Scientists figure out why diabetes causes gum disease and a loss of oral health

The relationship between diabetes and periodontitis is one that has been known about for quite some time but has been dismissed as coincidental. Until now, that is. A recent study led by researchers from the University of Pennsylvania has pinpointed oral microbiome as the link between these two conditions. Specifically, the study showed that diabetes prompts changes in the oral microbiome that increase the likelihood of bone loss and inflammation, two hallmarks of periodontitis.

Four years prior to this study, the European Federation of Periodontology and the American Academy of Periodontology issued a report dismissing any connections linking diabetes to shifts in the oral microbiome. This compelled Dana Graves, study senior author, and his colleagues to look into the issue themselves. As Graves told “The studies that had been done were not rigorous. My argument was that the appropriate studies just hadn’t been done, so I decided, ‘We’ll do the appropriate study’.”

The researchers began by comparing the oral microbiota of diabetic mice with those of healthy mice. Both groups of mice had similar oral microbiota, though this changed once the diabetic mice became hyperglycemic, or developed elevated blood sugar levels. The oral microbiota of the diabetic mice grew increasingly limited and pathogenic, so much so that the mice eventually acquired periodontitis. (Related: Forget to floss? You may be putting yourself at risk of more serious health conditions)

Also known as gum disease, periodontitis is a serious gum infection caused by bacteria. Periodontitis left untreated can progress from gum inflammation, to gum recession and bone loss, to tissue deterioration and tooth loss.

The researchers noted that the diabetic mice experienced a loss of bone that affected the teeth and raised levels of the molecule interleukin-17 (IL-17). An abundance of this molecule has been linked to periodontitis as well.

Further into their study, Graves and his colleagues transferred oral microbiota from the diabetic mice into mice that had been raised without microbial exposure. A micro-CT scan on the second group of mice revealed that they had undergone serious bone loss. “We were able to induce the rapid bone loss characteristic of the diabetic group into a normal group of animals simply by transferring the oral microbiome,” Graves said of this development.

The researchers suspected inflammatory cytokines like IL-17 had played a role in this drastic change. To prove this, they injected diabetic mice with anti-IL-17 antibodies before transferring their oral microbiota into germ-free mice. When compared with mice who received microbiota from untreated diabetic mice, this group displayed significantly less severe bone loss.

Graves added that, in addition to establishing a solid connection between periodontitis and diabetes, their study underscored the importance of blood sugar control and good oral hygiene for diabetic patients.

“Diabetes is one of the systemic diseases that is most closely linked to periodontal disease, but the risk is substantially ameliorated by good glycemic control. And good oral hygiene can take the risk even further down,” Graves stated.

How to maintain good oral health

The key to healthy teeth and gums lies in the removal of harmful bacteria and plaque. To prevent these from accumulating in the mouth, keep these oral hygiene practices in mind:

  • Brush teeth at least twice a day and floss at least once.
  • If possible, brush after meals to remove any food debris and plaque trapped between the gums and teeth.
  • Avoid smoking or chewing tobacco, since these can boost the risk of periodontitis.

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