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A Two-Way Relationship: Gum Disease & Diabetes

If you’ve got diabetes, you probably also have gum disease. There’s also a good chance that the gum disease is severe.

In fact, the two conditions come together in a pretty vicious circle. Diabetes raises the risk of periodontitis, the severe form of gum disease, which slowly destroys the bone and other tissues that support your teeth. Periodontitis, in turn, has a negative effect on glycemic control and the course of diabetes.

Naturally, that raises a question: If you treat one condition, does the other get better, too? The evidence so far suggests that yes, yes it does.

“Conventional Periodontal Treatment Can Improve Metabolic Control”

Consider the findings of a 2020 review and meta-analysis in the Journal of Applied Oral Science.

Its authors began by searching two major databases for randomized clinical trials (RCTs) looking at the impact of periodontal treatment on glycemic control in patients with type 2 diabetes. RCTs have long been considered the gold standard in medical research because their design eliminates a lot of the bias that can affect other types of studies.

Nine studies made the cut. Altogether, they showed that when patients had their gum disease treated, both their HbA1c and C-reactive protein levels dropped significantly. The latter is a common measure of inflammation, a symptom that’s common to both gum disease and diabetes.

The present systematic review with its two meta-analyses indicates that conventional periodontal treatment can improve metabolic control and reduce systemic inflammation in patients with [type 2 diabetes] by reducing serum levels of HbA1c and CRP, respectively. The results of the metabolic control achieved by treatment and the reduction of systemic inflammation are consistent with the results of other systematic reviews and meta-analyses. [emphasis added]

Notably, the studies considered looked only at conventional treatment, which is a procedure known as scaling and root planing (SRP). You often hear it described as a “deep cleaning.” How much more improvement might there be if treatment included ozone, as well? One recent RCT, for instance, showed that the patients with periodontitis who received ozone in addition to SRP “showed a marked improvement in periodontal conditions compared with the test group.”

Gum Disease Treatment May Even Reduce Overall Healthcare Costs

Not only is there good evidence that treating gum disease can improve diabetes symptoms; there’s evidence that it can reduce overall healthcare costs, as well.

This was most recently shown through a study in the Journal of the American Dental Association (JADA), which analyzed insurance data from IBM and Medicaid databases to see the relationships between periodontal treatment and total healthcare costs per patient.

“In our study of both commercial insurance claims and Medicaid data,” wrote the study authors, 

we found that periodontal treatment in the 2 years before 2019 was associated with a significant decrease in overall health care costs in 2019 for patients with DM [diabetes mellitus]. These results are consistent with those from prior studies that showed a reduction in health care costs after periodontal treatment for patients with DM.

Those patients with private insurance saw a 12% drop in healthcare costs, while those with Medicaid had a 14% drop.

Another study explored the issue among nearly 12,000 adults with diabetes, coronary artery disease, or both conditions, who were enrolled in a commercial health plan that provided preventive dental coverage. The analysis was relatively simple: The research team compared the healthcare costs for people who had at least one preventive dental visit a year to the costs for those who got no dental care at all. And what did they find?

  • Diabetic patients who got dental care saved an average of $549 per year.
  • Heart patients who got dental care saved an average of $548 per year.
  • Patients with both conditions who got dental care saved an average of $866 per year.
  • The savings were largely the result of a reduced need for serious inpatient care.

These results are consistent with the few studies previously reported. Jeffcoat and colleagues reported significant savings for people with follow-up dental care among both those with type 2 diabetes and those with CAD who also had periodontal disease. They found annual savings of $2,890 and $1,040 for the two groups, respectively. A recent study that assessed the relationship between periodontal interventions (any visit with CPT-4 codes D4000-D4999 in 2 years) and healthcare costs and utilization among patients with type 2 diabetes in an integrated dental, medical, and pharmacy commercial claims database found similar cost savings as the present study: $1,799 for 2-year follow-up versus approximately $750 per year for this study. Lamster et al recently reported similar inpatient cost savings in an 18-month study of New York state Medicaid data using different inclusion criteria.

Bottom line? Tending to your mouth’s health is tending to your body’s health – and even, a little bit, your financial health, as well.