Microvascular Disease

Dental checkups can detect more than oral health problems.

Charles W Martin By Charles W Martin, DDS
Founder, DentistryForDiabetics.com

If you've read my column Guard Your Heart: Gum Disease, Diabetes Can Be Devastating Duo, you've read about the links between heart attack, diabetes and gum disease, and a little bit about what I call the Rust Effect, which is not a medical term but an analogy I use for microvascular disease. Here we discuss what the Rust Effect really is, the role it plays in heart disease and stroke and what goes on at the microvascular level in the small, even microscopic, parts of our circulatory system.

The Effects of Microvascular Disease

The pathways of your microvascular system include venules, which go between veins and capillaries. Capillaries are where the blood starts exchanging various substances with tissues. Much of the total circulatory activity in the body happens at this level. Capillaries connect with arterioles, the smallest part of the system, where only one blood cell squeezes through.

Damage done at this level is precisely what causes a lot of the other problems related to diabetes. These include decreased vision, loss of sensation, impotence, and blood pressure problems. Almost all of these are caused by a combination of two factors.

  • First, there is the stiffness in the wall of the blood vessels that we have talked about earlier.
  • Second, there is the Rust Effect. To explain, think about an old hammer left out in the rain. If you pick it up by the head it's rough and pitted with some sharp edges on the pits.

Now, imagine you have a blood cell that has rusted. Its surface is scratchy and sharp. When that cell wriggles through the tiny arterioles its sharp edges scratch and scrape the walls. If those walls have lost their elasticity due to the hardening process that is triggered by the inflammatory response – which, in turn, was set off by infection by periodontal bacteria – the wall eventually breaks or clogs. Either outcome is bad news.

Where does the rust come from? It's a process called glycation, which happens when your blood sugar is too high and glucose actually bonds to cells in your blood. When they bond on the outside of the cell, they form the rust with its scratchy, sharp surfaces that wear away at vessel walls.

Side Effects That Can Damage Your Quality of Life or Kill You

It's not surprising that this microvascular disease can cause some serious problems for people with diabetes, including:

  • Diabetic retinopathy. Left untreated, it can lead to blindness. As many as 45 percent of all people with diabetes have some level of diabetic retinopathy.
  • Paresthesia and peripheral neuropathy. Paresthesia is a term for odd sensations of the skin. It's usually felt in the hands, arms, legs or feet but can occur in other parts of the body. It's a warning sign of worse nerve damage that may be in progress called peripheral neuropathy, which robs you of feeling and use of limbs.
  • Impotence or erectile dysfunction, which now affects as many as 45 percent of all men 40-69 years old. As many as 50 percent of men with diabetes experience ED.
  • Peripheral artery disease or PAD. This is a blockage in the arteries leading to the extremities, the lower extremities in particular. This can make it difficult and painful to get exercise, limiting your ability to help control your diabetes with daily activity. Plus the narrowed arteries in the leg and foot are a prime place for a blockage. Once that happens, the tissue below the blockage starts to die, ulcers develop and it progresses to gangrene which can lead to amputation or death.

The tragedy is that many of these negative health effects are a consequence of blood glucose that's out of control. They may possibly be avoided by a simple dental checkup to find out if you have gum disease. Proper treatment can help stop serious gum disease and other dental problems in their tracks. Sometimes that includes reversing the damage done to your teeth and gums. An extra benefit is that good oral care can help you manage your diabetes and lead a healthier, longer life.

For more information about dental care for people who have diabetes visit http://www.dentistryfordiabetics.com and Dr. Martin's blog, http://www.dentistryfordiabetics.com/blog.

This article was excerpted from Dr. Martin's new book about the two-way connections between diabetes and gum disease.

Read Dr. Charles Martin's bio here.

Read more of Dr. Martin's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition. 

Last Modified Date: July 01, 2013

All content on dLife.com is created and reviewed in compliance with our editorial policy.

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by Brenda Bell
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