Most people don't think about their teeth until something goes wrong. Several dental journals have recently published reports about the effect of diabetes on oral health.

A study at the Medical College of Georgia School of Dentistry reported that adolescents with type I diabetes have a higher incidence of inflammatory gingival (gum-related) disease than adolescents without diabetes.

It was learned by researchers at the Clinical Research Center for Periodontal Disease at the University of Minnesota that, "Diabetics who maintained reasonably good metabolic control had not lost more teeth or experienced more periodontal attachment loss than non-diabetics." However, "long-duration diabetics" and those with poor control had many problems, including periodontitis and tooth loss. It was determined that contributing factors for oral disease may be vascular change, neutrophil dysfunction (which involves a type of white blood cell), altered collagen synthesis, and genetic predisposition. The research report states that, "Minimizing plaque...through careful self-care and regular professional care is important to reduce the risk of periodontitis in diabetics."

Researchers in the Government Dental Hospital in Ahmedabad, India found that there is a "significantly higher" level of salivary calcium in people with uncontrolled diabetes than in other patients. These levels contribute to calculus formation, "and hence increase the severity of periodontal disease." Calculus is hard, crusty material that develops around the base of the teeth near the gums.

More evidence comes from a study in Helsinki, Finland. After following patients for two years, it was discovered that those with uncontrolled diabetes exhibited more degeneration of alveolar bone, part of the gum into which teeth are attached. Of course, without bone to anchor into, teeth will eventually come loose. Another study in Finland, at the University of Oulu, found that "sex, age, and type of diabetes were not significant variables," meaning that the common factor in diabetes-related oral disease is poor blood glucose control.

Perhaps the most fascinating study was conducted at the University of Istanbul in Capa, Turkey. It focused on a test, similar to the hemoglobin A1c, the test that helps determine glucose control over a period of 3-4 months. The research report reads:

"Fructosamine assay is a test used in the diagnosis and monitoring of diabetic patients. This assay may be of interest to the periodontist for, while the traditional plasma glucose value would give a general view and information about diabetic control at a certain point, the fructosamine concentration gives an indication of the plasma glucose level over a considerable period of time, such as one to three weeks. We investigated whether there was any relation between the diseased state of the periodontal tissues and plasma fructosamine and the plasma glucose values in [type 2] patients. We found that fructosamine correlated with the degree of gingival bleeding, however serum glucose levels had little or no correlation." [Our advisory board notes that one could expect to find similar results between the hemoglobin A1c and dental disease. The fructosamine assay is similar to the hemoglobin A1c, but tests back only a few weeks as opposed to 3-4 months.]

A study in Italy determined that "diabetes should not considered as the direct cause of periodontal disease but rather as a systemic promoting factor, able to produce conditions suitable for local agents producing gingivitis and periodontitis. The overriding oral problem in diabetes is infection, like with any of the dermal lesions in the diabetic."

So what does all this tell us? Do what Mom always told you to do-take good care of your teeth, and see your dentist every three months for plaque removal!