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Oral Indication
A key screening tool for diabetes might be in your mouth.

Illustration by Firecatcher

Dr. Paul Luepke, a periodontist and assistant professor at the Marquette University School of Dentistry, was examining a patient referred to him for possible periodontitis. But he spotted something else, something that worried him: granulated tissue similar to the skin of a strawberry.

Luepke suspected that the middle-aged man’s health issues went much deeper than gum disease.

The granulated tissue Luepke saw is more common in patients with diabetes. And this patient noted that he hadn’t been tested recently but had a family history for the disease. He agreed to follow up with his physician. The result? Luepke’s suspicions of type 2 diabetes were confirmed.

Although research has linked dental health and diabetes since the 1980s, new research has shown dental health might serve as a screening tool. In a Columbia University study published last summer in the Journal of Dental Research, researchers found they could effectively identify patients who were diabetic or prediabetic by looking at the number of missing teeth and deep periodontal pockets. The group of patients studied had at least one self-reported risk factor for diabetes, such as family history or hypertension. Just like Luepke’s patient.

Dr. Paul Knudson, an endocrinologist at Froedtert & The Medical College of Wisconsin, says the Columbia University findings could be an important tool for diagnosing diabetes in patients with limited access to care, such as those without health insurance. The screening formula researchers designed is another mechanism to try to capture the underserved diabetic, he says.

But the link goes further than diagnosis. Research shows a cyclical relationship between dental health and diabetes: Poor dental health leads to increased diabetes problems, and poorly controlled diabetes leads to increased dental problems. “The mouth does reflect inside the whole body and the health of the whole body,” says Dr. Lynn Lepak-McSorley, president-elect of the Greater Milwaukee Dental Association.

Research also suggests that regular dental care may help diabetic patients maintain better overall health. A study published in the January issue of The Journal of the American Dental Association found diabetics who received regular dental care had reduced diabetes-specific visits to the emergency room and fewer hospital admissions.

Periodontal disease, for instance, is more severe if blood sugar is not under control, and periodontal disease itself can lead to higher blood sugar, says Knudson. “They have relationships in both directions,” he says.

Although the exact nature of the relationship is unclear, diabetics whose blood sugar is not under control have depressed immune systems, which makes it easier for an infection to take root, Knudson says. Having an infection makes diabetics resistant to insulin, so patients must take more insulin to control their blood sugar, he says. It’s a vicious cycle.

Doctors have been preaching about good oral care to diabetic patients for at least a decade – with mixed success. “It’s a message that keeps getting drowned out by the other hum of diabetes complications,” he says. The complications most people are aware of are blindness, kidney failure and limb amputation.

As for Luepke’s patient, his periodontitis was caught in time. “We were able to get him the proper care through his physicians, and we carried on with our treatment for him in the dental chair,” Luepke says. “We were able to save those teeth.” 

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