I still remember my patient's reaction — a 47-year-old businessman — when I told him that his infected gums were very likely contributing to his hard-to-control HbA1c. "What do teeth have to do with blood sugar, Doctor?" As it turns out, a great deal — and this is not speculation, it is very well-established science.
The Oral Cavity: A Window into Whole-Body Health
The mouth is the body's main entry portal for bacteria. Under normal conditions, oral bacteria are kept in check by the immune system and a balanced bacterial flora. But when periodontitis (infection of the gums and tooth-supporting bone) occurs, pathogenic bacteria and their inflammatory products can enter the bloodstream continuously — a condition called bacteraemia.
This is not a fringe theory. As of 2024, the link between periodontal health and systemic disease has been documented in thousands of peer-reviewed studies.
Periodontitis and Coronary Heart Disease
Two main mechanisms explain this connection:
- Chronic systemic inflammation: Periodontitis raises levels of C-Reactive Protein (CRP) and pro-inflammatory cytokines (IL-6, TNF-α) in the circulation — the same markers found in the process of atherosclerosis (hardening of the arteries).
- Bacteria found directly in atherosclerotic plaque: DNA from oral bacteria, particularly Porphyromonas gingivalis and Treponema denticola, has been found inside the coronary artery plaque of heart attack patients.
Large meta-analyses show that individuals with periodontitis have a 25–35% higher risk of coronary artery disease compared to individuals with healthy gums.
A Two-Way Relationship: Diabetes and Gum Health
This is a relationship I discuss very often with our internal medicine specialist colleagues: diabetes worsens periodontitis, and periodontitis worsens diabetes.
- Chronically high blood sugar weakens the immune response → oral bacteria grow more aggressively → periodontitis becomes more severe
- Conversely, an active periodontal infection increases systemic inflammation → lowers insulin sensitivity → blood sugar control becomes even harder
What's interesting: several studies show that treating periodontitis alone can lower HbA1c by 0.4–0.5% in diabetic patients — equivalent to adding one mild antidiabetic medication. That is not a number to ignore.
Pregnant Women: The Often-Neglected Gum Health
Pregnancy raises progesterone and oestrogen levels, making the gums more reactive to bacterial plaque — a condition known as pregnancy gingivitis. More worrying: fairly strong epidemiological evidence links periodontitis in pregnant women to:
- A risk of premature birth (before 37 weeks) increased by up to 4–7 times in severe cases
- Low birth weight (LBW)
- Preeclampsia
I strongly recommend a dental check-up and scaling as part of pregnancy preparation — ideally before conception, or in the second trimester if it slips your mind until then.
Modern Filling Materials: Why Amalgam Has Been Left Behind
Patients who come in with old silver fillings often ask whether they need replacing. The answer: they don't all have to be replaced at once, but there are scientific reasons why amalgam is no longer recommended for new fillings.
The Problems with Amalgam (Silver Fillings)
- Mercury: Amalgam contains 50% mercury — although the daily release is very small and considered safe by many health authorities, there are specific concerns for children, pregnant women, and patients with kidney disorders
- Thermal expansion: Amalgam expands and contracts more than natural tooth structure with food and drink temperature changes → over time this can cause microfractures in the tooth
- Aesthetics: The dark colour is unattractive and can make the tooth look grey from the outside
- The 2013 Minamata Convention encourages the phased elimination of dental amalgam worldwide
Composite Resin and Inlay/Onlay Alternatives
- Composite resin (tooth-coloured filling): The most common material today. Its colour can be matched to the natural tooth, it contains no metal, and it requires less removal of tooth structure. Lasts 5–10 years with good care.
- Ceramic inlays and onlays: Restorations made in a laboratory (or via CAD/CAM) and bonded to the prepared tooth. Stronger than composite for large cavities, more conservative than a full crown. This is the gold standard for back teeth with moderate to large damage.
- Zirconia crowns: For very extensive damage or teeth that have undergone root canal treatment — modern zirconia has metal-like strength with far better aesthetics.
A Cavity Prevention Guide for the Whole Family
As a dentist with an academic background (M.KG), I always emphasise: prevention is far more efficient and cheaper than treatment. Here is an evidence-based guide:
For Children (0–12 years)
- Clean your baby's gums with a damp cloth from birth — long before the first tooth appears
- Brush twice a day with fluoride toothpaste — start with a rice-grain amount, then a pea-sized amount
- Fissure sealants on permanent molars as soon as they erupt (around age 6) — proven to reduce molar cavities by up to 80%
- Reduce sugary drinks and packaged fruit juice — especially between meals
For Adults
- Brush 2× a day with the correct technique (circular/modified Bass) for 2 minutes
- Floss once a day — 40% of tooth surfaces are unreachable by a toothbrush
- Use a fluoride- or chlorhexidine-based mouthwash if you are at high risk of cavities
- Visit the dentist routinely every 6 months — not only when in pain
- For smokers: the risk of periodontal disease is 3× higher and healing is slower. Quitting smoking is the single most important oral health intervention you can make
Why Is the M.KG Degree Relevant to You as a Patient?
The Master of Dental Medicine (M.KG) degree is earned through an academic postgraduate programme with research and a scientific thesis — distinct from clinical specialisation. It means my practice is grounded not only in clinical experience, but also in a deep understanding of the latest scientific literature, dental material biomechanics, and evidence-based approaches.
In practical terms, this means the recommendations you receive are based not merely on habit or personal preference, but on evidence-based dentistry — the best options supported by data.
"Oral health is an investment in the health of your whole body. Every rupiah you spend on routine check-ups and prevention today can save far greater treatment costs — and prevent unnecessary health complications — in the future."
— drg. Andreas Wijaya, M.KG