Q: Can biting your nails cause gum disease and diabetes?

A: Biting your nails can sometimes cause gum recession or clefting. I am not aware of any studies correlating diabetes with nail biting.

CHICAGO – November 21, 2001 – Pregnant diabetics have more gingival inflammation and deeper pockets between their teeth and gums, which are symptoms of periodontal disease, than non-diabetic pregnant women, according to a new study in the Journal of Periodontology. These findings are significant because periodontal disease is a bacterial infection that may make diabetes more difficult to control. Previous studies have shown that periodontal disease may increase women’s risk of delivering a preterm, low birth weight baby. Study Abstract *

The study compared 13 type-1 diabetic and 20 non-diabetic women in their 20-39th week of pregnancy. “Many women experience periodontal problems, such as bleeding and swollen gums, during pregnancy,” explained Janet Guthmiller, D.D.S., Ph.D., the lead researcher of the study conducted at the University of Iowa, Colleges of Dentistry and Medicine. “But the more advanced periodontal disease we observed in pregnant diabetics, who are already considered high risk for pregnancy problems, may affect blood sugar control during this critical time.”

Exacerbating the problem, periodontal disease may independently be a risk factor for preterm, low birth weight babies. Periodontal disease may trigger increased levels of biological fluids that induce labor, and this response may be amplified in diabetics. “This self-perpetuating destruction could potentially further complicate diabetic control and pregnancy outcome in diabetic subjects,” according to the study.

“This study vividly illustrates just how connected our bodies’ processes can be. Periodontal disease is a bacterial infection, and the infection may impact other parts of the body,” said Kenneth Bueltmann, D.D.S., president of the American Academy of Periodontology (AAP). “Treating periodontal disease and reducing the bacteria load may benefit diabetic control as well as pregnancy outcomes.”

“Our hope is that periodontal evaluations will be routinely included in the prenatal care of pregnant diabetic women, just as ophthalmologic exams are,” said Guthmiller. The AAP recommends that all women considering pregnancy have a periodontal exam.

A referral to a periodontist in your area and free brochure samples including one titled Diabetes & Gum Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO – November 22, 1999 – Diabetes has long been known to increase the risk of severe periodontal disease. A study released today in the November issue of the Journal of Periodontology found that poorly controlled type 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are. In addition, the study further explains why diabetics are more susceptible to severe periodontal disease. Study Abstract *

The study concluded that poorly controlled diabetics respond differently to bacterial plaque at the gum line than well-controlled diabetics and non-diabetics, possibly due to elevated serum triglycerides. Poorly controlled diabetics have more harmful proteins (cytokines) in their gingival tissue, causing destructive inflammation of the gums. In turn, beneficial proteins (growth factors) are reduced, interfering with the healing response to infection.

“Increased serum triglyceride levels in uncontrolled diabetics seem to be related to greater attachment loss and probing depths, which are measures of periodontal disease,” said Christopher Cutler, D.D.S., Ph.D., the study’s lead researcher. “Diabetic patients should certainly be aware of their blood sugar levels, but it’s also important they have their serum triglycerides and cholesterol levels checked by their physician on a regular basis. Reducing cholesterol and serum triglyceride levels, preferably through diet and exercise, may be the most important changes that diabetics can make to improve their quality of life, as well as their oral health.”

The American Academy of Periodontology is encouraging diabetics to get a periodontal evaluation during National Diabetes Month in November, as recent research also has found that having periodontal disease makes diabetes more difficult to control. “We have a classic vicious cycle going on,” said Cutler.

“Controlling your periodontal disease may help you control your diabetes,” added Jack Caton, D.D.S., M.S., President of the American Academy of Periodontology (AAP). “Therefore, diabetic patients should be sure both their medical and dental care provider are aware of their medical history and periodontal status.”

