas. Despite similar plaque scores, patients with poorly controlled type 2 diabetes display more severe gingival bleeding compared to those with diabetes in good or moderate control3.

In broad terms, the risk of periodontitis is increased approximately three-fold in people with diabetes and the risk is greater with poor glycemic control. Unfortunately, many people with diabetes remain unaware of their increased risk of developing periodontal disease. A two-way relationship between periodontitis and diabetes has been described, with each condition having adverse impacts on the other. Periodontitis has been associated with worse long-term glycemic control4 in people with type 2 diabetes, as well as increased risk of diabetic nephropathy (macroalbuminuria and end-stage renal disease) and cardiorenal mortality, Ischaemic heart disease and diabetic nephropathy combined.

Furthermore, individuals with periodontitis have two to three times the risk5 of having a heart attack, stroke, or other serious cardiovascular events. Shared risk factors, such as smoking, unhealthy diet, and socioeconomic status, may explain the association. There’s an increasing suspicion that periodontal disease may be an independent risk factor for heart disease. The association between coronary heart disease and periodontal disease may be due to an underlying response trait, which places an individual at high risk for developing both periodontal disease and atherosclerosis. It was suggested that periodontal disease, once established provides a biological burden of endotoxin and inflammatory cytokines, especially thromboxaneA2, prostaglandin E2, interleukin (IL) 1L=1, and tumor necrosis factor-β, which serve to initiate and exacerbate atherogenesis and thromboembolic events6.

It is imperative that patients with diabetes and heart disease are made aware of the potential effects it may have on their oral and periodontal health7. It is highly recommended that patients with periodontal disease be assessed by dental professionals, it should be routine in people with diabetes to assess for both periodontitis and the other potential oral complications of the disease, such as dry mouth, candidal infections, burning mouth, and dental caries.