Poor Oral Health and Diabetes: A Mutual Relationship

The importance of oral hygiene has been impressed upon us since childhood. As children the discomfort of sitting in a dentist’s chair is adequate motivation to maintain good (enough) personal oral hygiene behaviours; as adults, social protocols are equally incessant in guiding our oral hygiene practices. Could there be a more poignant reason for us to make sure we are brushing our teeth twice a day? A recent study conducted by clinical professor and neurologist Dr Yoonkyung Chan suggests there is.

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A close but complex relationship exists between oral health and diabetes mellitus.

Both diabetes and oral diseases share many risk factors including alcohol, smoking, and high sugar diets, and is the reason both dentists and physicians caution against their use. Diabetes also shares a more direct link with poor oral health. High blood sugar, a trait characteristic of diabetes, increases the supply of sugar and starch to our teeth causing a buildup of plaque (a sticky film) to occur. The acids in plaque can damage the protective coating around teeth and reduce our ability to fight dental bacteria and infection, eventually leading to the development of cavities and gum diseases.

More recently, however, researchers have looked at whether the reverse is also true; can poor oral health lead to diabetes? Inflammation of the gums and gum diseases are known to create space in the gum where bacteria can collect. This bacterium, according to researcher Dr Chan, can then travel into the body’s circulatory system and trigger immune responses that reduce the body’s ability to control blood sugar levels. While difficult to prove because many factors involved in poor oral health are also associated with diabetes, Dr Chan and his colleagues were able to control for these factors and reveal a link between having oral diseases and developing new-onset diabetes. In effect, the study found that people with gum disease and moderate tooth loss (edentulism) were more likely develop diabetes than those without.  

For older adults who are at increased risk for edentulism and dental caries, this link between oral diseases and new-onset diabetes could create a double burden. Oral diseases have a profound bearing on general health and well-being through their influence on nutrition.  While the development of diabetes in later life can have more severe implications for physiological and cognitive health due to the interplay between the vascular complications associated with the disease and coexisting morbidities.

In recognition of the high prevalence of oral diseases in older adults and the close connection poor oral health has with chronic diseases such as diabetes, the World Health Organization (WHO) has made oral health a global health priority. The WHO Report on Ageing and Health recognizes oral health as a crucial and often neglected area of healthy ageing and outlines broader strategies for reducing the burden of oral diseases and non-communicable diseases in older populations through prevention strategies that target the modifiable risk factors shared between them.  

IFA believes improving and sustaining health in older age also requires the close collaboration of, and strategic alignment between, all stakeholders with vested interest in this population. As such, IFA is proud to play its role as a unifying agent and provide an important point of contact among experts through the IFA Expert Centre. To learn more about the critical work being done in the fields of gerontology and diabetes, please contact: Professor Alan J. Sinclair, WHO Expert in Diabetes and Frailty, Clinical Scientist and Diabetes Specialist, Prof. Dr Hans-Peter Hammes, Professor of Internal Medicine at the University of Heidelberg, Germany, and Head of Endocrinology at the 5th Medical Division and Prof. Leocadio Rodriguez Mañas, Head of the Department of Geriatrics at Hospital Universitario de Getafe (Madrid), and President of the Research Committee at Hospital Universitario de Getafe.