With Miguel Vinas, PhD, and Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE
If you're trying to manage your blood sugar, and you have gum disease, a trip to the dentist appears likely to reduce your risk of diabetes and lower your hemoglobin A1c levels.1 Hemoglobin A1c is a test that reflects a person’s average blood sugar levels over the past three months.
According to a study from Spain,1 a dental treatment known as scaling and root planing lowered blood sugar levels in individuals with type 2 diabetes who received periodontal care—a more intensive plaque removal—when compared to those who got less intense oral cleaning to treat their gum disease.
Periodontal disease is caused by a build-up of plaque, the sticky bacterial film always forming on the teeth, especially at the gum line. This plaque build-up leads to an infection of the tissues that surround and support your teeth. When not treated, gums may bleed and can begin to pull away from the teeth, eventually causing tooth loss.
In this six-month study,1 people who underwent the root planing and scaling procedure had lower hemoglobin A1c levels than a process of removing the plaque with ultrasound, says Miguel Vinas, PhD, a study coauthor, and researcher at the University of Barcelona.
The researchers randomly assigned 90 people diagnosed with type 2 diabetes who had an average hemoglobin A1C of 7.7% at the start to either the scaling and root planing group or the ultrasound group.
At three months and again at six months, the researchers evaluated the depth of the pockets around the teeth and other indicators to measure the level of gum disease present.1 They also gave both groups blood tests to measure their A1c, a standard measure of individual blood sugar levels.
At the end of six months, the ultrasound groups had an average reduction in A1c of .06%, while the root planing and scaling group had a significantly greater average reduction of .51%.1
“While the reduction may seem modest,” Dr. Vinas says that any reduction is good and helps to reduce long-term complications of periodontal disease.
In fact, he tells EndocrineWeb, “a reduction of just 1% in A1c can produce good results” in lowering risks associated with diabetes. In one study that tracked reduced hemoglobin A1c and its effects over a decade, a reduction of 1% reduced diabetes-related death by 21% and heart attack risk by 14% over the follow-up, among other benefits,2 he says.
The strong link between diabetes and oral health problems, especially gum disease, is well known, says Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE, the transitional program coordinator at Kovler Diabetes Center, Chicago, and a member of the EndocrineWeb editorial advisory board.
According to the American Dental Association (ADA),3 gum disease can raise blood sugar in people both with and without diabetes. Some experts say that germs in the infected gums may leak into the bloodstream following activities such as chewing food or brushing your teeth. This interaction may cause your body's defense system to react to the germ invasion, and the end result may be higher blood sugar levels.
However, evidence supports aggressive treatment for severe gum disease leads to a reduction in blood sugar levels, with about the same effect as adding on another medicine to your usual diabetes medication routine.3
Exactly why the dental treatment appears to help lower levels of hemoglobin A1c is still being investigated, Dr. Vinas tells EndocrineWeb, ''but it seems clear that periodontitis enhances inflammation,'' he says, and inflammation worsens diabetes. "It is a vicious cycle in which diabetes worsens periodontal disease and periodontal disease worsens diabetes," he says, and treatment appears to break this cycle.
There's no pat answer for how often you should see your dentist if you have both diabetes and gum disease, acknowledge both experts.
However, the research does suggest the need to take your oral health seriously, Hess-Fischl says. She suggests working with your health care provider to lower blood sugar levels, but also to see your dentist at least every six months, or perhaps every three months, depending on the severity of the gum disease and based on the advice of your healthcare team.
For those with gum disease, the study suggests the clear benefit of treating it every three months, she says.
“The optimal treatments will depend on the level of inflammation in the gums and the buildup on the teeth,” Dr. Vinas says. Your dentist will evaluate the severity of gum disease by measuring the depth of the pockets around the gums and other factors such as bleeding in assessing the appropriate frequency recommended for oral health visits.
Proper meal planning remains a key aspect of diabetes care. Between dental appointments, it is crucial to brush your teeth after each meal and before bedtime,4 according to the American Academy of Periodontology (AAP). The AAP also recommends flossing at least once a day and, if gum disease is diagnosed, consider a consultation with a gum disease specialist known as a periodontologist.