Dental Tribune Europe

Fourth European JSDEI seminar discusses holistic treatment of diabetes and periodontitis

By Anne Faulmann, DTI
November 09, 2015

BARCELONA, Spain: On 6 November, a record number of 470 international delegates from various fields of dentistry and medicine came together in Barcelona for the fourth European session of the Joslin–Sunstar Diabetes Education Initiative (JSDEI) organised by the Sunstar Foundation and the Joslin Diabetes Center in Boston in the US. The speakers presented the latest cutting-edge research on the links between diabetes, periodontal disease and nutrition.

The JSDEI seminar, held annually both in Europe and worldwide, aims to promote interdisciplinary collaboration between medical and dental professionals and to highlight the still underestimated relationship between oral and systemic health. At the event, which was the 19th JSDEI seminar worldwide and the first to be held in Spain, eight distinguished experts from Spain and the US elaborated on the topic “Diabetes, oral health and nutrition: Inter-relationships, innovations and interaction”. The symposium was complemented by a press conference on 5 November to inform the media about the purpose of JSDEI, the latest findings in periodontitis and diabetes research, and the role of the dentist in helping to detect diabetes.

“We are very much pleased to contribute to disseminating the importance of the link between oral health and systemic health,” Masakazu Nakamura, CEO of Sunstar Suisse, the main sponsor of the event, said at the press conference.

At both the press conference and the seminar, the international speakers stressed the bidirectional relationship between diabetes mellitus and periodontal disease: periodontitis doubles the risk of developing diabetes and diabetics are three times more likely to have oral problems. Therefore, involving dentists in the detection of diabetes is crucial to reduce the underdiagnosis of the disorder. “At least half of the people that have diabetes don’t know that they have it,” Dr Eduard Montanya, Professor of Endocrinology at the University of Barcelona and Scientific Director of the Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), pointed out at the press conference.

At the seminar, Montanya, one of the event chairmen, focused on the interrelation between diabetes and periodontitis from a medical perspective. He especially emphasised the similarities in treatment and management of the two diseases, and encouraged medical and dental professionals to collaborate more closely in order to ensure optimal treatment of patients suffering from both conditions. In this context, he explained that some studies have shown that treating periodontitis may improve glycaemic control in diabetics.

Considering the link between oral and systemic health from a dentist’s perspective, Dr Mariano Sanz, the second chairman of the event and Professor of Periodontology at the Complutense University of Madrid in Spain, explained that periodontitis is a potential risk factor for various systemic diseases, including diabetes, cardiovascular disease and rheumatoid arthritis. “Patients with periodontitis share risks, such as smoking, overweight or hypertension, with these diseases. Therefore, oral professionals should refer patients with gum infections to the corresponding specialists. In fact, many tips for preventing modifiable risk factors should be given at the dentist’s as part of the periodontal treatment,” he stated, pointing out the importance of prevention and the promotion of a healthy lifestyle.

In order to better understand the bidirectional relationship between periodontal disease and diabetes, researchers have begun examining the role of the microbiome in this regard. Dr Robert J. Genco, Distinguished Professor of Oral Biology, Periodontics and Microbiology at the State University of New York at Buffalo in the US, presented some of the findings of this research, including possible microbial mechanisms—such as oral bacteria entering the bloodstream—that may account for the association between the two diseases.

Dr William C. Hsu, Assistant Professor of Medicine at Harvard Medical School in the US, discussed the role of nutrition in the management of diabetes and periodontitis. “The change of our diet over the course of the last decades could be responsible for the rise of both conditions,” he stated, referring to the increasing over-nutrition and westernisation of diets (high intake of fat and simple carbohydrates) all over the world. He showed that high-fibre and low-fat diets, such as the traditional Asian diet, are very beneficial for patients with diabetes and periodontitis. These kinds of diets evidently reduced insulin resistance and promoted weight loss, while also improving periodontal disease markers and metabolic profiles, Hsu said.

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Dr Carlos Mendieta, Professor of Periodontology and head of the periodontics unit at the University of Barcelona, considered the role of xerostomia as a symptom of many systemic diseases and an adverse effect of many medications taken by diabetics. The consequences of a dry mouth include an increased risk of dental caries and oral mucosal infection. Therefore, treatment is very important in order to improve the oral health and overall quality of life of diabetic patients, he concluded.

Dr George L. King, Professor of Medicine at Harvard Medical School, spoke about the vascular complications of diabetes, including cognitive dysfunction, cardiovascular disease and periodontal disease. In this context, he discussed the toxic effects of hyperglycaemia as a risk factor for diabetic complications and the role of insulin as a potential protective factor for preventing vascular disease in diabetic patients.

In addition, Dr David Vincent López from the Hospital Universitario La Paz in Madrid discussed the link between obesity and Type 2 diabetes. He explained that obesity is characterised by multi-systemic inflammation, which seems to be a determining factor for both insulin resistance and diabetic hyperglycaemia. On the same topic, Dr C. Ronald Kahn from Harvard Medical School presented a study that found a link between the composition of the intestinal microbiome and certain genetic and environmental factors, which altogether had an impact on susceptibility to obesity and thus the risk of Type 2 diabetes.

For the first time in the history of JSDEI, the seminar also involved patients, scientific associations, as well as future dentists and physicians in its efforts to raise awareness of the link between oral health and diabetes. Through collaboration with several universities, the symposium was streamed live, enabling students of eight Spanish, six Italian and one French university, as well as ten clinics in Spain and Germany, to participate interactively by asking questions online.

Moreover, prior to the seminar, Sunstar collaborated with Sociedad Española de Periodoncia y Osteointegración (SEPA—Spanish society of periodontology and osseointegration), Sociedad Española de Diabetes (SED—Spanish society of diabetes) and Federación de Diabéticos Españoles (Spanish diabetic federation) for a lecture series titled “Watch your gums, control your diabetes” and held in seven Spanish cities. In this context, periodontists and endocrinologists gave diabetic patients a simplified explanation of the link between oral disease and increased blood sugar. “We hope that the people will spread this information, so that in the future it will also have an impact on our policymakers and the health authorities, and they will include periodontitis diagnostics, treatment and prevention in Spain’s national health care system,” Dr David Herrera, SEPA chairman and coordinator of the SED–SEPA working team on diabetes and periodontal disease, said at the press conference.

The JSDEI seminar was supported by the Sunstar Group, FDI World Dental Federation, SEPA, European Federation of Periodontology, Sociedad Española de Endocrinología y Nutrición (Spanish society of endocrinology and nutrition), and CIBERDEM. The next symposium will be held on 15 January 2016 in Singapore.

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