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Oral care: diabetes, tooth loss and cognitive decline
Maintaining good oral hygiene is essential for overall health
The health of your mouth can actually determine a lot about your overall health, according to dentists.
“(Your) mouth is considered a gateway to the rest of the body. Poor oral hygiene can lead to gum disease and infections, allowing harmful bacteria to enter the bloodstream and contribute to systemic conditions such as cardiovascular disease and respiratory infections,” says Dr. Sukirth Ganesan, assistant professor and director of the Advanced Education Program in Periodontics at the University of Iowa’s College of Dentistry.
In fact, having tooth loss along with diabetes can contribute to worse cognitive function and more rapid cognitive decline, according to a new study published in the “Journal of Dental Research.”
Ganesan agrees. “Yes, oral health issues, particularly gum disease, have been linked to complications like diabetes,” he says.
Ganesan, who has been with the University of Iowa since 2019 and was honored as a Leadership Fellow by the American Dental Education Association Leadership Institute for 2023-24, sees firsthand the direct link between a patient’s mouth and their body.
“In fact, gum disease, also known as periodontitis that ultimately leads to tooth loss, is considered as the sixth complication of diabetes. And diabetes is one of the two established risk factors for periodontitis,” he says. “Conversely, poor oral hygiene can contribute to inflammation and infection, affecting blood sugar control in individuals with diabetes. Diabetes can also impair the body's ability to fight infections, making those with the condition more susceptible to oral health problems.”
Dr. Sukirth Ganesan. Submitted photo.
Dr. Sukirth Ganesan conducts research at the University of Iowa College of Dentistry. Submitted photo.
The bottom line, he adds, is that maintaining good oral hygiene is essential for overall health, especially for those trying to manage diabetes.
There’s little medical research focusing on the impact of having both diabetes and missing teeth when it comes to the joint impact on cognitive decline. But the University of Michigan did a Health and Retirement Study, looking at 12 years of data.
It found that older adults, from the ages of 65 to 84, with both diabetes and tooth loss had worse cognitive function than their peers. They had the fastest rate of decline in contrast to patients with just one of the conditions.
“At any point of time, there are 700-800 bacterial members colonizing the oral cavity. These bacterial members consistently interact with the host immune system to maintain health,” Ganesan says. “Disturbances in this balance between the bacteria and immune system are linked to oral diseases. Oral inflammation, often stemming from conditions like gum disease, can contribute to systemic inflammation. The presence of harmful bacteria in the mouth can lead to the release of inflammatory substances into the bloodstream. This systemic inflammation may, in turn, exacerbate existing health conditions such as cardiovascular disease or diabetes.”
The link is a reminder that good oral hygiene can prevent the spread of inflammation to other parts of the body, and in turn promote overall health.
Ganesan is aware of the emerging research that suggests a potential link between poor oral health and cognitive decline. He explains the process as chronic inflammation from gum disease releasing inflammatory substances that can reach the brain, contributing to neurodegenerative processes.
“While more research is needed to establish a definitive connection, maintaining good oral hygiene is considered a prudent measure for overall health, including potential cognitive well-being,” he says.
This is why preventative care is critical, especially for older adults with diabetes.
“Preventative care is extremely important when it comes to oral health. Regular dental check-ups, biannual professional cleanings and practicing good oral hygiene at home can help prevent the onset of issues like cavities, gum disease and early screening for oral cancer,” Ganesan explains.
The earlier potential problems are detected, the quicker intervention can prevent more serious complications and costly dental issues down the road, he adds. Not to mention, good oral health has broader implications for overall well-being because it reduces the risk of conditions like heart disease.
“A lot of the time, patients see their dentists more often than their physicians. For example, in my personal practice, I had a patient reporting frequent abscesses (gum boils/swellings) and I had asked the patient to check for diabetes, and we found that she was actually diabetic,” Ganesan says.
Dr. Sukirth Ganesan in the lab with his students at the University of Iowa College of Dentistry. Submitted photo.
Here are his top five tips for optimal oral health:
- Keep up with regular check-ups.
- Brush and floss twice a day.
- Eat a balanced diet.
- Avoid acidic and sugary foods.
- Stay hydrated.
He adds that using cigarettes or e-cigarettes impacts your oral and systemic health.
“If someone is diabetic, obese or diagnosed with cardiovascular diseases such as metabolic syndrome, diligent preventive oral care is critical. Mechanical disruption of the plaque (also known as cleaning) is the most important, and easiest, way of maintaining oral health. Addressing dental concerns promptly ensures early intervention, preventing potential complications and supporting overall well-being,” Ganesan says.
Researchers are pushing medical providers to educate patients about the link between oral care and other more serious health issues, like cognitive decline. In addition to regular dental visits, they stress the importance of adhering to diabetes treatment, self-care to control blood sugar levels and cognitive screenings in primary care visits.
Ganesan admits that, especially in some population pockets, oral hygiene has not been a primary focus.
“There is limited emphasis on oral health education and routine dental care in some communities. Integrating oral health with overall health is gaining a lot more significance with the increasing number of publications,” he says.
He adds that there has been a longstanding disconnect between general health and oral hygiene that keeps many patients from understanding the correlation.
“It is very unfortunate that, historically, dental and general healthcare are separated. I think this is one of the reasons for the lack of integration in public awareness,” Ganesan says. “Access to oral health is difficult and expensive due to inadequate resources and insurance coverage. Additionally, oral health issues, often chronic, manifest gradually and are largely asymptomatic before it becomes acutely symptomatic.”
In other words, Ganesan wants more of us to take oral hygiene seriously so the conditions that may result are not ones that become chronic and difficult to treat.
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