How Does Diabetes and Smoking Increase Gum Disease Risk?

Gum disease can be of two forms. GINGIVITIS is the superficial form that involves bleeding and inflammation of the gums in response to the presence of bacteria called PLAQUE. Gingivitis can then progress to PERIODONTITIS. This involves the bone around teeth dissolving. This means that teeth gradually lose support and become loose until they are eventually lost.

Who is more prone to periodontitis?

Not everyone gets periodontitis because we have an immune system that defends us against the bacteria. There is one particular cell in the immune system that plays a vital role, called the NEUTROPHIL. Individuals in whom the neutrophil does not work too well, therefore, don’t defend themselves well against the plaque bacteria, so are extremely susceptible to the bone around their teeth dissolving and their teeth subsequently being lost. We don’t know why the neutrophil doesn’t work well at the gums in some people, but it can happen in anybody for unknown reasons. What we do know, is it happens a lot in SMOKERS and DIABETICS.

Smokers and diabetics just don’t cope with the same level of plaque on their teeth and gums that other individuals might. It is therefore of vital importance that they remove the plaque bacteria much more efficiently than other individuals, therefore giving their weakened immune system an easier job to do.

In a similar way that diabetics can’t cope with sugar, they can’t cope with plaque either. Other people may be walking around with plaque in their mouths according to the level of tooth brushing they are performing. That’s fine, if the immune system is doing its job properly. In diabetics though, plaque must be kept to a bare minimum.