Periodontitis and diabetes are two prevalent diseases with a strong bidirectional relationship between them. Poorly managed diabetes promotes the progression of periodontitis and complicates its treatment. Conversely, active periodontitis adversely affects diabetes management and treatment.

In honor of World Health Day, Tommi Pätilä, a heart and transplant surgeon at HUS New Children's Hospital, in Finland, and Timo Sorsa, a professor of oral and maxillofacial diseases at the University of Helsinki, reflect on the connection between these two prevalent diseases from the perspective of oral health.

Diabetes and gum inflammation are two significant global health issues that require immediate attention. About half of the world's population suffers from gum inflammation, while nearly half a billion people have diabetes.

In Finland alone, there are approximately 500,000 diabetics, with about 50,000 suffering from type 1 diabetes and around 400,000 from type 2 diabetes. Additionally, it is estimated that there are up to 100,000 undiagnosed type 2 diabetics in Finland.

Understanding the Close Connection

Periodontitis is a disease of the tooth-supporting tissues that progresses from gum inflammation and can ultimately lead to tooth loss. Symptoms of the disease include red, swollen, and bleeding gums, gum recession, formation of gum pockets, loosening of teeth, bad breath, and possible swallowing and chewing problems.

Periodontitis is associated with many risk factors, such as smoking, genetic factors, and systemic diseases like diabetes.

The symptoms of the disease can vary from mild to severe and often require evaluation and treatment by a dentist or dental hygienist. Early detection and treatment are crucial for managing periodontitis.

Diabetic patients have an increased risk of developing periodontitis, and conversely, periodontitis has a negative impact on diabetes treatment and management. High blood sugar levels increase inflammation in the mouth and hinder the healing of periodontitis. The combined effect of these two diseases is also reflected in systemic inflammatory markers and blood sugar levels.

Traditional diagnostic methods are not always sufficient to identify the risk of periodontitis and diabetes. Therefore, new biomarker-based rapid tests have been developed to help identify the risk of these diseases at an early stage.

Oral Health Status Revealed in Minutes

The aMMP-8 rapid test developed in Finland is based on measuring the concentration of active matrix metalloproteinase 8 (aMMP-8) in mouthwash. Studies have shown that elevated levels of aMMP-8 may indicate both periodontitis and diabetes.

The aMMP-8 rapid test can be performed at the dentist's office, and the results are obtained immediately. This allows for early intervention in the development of periodontitis and assessment of the risk of diabetes. Additionally, the test provides patients with important information about their oral health and the risk of diabetes, which encourages better self-care and adherence to healthy lifestyles.

"The test allows for the detection of signs of periodontitis even before symptoms occur, which provides an opportunity for early treatment and prevention of complications," says Professor Timo Sorsa of the University of Helsinki's Department of Oral and Maxillofacial Diseases.

The test has proven to be useful in screening patients with type I, type II, and gestational diabetes.

Oral Health: A Crucial Factor for Diabetics

Diabetic patients with periodontitis require special attention, reminds pediatric heart and transplant surgeon Tommi Pätilä. Pätilä is also one of the developers of the Lumoral innovation, which enhances mechanical oral hygiene.

"It is especially important for diabetics to invest in regular oral hygiene and dental visits. This not only improves patients' quality of life but also reduces the risk of long-term complications," says Pätilä.

According to Pätilä, adjunctive therapies can be combined with at-home oral hygiene management, such as low-dose doxycycline acting as an aMMP-8 inhibitor and light-activated mouthwashes with anti-inflammatory effects.

"Antibacterial Lumoral treatment effectively removes harmful plaque bacteria from tooth surfaces and gum lines. Home-administered Lumoral treatment has been shown to be significantly more effective and better tolerated than chlorhexidine-based mouthwashes commonly used today," Pätilä explains.

Pätilä emphasizes that antibacterial treatment complements mechanical tooth cleaning and does not replace the need for brushing and cleaning between teeth. Why is additional treatment needed to enhance mechanical oral cleaning?

"Research shows that brushing only removes 65% of plaque. Residual plaque remains in the mouth even after the most effective brushing. Lumoral helps remove this residual plaque. Regular Lumoral treatment ensures that tooth surfaces are thoroughly clean. Diabetics, in particular, benefit from this removal of residual plaque," says Pätilä.

According to studies, regular adjunctive antibacterial treatment alongside traditional non-surgical standard treatment reduces inflammation in gum tissues and improves oral hygiene and healing of deep pockets in chronic periodontitis compared to conventional treatment.

Antibacterial treatment has also been shown to prevent and improve inflammation of peri-implant tissues. The treatment is suitable for everyone, but light-activated antibacterial treatment is seen as most effective for patients who require enhanced oral hygiene.

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World Health Day, launched by the World Health Organization (WHO), is celebrated globally on April 7th to increase awareness of health issues. This year, the timely theme "My health, my right" emphasizes the importance of health equity.

