We return after a much-needed revival break to regroup and reflect.
Last time we did a deep dive into the beginnings of diabetes after blood sugar imbalances.
As mentioned in the previous edition, through the chemicals produced in diabetes and blood sugar imbalance, the Advanced Glycation End products, and AGEs ( extra sugar from your diet attaching to proteins), there may be damage to body organs, including periodontal (gum) tissues. When your doctor or nurses checks for diabetes, they will check glycated haemoglobin (HbA), which is an AGE. Today we will go through how this may happen and why having a balanced blood sugar level should be a concern for us all, diabetic or not.
Impaired blood sugar levels cause inflammation.
Inflammation is the central feature of both periodontitis and diabetes. Diabetes increases inflammation in the gum tissues through various immune signalling chemicals knowns as cytokines.
Raised blood sugar can create a sugar and protein hybrid chemical AGEs. These have been shown to accumulate in gum tissues. This chemical causes the immune system to increase inflammation. They also damage the lining of the blood vessels that supply oxygen and nutrition to the gum tissues. This changes the blood supply to the area resulting in increased bleeding ulceration with poor building blocks immune supply to repair the damage. Furthermore, AGEs disrupt new bone formation and repair through their action on collagen in periodontal tissue cells.
Finally, high blood sugar levels can increase the production of chemicals called free radicals. These unstable little rockets damage cells by piercing a hole within them, causing water to leak or pop the cell. Both actions destroy the cells and, eventually, tissues.
Oral microbiome
Diabetes is known to reduce saliva rate, causing the oral tissues to be more dehydrated. This will invariably result in lower ''flushing'' action of bacteria. Encouraging increased growth of biofilm communities. Adding assault to injury, blood sugar imbalance will also prolong the immune response to Porphyromonas gingivalis (P.gingivalis) bacteria causing gum disease and indirectly encouraging the growth of these bacterial species.
While the research is still catching up on human studies, some animal studies have indicated that P. gingivitis in the oral tissues can negatively influence the immune system, leading to impaired insulin production and usage.
The resulting impact is a distorted immune response to the biofilm, which results in an exaggerated set of symptoms for people with diabetes. Even more interesting is that individuals with poor gum disease control can impact blood sugar levels through inflammation, worsening diabetes or increasing the risk of diabetes.
Research has shown that a person's overall blood sugar may improve through effective gum disease treatment! So as always, we move towards hope for better health and well-being.
For those who'd like to read more on diabetes and periodontal disease's bi-directional relationship, we refer you to academic articles here, here and here. We would also want you to point to Dr Varkha Rattu, a valuable source on periodontics and diabetes intersectionality.
Since last time, we have received some helpful feedback. Some of our readers felt that the previous edition's depth and length took a lot of work to follow. Based on this, we've decided to keep today's article simple. We always welcome feedback of this kind as it helps improve the quality and understanding of future issues.
This week’s art illustrations shining a spotlight on the works of artist Studio Lenca. His work often uses double figures who appear the same but have unique differences. We felt it could be used as metaphor for the shared nature of diabetes and periodontal diseases. Both uniquely different illnesses with their own set of symptoms but tied together by the underlaying inflammation.
Next week we return with a focus on balancing blood sugar levels and reducing the production and consumption of AGEs through diet and lifestyle. Something that needs to be better understood and communicated by dental teams.