A referral to a periodontist in your area and free brochure samples including one titled Diabetes and Gum Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO – April 11, 2006 – Results of a new study support the hypothesis that periodontal therapy may improve metabolic control (lower HbA1c) in diabetic patients. This study appears in April’s issue of the Journal of Periodontology. Study Abstract *

The results suggest that periodontal therapy may reduce a diabetic patient’s HbA1c count by as much as 20 percent at three and six months following treatment. According to the American Diabetes Association, HbA1c provides patients with a picture of their average blood sugar changes in the past two to three months and gives them a good idea of how well their diabetes treatment plan is working. A healthy HbA1c count is between the ranges of 4.0 to 6.0.

“We found that conventional treatment for chronic moderate generalized periodontitis, which included a simple, non-surgical procedure called Scaling and Root Planing (SRP) lowered the study group’s HbA1c count from 7.2 to 5.7,” said study authors Prof. Antonio Bascones and Dr. Ricardo Faria-Almeida from Department of Medicine and Buccofacial Surgery of the Complutense University in Madrid Spain. “This could significantly put diabetic patients who are just above the normal HbA1c range into the healthy range and reduce their risk of serious complications from diabetes.”

Bascones cautioned that these findings should not be considered definitive or universally generalizable because of the study sample size. In addition, this study compared the response to conventional periodontal treatment between type 2 diabetic and non-diabetic patients with chronic moderate generalized periodontitis and did not include a group of diabetics that was not undergoing periodontal treatment. The absence of this information is a limitation because it is not known how diabetic patients who were not undergoing periodontal treatment would have progressed.

“For a long time we’ve know that diabetic patients have a higher risk of developing periodontal disease compared to non-diabetics,” said Kenneth A. Krebs, DMD and AAP president. “The results of this study provide additional evidence about the other side of the equation: that periodontal treatment may affect metabolic control in diabetic patients who have periodontal disease. While we can’t say periodontal treatment will definitively help, to date no reports indicate a harmful effect of periodontal treatment on a diabetic patient’s metabolic control.”

A referral to a periodontist in your area and free brochure samples including one titled Diabetes & Periodontal Diseases are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

* EDITOR’S NOTE: Representatives of the media may contact the AAP Public Affairs Department to receive a copy of the study Clinical and metabolic changes after conventional treatment of type 2 diabetics with chronic periodontitis. Abstracts of Journal of Periodontology articles are available to the public online. Full-text of studies may be accessed by AAP members and Journal subscribers or purchased online for $20.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO—October 31, 2006—When patients with Type 2 diabetes and periodontal disease receive periodontal therapy, they often experience a reduction in their levels of oxidative stress, a condition in which antioxidant levels are lower than normal. Patients’ stress levels after periodontal therapy were similar to those of nondiabetic patients, according to a new study that appeared in the November issue of the Journal of Periodontology (JOP). Study Abstract *

Researchers from Kyushu Dental College in Kitakyushu, Japan investigated the impact of periodontal therapy on patients with Type 2 diabetes, as compared to nondiabetic patients. They found that periodontal therapy decreased lipid peroxide (LPO), an oxidative stress index, in diabetic patients.

“Our research emphasized one of the benefits of having periodontal therapy for patients with diabetes,” said Dr. Kazuo Sonoki, M.D. PhD at Kyushu Dental College, one of the study authors. “However, this was just a preliminary study and more research should be conducted to evaluate how periodontal disease affects both people with and without diabetes.”

It has been found that diabetes and periodontal disease can lead to atherosclerosis, which occurs when deposits of fatty substances, cholesterol, and other substances build up in the inner lining of an artery. This buildup is called plaque. It has been thought that oxidative stress is linked to heart disease because oxidation of LDL (low-density lipoprotein) in the endothelium is a precursor to plaque formation. Recently, oxidative stress has emerged as an important factor for atherosclerosis in patients with diabetes.

“We hear every day about how more and more people are being diagnosed with diabetes,” said Preston D. Miller, DDS and AAP president. “This research confirms that patients with diabetes should be especially conscious of their periodontal health. While more research needs to be done to evaluate the relationship between periodontal disease and diabetes, we do know that treating periodontal diseases can save teeth, and can promote overall health.”

