Focus
on Research
Oral
health key to diabetes
By
LOIS BAKER
Contributing Editor
Studies
conducted in two Native American populations with a high prevalence
of both Type 2 diabetes and gum disease have underscored the importance
of oral health in controlling adult diabetes.
Researchers
from the School of Dental Medicine, working with the San Felipe and
Santo Domingo communities of the Pueblo Indians in Santa Fe, N.M., found
that reducing gum infections with antibiotics also improved diabetes
control, based on concentrations of glycated hemoglobin, a marker of
blood sugar control.
Another
study involving Pima Indians from the Gila River Indian community in
Mesa, Ariz., who have the highest reported rates of both diabetes and
gum disease, showed that glycated hemoglobin levels don't fall, even
when sufferers have lost all of their teeth and thus no longer have
periodontal disease.
UB
dental researchers and others have shown in previous studies that a
relationship clearly exists between periodontal disease and diabetes.
Sara Grossi, UB clinical assistant professor of oral biology and supervising
scientist on both current studies, said she has come to believe periodontal
disease may be the most important of all the factors known to contribute
to diabetes onset, including age, gender, obesity and smoking.
The
Pueblo community study involved 75 persons with Type 2 diabetes and
severe periodontal disease who were randomized into four treatment groups.
Each group received the same active antibiotic to treat their gum disease,
but the regimen differed. Blood samples were taken at three, six, nine
and 12 months to evaluate levels of glycated hemoglobin, which indicated
the state of glucose control.
Results
showed levels of glycated hemoglobin could be reduced and maintained
at a reduced level most effectively on a regimen combining a repeated
oral antibiotic with a topical antibiotic applied to the gums every
three months.
"The
study shows that in this group of severe diabetics, we were able to
increase glucose control with repeated treatment of their periodontal
infection," Grossi said. "This reduction in glycated hemoglobin was
equal to and independent of any reduction brought about by diabetes
medication."
The
Pima Indian study was a retrospective analysis of data collected from
818 subjects in the Pima Indian Epidemiological Study conducted by UB
in conjunction with the Indian Health Service. Participants, all of
whom had Type 2 diabetes, were divided into three groups, depending
on their dental status: no teeth, severe gum disease and mild or moderate
gum disease.
Grossi
noted that in this population, tooth loss is due almost entirely to
periodontal disease because the high level of natural fluoride in the
region's water supply prevents the cavities that contribute to tooth
loss in other populations.
Results
showed that those who have lost all of their teeth to gum disease showed
equal or higher levels of glycated hemoglobin as those with severe periodontal
disease. Those with no teeth also had had diabetes longer than those
with severe gum disease.
"This
shows that once the cascade of severe periodontal infection has taken
its toll on the chronic disease of diabetes, it is too late to turn
it back," said Grossi.
"This
underscores the importance of prevention and early treatment of periodontal
disease in persons at high-risk of diabetes, and even those at moderate
risk," she said.
Additional
researchers on the Pueblo study were Fred Skrepcinski of the Indian
Health Service; Alex Ho, statistician in the UB Department of Oral Biology;
Steve Garrett and Wess Ortolano of Atrix Laboratories, Inc, and Robert
J.Genco, UB vice provost, SUNY Distinguished Professor and chair of
the Department of Oral Biology.
The
study was supported by grants from the Division of Health and Human
Services and Atrix Laboratories, Inc.
Additional
researchers on the Pima study were Stanley Shih, a UB dental student,
and Ho.