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Karabin has diagnosed several cases of diabetes from her dentist's chair. "When I see a patient with multiple abscesses in their mouth ... I immediately think 'diabetes.' I will send that patient for a glucose tolerance test." Nearly one-third of people with diabetes are unaware that they have it, and dentists can play a big role in diagnosing these patients, Genco says.

Diabetes and gum disease can interact in a vicious circle. Infections of any kind, including gum disease, cause the body to produce proteins called cytokines, which increase insulin resistance and make blood sugar more difficult to control, Karabin says. Conversely, uncontrolled diabetes impairs the body's healing mechanism, which makes it harder to control gum disease, Cram says.

Diabetic patients who avoid dentists out of fear or anxiety will have problems that go beyond tooth loss, says John Buse, MD, PhD, director of the Diabetes Care Center at the University of North Carolina School of Medicine. "You probably won't be able to do a good job taking care of diabetes unless you go to a dentist."

Gum disease may also speed the progression to full-blown diabetes in the 54 million Americans who are classified as prediabetic. According to the American Diabetes Association, many people first become aware they have diabetes when they develop dental disease.

In a 2007 study, Danish researchers compared prediabetic rats with gum disease to prediabetic rats without gum disease. The rats with gum disease soon displayed increased insulin resistance and other signs of progression toward type 2 diabetes.

Oral Health and Heart Disease

People with periodontal disease are nearly twice as likely to suffer from coronary artery disease as those without, according to the American Academy of Periodontology. One theory is that oral bacteria attach to fatty plaques in the coronary arteries and contribute to the clots that can lead to heart attacks. Another is that inflammation increases plaque buildup.

Although evidence has been mixed, more than 20 "good-sized" studies have demonstrated the relationship between gum disease and heart disease, Genco says. But that relationship is still not confirmed as with other known risk factors such as smoking or obesity. Genco is planning a major study to see whether treating gum disease can forestall a second heart attack in people who have already had one.

Continued

Recent analysis suggests that common oral problems could increase the risk of cardiac problems. Indra Mustapha, DDS, a periodontist who teaches at Howard University in Washington, D.C., and colleagues analyzed the results of other research studies and found that periodontal disease with signs of bacterial exposure was associated with greater risk of heart disease.

The American Heart Association states, "At this time, promoting dental treatment expressly to prevent atherosclerotic cardiovascular disease and/or acute cardiovascular events is not recommended."

Oral Health and Premature Birth

"Ob-gyns always knew that preterm and low-birth-weight births could be triggered by infections in the body, " says Karabin. "They looked for urinary tract infections and throat infections, but never really thought about the mouth until a periodontic researcher looked into it."



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