A referral to a periodontist in your area and free brochure samples including one titled Diabetes & Periodontal Diseases are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO—March 13, 2007—Periodontal diseases may contribute to the progression to prediabetes, according to a new study that appears in the March issue of the Journal of Periodontology. Study Abstract *

Prediabetes is a condition in which blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes. The American Diabetes Association estimates 54 million people in the United States have prediabetes, and a significant portion of those people will develop Type 2 diabetes within 10 years.

Researchers from Denmark investigated if having periodontal diseases can influence prediabetes and contribute to the progression of diabetes. They found that having periodontal disease can cause someone to develop prediabetic characteristics, and probably disturb the glucose regulation of a non-diabetic who has prediabetic characteristics, contributing to the progression of Type 2 diabetes. The study, conducted with rat models known to exhibit prediabetes characteristics, is believed to be the first to evaluate the relationship between periodontitis and prediabetes.

“This study found that having periodontal diseases can alter the metabolic conditions which would probably lead to the progression to prediabetic characteristics and Type 2 diabetes,” said Dr. Carla Pontes Andersen, Department of Periodontology at the University of Copenhagen.

“We have known that people with diabetes are more susceptible to periodontal diseases and have more severe disease,” said Preston D. Miller, DDS and AAP president. “This breakthrough research shows having periodontal disease may aggravate prediabetes, which is a precursor for diabetes. These findings underscore the importance of taking good care of your teeth and gums: it may be a simple way to prevent diabetes, or to prevent the progression of diabetes.”

To asses your oral health, take the AAP’s online test to assess your gum disease risk. A referral to a periodontist in your area and free brochure samples including one titled Diabetes & Periodontal Diseases are available by calling 800-FLOSS-EM (800-356-7736) or visiting the AAP’s Web site at www.perio.org.

To check if you may be at risk of developing diabetes, visit the American Diabetes Association’s Web site.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO—November 3, 2009—New clinical guidelines released by the International Diabetes Federation (IDF) emphasize the importance of periodontal health for people with diabetes. Diabetes affects approximately 285 million people worldwide, and this number is only expected to increase. The IDF is an organization of 200 national diabetes associations from 160 countries.

The new IDF oral health clinical guideline supports what research has already suggested: that management of periodontal disease—which affects the gums and other supporting tissues around the teeth—can help reduce the risk of developing diabetes and can also help people with diabetes control their blood sugar levels. Studies have suggested there is a two-way relationship between diabetes and periodontal disease, and the IDF guideline outlines helpful guidance for health professionals who treat people living with and at risk for diabetes.

The IDF guideline contains clinical recommendations on periodontal care, written in collaboration with the World Dental Federation (FDI), that encourage health professionals to conduct annual inquiries for symptoms of periodontal disease such as swollen or red gums, or bleeding during tooth brushing; and to educate their patients with diabetes about the implications of the condition on oral health, and especially periodontal health.

“Everyone should maintain healthy teeth and gums to avoid periodontal disease, but people with diabetes should pay extra attention,” said Samuel Low, DDS, MS, Associate Dean and professor of periodontology at the University of Florida College of Dentistry, and President of the American Academy of Periodontology (AAP). “Periodontal disease triggers the body’s inflammatory response which can affect insulin sensitivity and ultimately lead to unhealthy blood sugar levels. Establishing routine periodontal care is one way to help keep diabetes under control.”

In recognition of American Diabetes Month, the American Academy of Periodontology commends the International Diabetes Federation on the release of the Guideline on Oral Health for People with Diabetes, and supports its encouragement of continued collaboration and communication between diabetes and oral healthcare professionals.

In addition to helping increase awareness about the importance of oral care for people with diabetes, Dr. Low believes the guideline presents more opportunities for medicine and dentistry to work together. “I know that these clinical recommendations will be helpful for those professionals who work with and treat people with diabetes. I also encourage the medical and dental communities to work together to provide the best possible care for our patients.”

For more information on the link between diabetes and periodontal disease, or to speak with an AAP spokesperson, please contact the AAP’s Public Relations Office at 312-573-3242 or meg@perio.org.

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