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Diabetes and Smoking

How Does Diabetes and Smoking Increase Gum Disease Risk?

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Gum disease can be of two forms. GINGIVITIS is the superficial form that involves bleeding and inflammation of the gums in response to the presence of bacteria called PLAQUE. Gingivitis can then progress to PERIODONTITIS. This involves the bone around teeth dissolving. This means that teeth gradually lose support and become loose, until they are eventually lost.

Who is more prone to periodontitis?

Not everyone gets periodontitis, because we have an immune system that defends us against the bacteria. There is one particular cell in the immune system that plays a vital role, called the NEUTROPHIL. Individuals in whom the neutrophil does not work too well therefore don’t defend themselves well against the plaque bacteria, so are extremely susceptible to the bone around their teeth dissolving and their teeth subsequently being lost. We don’t know why the neutrophil doesn’t work well at the gums in some people, but it can happen in anybody for unknown reasons. What we do know, is it happens a lot in SMOKERS and DIABETICS.

Smokers and diabetics just don’t cope with the same level of plaque on their teeth and gums that other individuals might. It is therefore of vital importance that they remove the plaque bacteria much more efficiently than other individuals, therefore giving their weakened immune system an easier job to do.

In a similar way that diabetics can’t cope with sugar, they can’t cope with plaque either. Other people may be walking around with plaque in their mouths according to the level of tooth brushing they are performing. That’s fine, if the immune system is doing its job properly. In diabetics though, plaque must be kept to a bare minimum.

How can you tell if you have periodontitis?

The problem with periodontitis is that it does not hurt, so the patients’ bone is gradually dissolving while they don’t know about it. It can even be rather difficult for a dentist to find it, until it becomes too late. A Periodontist however is trained to find signs of the disease and intercept it whilst it is still treatable. It is imperative therefore that all diabetics and smokers see a Periodontist to check their bone levels and intercept any disease early.

Is periodontitis treatable?

Periodontitis is easily treatable, by removing the causative bacteria then designing a specified regime for the patient to keep them removed daily. This regime goes far beyond simple tooth brushing. The shapes of the gum margins and the gaps between the teeth are measured separately, then a selection of different sized and shaped brushes are selected to accurately remove the bacteria to a much greater level than routine tooth brushing.

Who else is susceptible to periodontitis?

It is important to remember that whilst smokers and diabetics are the most susceptible to periodontitis, anyone else can get it too. That neutrophil could become a little lazy in any of us, so healthy individuals should check for presence of disease too. Research has shown that 10% of us are resistant to gum disease, 80% have it to some degree, and 10% of us have it really badly. It’s all to do with a combination of age, genetics and the amount of bacteria being left behind after tooth brushing.

If you are concerned about having gum disease, schedule a visit with a Periodontist and be assessed, before it’s too late.

Dr. Samy Darwish

Dr. Samy Darwish
Consultant Periodontist and Oral Surgeon, UK
BSc, BDS, MFDRCS DipDSed, MSc, MClinDent, MRDRCS, LLM, FDSRCS
Dubai Healthcare City

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