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In most cases, periodontal diseases in people with diabetes are the result of poor glucose (blood sugar) control. Those with chronically elevated glucose (hyperglycemia) tend to suffer infections that are more frequent and more severe. They also are more likely to lose teeth than those who control their glucose.

It appears that poorly controlled glucose contributes to:

• Unhealthy levels of cholesterol and other lipids, particularly elevated serum triglycerides. These appear to contribute to greater attachment loss and probing depths, which are measures of periodontal disease.
  
  

  

• Elevated levels of cytokines in gingival tissue. High levels of these proteins (involved in immune system response) can cause destructive inflammation of the gums.
  
  
• Lower levels of growth factors. The lack of these beneficial proteins interferes with the healing response to infection. 

Other factors related to diabetes that raise the risk of periodontal disease include:

• Poor maintenance of the teeth. Lack of proper brushing and flossing promotes the formation of dental plaque, a sticky bacteria film that builds up on teeth. Such germs cause gum disease.
  
  
• Bacteria. Germs that are harmful to teeth thrive on sugars, including glucose. High levels of glucose in mouth fluids are a breeding ground for bacteria and set the stage for gum disease.
  
  
• Thickening of blood vessels. Blood vessels bring oxygen and nourishment to tissues throughout the body and carry away waste products. Diabetes often damages these vessels, causing them to thicken. This hampers the flow of nutrients to tissues and the removal of wastes, increasing the susceptibility of gum and bone tissue to infection.
  
  
• Smoking. People who smoke are five times more likely than nonsmokers to have gum disease, and the risk for diabetes patients is even greater. Diabetic smokers age 45 or older are 20 times more likely than a person without these risk factors to get severe gum disease.