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References:

Trujillo K, Räisänen IT, Sorsa T, Pätilä T. Repeated daily use of dual-light antibacterial photodynamic therapy in periodontal disease—a case report. Dent J (Basel). 2022;10(9):163. doi:10.3390/dj10090163

Pakarinen S, Saarela RKT, Välimaa H, et al. Home-applied dual-light photodynamic therapy in the treatment of stable chronic periodontitis (HOPE-CP)—three-month interim results. Dent J (Basel). 2022;10(11):206. doi:10.3390/dj10110206

Gholami L, Shahabi S, Jazaeri M, Hadilou M, Fekrazad R. Clinical applications of antimicrobial photodynamic therapy in dentistry. Front Microbiol. 2023;13:1020995. doi:10.3389/fmicb.2022.1020995

Lähteenmäki H, Pätilä T, Räisänen I, Kankuri E, Tervahartiala T, Sorsa T. Repeated Home-Applied Dual-Light Antibacterial Photodynamic Therapy Can Reduce Plaque Burden, Inflammation, and aMMP-8 in Peri-Implant Disease – A Pilot Study. Curr Issues Mol Biol 2022; 44: 1273–1283. doi: 10.3390/cimb44030085

Clean teeth – for real. Through dual light therapy, the new Lumoral treatment removes 99.99 percent of harmful bacteria in your mouth – something that neither a toothbrush or flossing can do.

Plaque causes 95% of all oral diseases – and can ultimately also increase the risk of more serious diseases such as heart attack and diabetes. But simply brushing your teeth is not enough to remove the harmful bacteria.

– Mechanical brushing is a very important step that removes about 65% of the plaque, so we absolutely shouldn’t stop doing it. But to really get rid of all the harmful bacteria, a complement is needed, says Ing-Marie Albinsson, a dental hygienist at the clinic Lilla Tandkronan in Arvika, Sweden.

The Finnish innovation Lumoral does just that. Through dual light therapy, harmful bacteria are eliminated from the teeth surfaces and around the gums.

– Lumoral is truly a revolutionary technology that is also very easy to use. You first rinse your mouth with the green Lumorinse mouthwash and then use the Lumoral mouthpiece for 10 minutes, says Ing-Marie Albinsson.

Lumoral uses a patented light in two different wavelengths, which in combination with the Lumorinse mouthwash removes 99.9 percent of the harmful bacteria we have in our mouths. The method is very carefully tested and used in a number of medical treatments, so it is completely safe to use.

– My patients who have used Lumoral are very satisfied. Those who have had problems with even quite severe tartar describe it as if it feels like the tartar is running off the teeth, and even those with severe gingivitis have had very good results, says Ing-Marie Albinsson.

Bacteria spread through the gums

Lumoral is a Finnish innovation and was actually invented not by a dentist but by a heart surgeon.

– I have operated on many patients where we have seen that oral bacteria have caused heart problems. But about 10 years ago, I operated on a child who had a serious heart infection precisely because of oral bacteria, and I felt that enough was enough. I don't want to see another patient having to go through this because of poor oral health, says Tommi Pätilä, founder of Koite Health, which developed Lumoral.

Pätilä put together a research team, and seven years ago, Lumoral was launched and is now available in several European markets and soon in Asia.

– The tricky thing about oral infections is that they have no symptoms. If dental plaque is not removed thoroughly, it can pass through the gums into the bloodstream, says Tommi Pätilä.

So how can you prevent this from happening?

– Brushing your teeth thoroughly and using dental floss or interdental brushes is the first step. You also need to visit your dentist or dental hygienist regularly. And then use Lumoral. The treatment is preventive for everyone but is particularly important for those who have already had problems with tooth loss or gum inflammation, says Pätilä.

(This article is based on the writing of dentist Viktoria Ljutkina, published in the largest dental medicine periodical in Estonia, Ajakiri Hambaarst. Ljutkina works as a dentist at Läänemere Hambakliinikus dental clinic in Tallinn.)

Periodontitis is a common disease affecting an estimated 20–50% of the population. This severe oral condition originates in the gum tissue, and if left untreated, the inflammatory process spreads deeper, leading to tooth loss (1). Periodontitis is a multifactorial disease primarily caused by bacterial colonization in the oral cavity (2). Many risk factors, such as diabetes and smoking, contribute to the development of periodontitis and influence its prognosis.

The goal of periodontitis treatment is to eliminate factors promoting inflammation in the oral cavity and support the patient's immune system. Fundamental to gum disease treatment is meticulous oral hygiene, preventing the formation of new dental calculus and reducing the number of bacteria in the oral cavity, thereby promoting periodontitis healing (3). The effects of Antimicrobial Photodynamic Therapy (aPDT) on oral diseases, including periodontitis and peri-implantitis, have been extensively studied, with substantial clinical evidence supporting its effectiveness.

The Lumoral oral care method, developed by Finnish scientists, is based on dual-light antibacterial therapy that can be administered at home. Lumoral's effects have been scientifically proven in various clinical studies. Regular use of Lumoral prevents tooth decay and significantly reduces the count of periodontal bacteria in the mouth (4).

