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.

***

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.

*** 

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

An untreated inflammation in the gums can eventually lead to periodontitis. Yet, many people overlook the symptoms of gingivitis, as it is also called. Here are the signs you should be on the lookout for - and the best tips for healthy gums.

Plaque, the bacterial buildup on teeth, causes 95 percent of all oral diseases. Gingivitis is no exception.

- Gingivitis is an inflammation that affects the dental tissue, i.e., the gums. It occurs because the harmful bacteria that we all have in our mouths have not been sufficiently removed, allowing them to grow, says Ing-Marie Albinsson, a dental hygienist at the Lilla Tandkronan clinic in Arvika.

The immune system responds to the bacteria by sending more white blood cells to the area. Blood flow increases, causing the gums to swell.

- Unfortunately, in this case, it has a somewhat undesired effect. The bacteria that caused the inflammation thrive especially well in an oxygen-poor environment, and protected by the swollen gums, they can grow even more, says Ing-Marie Albinsson.

The first sign of gingivitis is thus swollen gums, something that is not always easy to detect. The next step is that the gums become even more inflamed and start bleeding. At first, it occurs infrequently, but gradually more often and due to lighter strains.

- If it bleeds every time you brush your teeth or, for example, bite into an apple, then the inflammation has progressed relatively far, says Ing-Marie Albinsson.

Choose the right tool

The most important step to combat gingivitis is cleaning - both on and between the teeth.

- With the toothbrush, you only reach the free surfaces, such as the outside, inside, and chewing surfaces. But between the teeth, we need to use other tools, such as interdental brushes or dental floss, says Albinsson.

The choice of tool depends on the size of the gaps between the teeth. And how to use it is just as crucial.

- A large part of our treatment for patients with advanced gingivitis is education by the dental hygienist. If you don't use the right tool correctly, the effect is lacking, says Albinsson.

Dual Light treatment is effective

Succeeding in the treatment of gingivitis is incredibly important - because if it is not done, the consequences can be serious.

- If the bacteria continue to grow, they begin to grow downward, which can create deep pockets. Through them, the bacteria can eventually also reach the threads holding the teeth and attack them. This leads to periodontitis, says Albinsson.

To avoid this, Ing-Marie recommends a complementary treatment with the Finnish innovation Lumoral, which removes 99.9 percent of the harmful bacteria in our mouths through a patented light treatment. 

- When we brush our teeth, 65 percent of the bacteria disappear. With Lumoral, you get a completely different result. The method is easy to use and is especially effective for those who already have problems. But it can also be used preventively, both to stay healthy and to reduce the costs of future dental care, says Albinsson.

This is Lumoral

The Lumoral method removes microscopic plaque from the surface of teeth and gums, slows down the formation of new plaque, and delays the onset of tartar. Its effect is based on the light-activated Lumorinse mouthrinse. The treatment targets its antibacterial effect only on plaque and thus benefits the normal bacterial flora in the mouth. Lumoral is a CE-marked medical device.

Lumoral consists of a mint-flavored mouthrinse, Lumorinse, used in combination with the special mouthpiece. The treatment eliminates the ability of plaque to stick to the surfaces of teeth so that teeth become clean and teeth surfaces  smooth.

The at-home treatment takes 10 minutes and is recommended once or twice a week.

Lumoral Junior

For children, there is Lumoral Junior. The Lumoral Junior mouthpiece is suitable for children between 4 and 12 years old. From the age of 12, the Lumoral mouthpiece for adults is generally suitable for a child to use. To use Lumoral, the child should be able to rinse his or her mouth with a mouthrinse.

(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