Changes induced by diabetes in the composition of oral flora entail inflammatory alterations that promote bone loss associated with periodontitis.

Diabetes and periodontitis are two closely related diseases.Not surprisingly, there are numerous studies that have demonstrated, on the one hand, that people with poorly controlled diabetes have a risk of developing periodontitis and, on the other, that periodontitis can initiate or increase insulin resistancein a similar way to how obesity does, thus promoting the appearance of diabetes.

In fact, it is very possible that periodontitis is an early sign of non -diagnosed diabetes.

But what are the mechanisms that explain that diabetes and periodontitis go hand in hand?Well, the truth is that they don't know each other very well.Or so it has been until now, since a study led by researchers from the University of Pennsylvania in Philadelphia (USA) could have found the key to explaining the relationship between both diseases.And according to their results, diabetes seems to cause changes in the oral flora of patients who promote the development of periodontitis.

As Dana Graves explains, director of this research published in the magazine «Cell Host & AMP;Microbe »," until now we did not have concrete evidence that diabetes would affect oral microbiome.However, the studies developed in this regard were not too rigorous.Thus, and since he considered that the work done in this regard were not appropriate, we decided to carry out the appropriate study ».

oral microbioma

Periodontitis or ‘gum disease’, commonly known as pyorrhea, is a pathology basically characterized by the inflammation and bleeding of gums.A disease that, in case of not being treated, causes the destruction of the bone mass that supports the dental pieces and, therefore, to the irreversible loss of the teeth.But there are even more: numerous studies have demonstrated the association of periodontitis with different very serious and potentially mortal diseases, case of cardiovascular or different types of cancer.And also, of diabetes.

In the study, the authors analyzed the composition of the oral flora of an animal model - trays - without diabetes.And later, they caused the disease in half of the ‘participants’.And what happened?Well, although oral microbiome was totally indistinguishable when all animals shared similar levels of blood sugar, the composition differ, and much, depending on the mice were healthy or had diabetes.In addition, the flora of animals with the disease had a lower diversity of bacterial species.That is, diabetes had changed the composition of this microbiome.

The risk of periodontitis in diabetes patients is substantially attenuated with good glycemic control
Serious Dana
More;Mice with diabetes also suffered periodontitis, certainly being evident the destruction of the bone mass that supports the teeth, and an increase in immunoglobulin 17 (IL-17) levels, signaling molecule that plays a very important role in the immune response andIn inflammation.A result to take into account given that the increase in IL-17 levels are associated with the development of periodontitis in humans.

As Dana Graves indicates, "the diabetic mice showed a behavior similar to that of human beings with loss of periodontal bone mass and an increase of IL-17 due to a genetic disease."

However, the results suggest, once again, the existence of an association between diabetes and periodontitis.They do not show that the changesIn the oral flora induced by diabetes are really the cause of periodontitis.Therefore, the authors conducted a second experiment: to transfer bacteria of both diabetic and ‘healthy’ animals to mice raised in an environment totally free of germs.

The results showed that, compared to those in which microorganisms of the oral flora of healthy animals were transferred, which received the bacteria of the diabetic mice experienced a loss up to 42% higher of periodontal bone mass and a significant increase in inflammatory markers.As a reference to the director of the research, "in our work we have been able to induce rapid loss of bone mass characteristic of the group with diabetes in normal animals by simple transfer of the oral microbiome."

treatment and hygiene

In short, diabetes causes changes in oral microbiome that promote periodontitis.A periodontal disease that, according to the suspicions of the authors, is mediated by the increase in IL-17 levels.But is it really so?Well, to evaluate it, the authors repeated the experiment of bacteria transfer to animals free of germs.But with a difference: half of the receivers had been previously treated with an antibody against IL-17.

The result is that the loss of bone mass was a lot, but that much, less significant.So much so that, as researchers highlight, treatment against IL-17, given their role in immune protection, could mean a ‘reasonable’ therapeutic strategy to prevent loss of bone mass associated with periodontitis in humans.

As Dana Graves concludes, «our findings unequivocally demonstrate that diabetes induced changes in oral flora entail inflammatory alterations that promote bone loss in periodontitis.Diabetes is one of the most closely associated with periodontal disease, but the risks are substantially attenuated in case of good glycemic control.And to this it is combined that good oral hygiene can further reduce this risk.

take care of your gums, control your diabetes

There are increasing number of studies that confirm the close and bidirectional relationship that exists between diabetes and oral health - and more specifically, with periodontal health.And not only people with diabetes are more susceptible to periodontitis, that is, the usual ‘gum disease’, commonly known as ‘piorrea’.Periodontitis is also associated with greater risk, very similar to that observed with obesity, appearance or increase in insulin resistance and, therefore, diabetes development.

So it is that the presence of gum problems can help to diagnose this metabolic disease early.Therefore, and in order to facilitate the oral health care of the population with diabetes by professionals, the Spanish period of periodontics and osteointegration (SEPA) and the Spanish Diabetes Society (SED) published the guide 'Take care of your gums,Control your diabetes: Information for the Dental Hygienist '.

As Kepa explains, «'Take care of your gums, control your diabetes: Information for the Dental Hygienist' is presented as a quick consultation guide in which the key points that a dental hygienist must take into account in the treatment of diabetics are collected».

The guide highlights the importance of establishing health education strategies among people suffering from diabetes, because from their involvement in treatment and self -care a better quality of life will be derived.Thus, and through a dozen practical recommendations, the guide shows,Among other aspects, what information should be procured to patients with type 1 or type 2 diabetes for a correct periodic surveillance of their oral health or in which cases dental treatments should be administered, especially in case of periodontitis.