Lumoral treatment relies on the administration of dual-light therapy through the Lumoral oral device – near-infrared light and antibacterial blue light. The near-infrared light has a wavelength of 810 nm, penetrating tissues up to 10 cm deep. Antibacterial blue light, with a wavelength of 410 nm, acts on inflammation-causing bacteria, slowing down their growth. When porphyrin molecules in the bacteria are exposed to specific wavelengths of light, they produce reactive oxygen species, which, in turn, kill the bacteria.

Lumoral is effective against harmful bacteria in the mouth

The Lumoral method includes a light source and a mouthwash. The photosensitive indocyanine green molecule in the Lumorinse mouthwash, in combination with the light source, achieves the desired therapeutic outcome. Indocyanine green (ICG) is water-soluble and highly light-absorbing. The dual light reacts with the ICG photosensitizer, generating reactive oxygen species (ROS) and heat, initiating a series of photochemical and biological processes that destroy the bacterial cell membrane, thereby damaging the bacterial cell structure.

The body's immune cells use a similar method to protect against harmful pathogens. Pathogenic bacteria contain porphyrin and flavin molecules with photosensitive properties. Therefore, Lumoral mainly affects pathogenic bacteria.

The Lumoral method has proven to be highly effective against harmful bacteria, with no development of bacterial resistance even with repeated use (5). The largest European study on periodontitis demonstrates significant improvement in treatment outcomes when dental calculus is regularly removed from the mouth. Lumoral has been shown to help users achieve better oral hygiene, even after using the most modern and efficient electric toothbrushes, which can leave plaque on teeth. The study also indicates that Lumoral aids in achieving better oral hygiene.

In support of brushing and flossing

Lumoral does not replace the need for mechanical brushing and cleaning between teeth but helps further improve oral hygiene. Effectively, Lumoral can remove bacteria from the surfaces of teeth and even from the gumline, where access with a toothbrush may be challenging.

aPDT treatment has proven to be significantly more effective and better tolerated than commonly used chlorhexidine mouthwashes. Home use of Lumoral reduces gum inflammation and enhances oral hygiene. Effective oral hygiene also enhances the efficiency of periodontal treatment (6).

Periodontal treatment and improvement of oral hygiene are considered the gold standard in periodontitis treatment. However, some patients may not respond positively to treatment due to risk factors and/or systemic diseases.

Smoking is considered a major risk factor for gum diseases, negatively impacting both the course of the disease and treatment outcomes. Nicotine in tobacco products hinders the oral cavity's defense mechanisms, impedes the healing of periodontal tissues, and adversely affects tissue blood circulation. Changes in the oral microbiome also occur due to smoking, promoting the development of advanced periodontitis and poorer healing after treatment. Finding effective treatment for smoking patients with periodontitis is crucial because managing periodontitis based on the aforementioned biological processes poses a significant challenge for physicians (7).

Independent Lumoral study shows efficacy

I decided to try the Lumoral method at Läänemere Hambakliinikus dental clinic to improve oral hygiene in patients with periodontitis. Twelve smoking patients with generalized periodontitis at stage III, grade B, and without other chronic diseases were selected for the clinical study. Half of the patients received Lumoral photodynamic therapy 2–3 times a week for six months (recommended dose after periodontal treatment twice daily for four weeks). The remaining patients received traditional periodontal treatment only. The general treatment strategy was similar for all patients, including comprehensive diagnostics (periodontal condition, radiological diagnostics, anamnesis), non-surgical periodontal treatment, and periodontal follow-ups at two weeks, three months, and six months. During the control visits, patients' dental calculus was stained to check oral hygiene.

I noticed that patients using Lumoral in addition to traditional treatment showed better results in periodontal treatment outcomes (pocket depths, tooth mobility, BOP, VIP, SUP) and oral hygiene compared to those not using Lumoral as an oral hygiene aid. Based on my clinical experience, we can conclude that using the Lumoral method improves patients' oral hygiene and leads to more positive treatment outcomes. It is essential to use the device correctly and regularly following the dentist's recommendations.

References:

Petersen, P. E., Baehni, P. C. Periodontal health and global public health. Periodontol 2000. 2012 Oct; 60 (1): 7–14.

Bartold, P. M., Van Dyke, T. E. Periodontitis: a host-mediated disruption of microbial homeostasis. Unlearning learned concepts. Periodontol 2000. 2013 Jun; 62 (1): 203–17.

Greenstein, G. Research, Science and Therapy Committee of the American Academy of Periodontology. The Role of supra- and subgingival irrigation in the treatment of periodontal diseases. J Periodontol. 2005; 76: 2015–27.

Villafuerte, K. R., Martinez, C. J. H., Vieira, L. H. P., Nobre, A. V. Benefits of antimicrobial photodynamic therapy as an adjunct to non-surgical periodontal treatment in smokers with periodontitis: a systematic review and meta-analysis. Medicina 2023, 59 (4): 684.

Lähteenmäki, H., Pätilä, T., Räisänen, I. T., Kankuri, E., Tervahartiala, T., Sorsa, T. Repeated Homeapplied dual-light antibacterial photodynamis therapy can reduce