Increased risk of gum bleeding for people living with type 2 diabetes due to high blood glucose levels

Researchers find that diabetes control can impact different levels of gum bleeding.

People with type 2 diabetes show how gum bleeding can be linked to different diabetes-blood glucose readings, even in those that have good plaque control.

New research has identified how differences in diabetes-related blood markers affect gum bleeding in patients with type 2 diabetes, even with good plaque control.

The relationships among blood markers, oral indicators and oral hygiene habits were studied, based on medical records of 145 patients with type 2 diabetes from the Sunstar Foundation’s Senri Dental Clinic in Japan.

Researchers found that even with reduced plaque in patients, higher HbA1c and high-sensitivity CRP (C-reactive protein) levels were associated with increased gum bleeding in patients with type 2 diabetes.

The findings of the Management of periodontal disease based on diabetes-related blood markers study were recently presented at a meeting of the Japan Diabetes Society.

Researchers showed that while plaque control is a key part of preventing gum bleeding, patients with high blood markers of HbA1c and high-sensitivity CRP had higher gum bleeding rates, even when their plaque control was as good as those with lower blood markers.

The frequency of oral hygiene habits, such as interdental cleaning and rinsing with oral care products, as well as toothbrushing, were also linked with good plaque control.

Following the research, Senri Dental Clinic has now introduced personalised plaque control routines and targets for periodontal patients with diabetes and is providing individual oral hygiene guidance to achieve these goals.

Study authors are similarly advising dental professionals to incorporate blood-marker targets (e.g. HbA1c and CRP) in patients with type 2 diabetes and recommending collaborative management between oral health professionals and medical providers in patients with type 2 diabetes, rather than one-off referrals.

Dr Hidenori Suzuki, Director at Sunstar Foundation Senri Dental Clinic, said: “For patients with both periodontal disease and diabetes, we have always explained the importance of plaque control and the relationship between the two diseases, but previously it has been difficult to present concrete goals.

“Although this is a cross-sectional study based on a single dental practice, we are now able to quantify plaque control goals based on blood markers.

“Periodontal treatment often takes a long time, and some patients can feel anxious thinking ‘when will it end?’ or ‘is it effective?’. Sharing personalised goals between patients and their care providers is the first step toward motivating both parties to work together on long-term treatment.”

The link between diabetes and periodontal disease is well established.

In Japan, guidelines from the Japanese Clinical Practice Guideline for Diabetes recommend periodontal treatment for patients with type 2 diabetes for effective glycaemic control.

Most existing studies have focused on the initial treatment of periodontal disease. However, there has previously been little focus on the need for, or approaches to, ongoing oral health management based on blood markers.

Read the DRWF diabetes information resource Looking after gum health with diabetes