Dental Care and Diabetes

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The Importance of Dental Care With Diabetes


Diabetes is a disease that can affect the whole body, including your mouth. Dental care is particularly important for people with diabetes because they face a higher than normal risk of oral health problems due to poorly controlled blood sugars. The less well controlled the blood sugar, the more likely oral health problems will arise. This is because uncontrolled diabetes impairs white blood cells, which are the body's main defense against bacterial infections that can occur in the mouth.

What Dental Problems Are People With Diabetes at Higher Risk For?

People with diabetes face a higher risk of:

• Dry mouth - Uncontrolled diabetes can decrease saliva flow, resulting in dry mouth. Dry mouth can further lead to soreness, ulcers, infections, and tooth decay.
• Gum inflammation(gingivitis and periodontitis) - Besides impairing white blood cells, anothe  r complication of diabetes is that it causes blood vessels to thicken, which slows the flow of nutrients to and waste products from body tissues, including the mouth. When this combination of events happens, the body's ability to fight infections is reduced. Since periodontal disease is a bacterial infection, diabetics with uncontrolled disease may experience more frequent and more severe gum disease.
• Poor healing of oral tissues - People with uncontrolled diabetes do not heal quickly after oral surgery or other dental procedures because blood flow to the treatment site can be impaired. Thrush. People with diabetes who frequently take antibiotics to fight various infections are especially prone to developing a fungal infection of the mouth andtongue. The fungus thrives on the high levels of sugar in the saliva of people with uncontrolled diabetes.
• Burning mouth and/or tongue - This condition is caused by the presence of thrush.

People with diabetes who smoke are at even a higher risk -- up to 20 times more likely than nonsmokers -- for the development of thrush and periodontal disease.Smoking also seems to impair blood flow to the gums -- which may affect wound healing in this tissue area.


Dental Care Tips for People With Diabetes

Since people with diabetes are more prone to conditions that may harm their oral health, it's essential to follow good dental care practices and to pay special attention to any changes in your oral health and to seek a prompt dental consultation if such changes occur. Here are some tips to consider.

• Keep your blood sugar as close to normal as possible.
• At each dental care visit, tell your dentist about the status of your diabetes. For instance, he or she may want to know your HgA1C level to determine how well controlled your diabetes is (good control is indicated by a level under 7%). If you've had a hypoglycemic episode in the past (low blood sugar, also called aninsulin reaction), you are at increased risk to have another one. Tell your dentist when your last episode was, how frequently such episodes occur, and when you took your last dose of insulin, if you take it.
• See your diabetes doctor before scheduling treatment for periodontal disease. Ask your doctor to talk to your dentist or periodontist about your overall medical condition before any dental treatment is performed. If oral surgery is planned, your doctor or dentist will tell you if you need to take any presurgical antibiotics or need to change your meal schedule or the timing and dosage of your insulin, if you take it.
• Make sure to give your dentist your diabetes doctor's name and phone number to include on your personal file. This information will then be readily accessible by your dentist should any questions or concerns arise.
• Bring your dentist a list of all the names and dosages of all medications you are taking. Your dentist will need to know this information to prescribe medications least likely to interfere with the medications you are already taking if medications are needed. If a major infection is being treated, your insulin dose -- for those taking insulin -- may need to be adjusted. Check with your doctor.
• Postpone nonemergency dental care procedures if your blood sugar is not in good control. However, acute infections, such as abscesses, should be treated right away.
• Keep in mind that healing may take longer in people with diabetes. Follow your dentist's post-treatment instructions closely.
• People with diabetes with orthodontic appliances (such as braces) should contact their orthodontist immediately if a wire or bracket results in a cut to their tongue or mouth.

Day-to-Day Dental Health Care Tips

• Have your teeth and gums cleaned and checked by your dentist twice a year. (Your dentist may recommend a closer interval depending upon your condition.)
• Prevent plaque buildup on teeth by using dental floss at least once a day.
• Brush your teeth after every meal. Use a soft-bristled toothbrush.
• If you wear dentures, remove them and clean them daily.
• If you smoke, talk to your doctor about ways to quit.

Myths About Diabetes and Dental Care

Are people with diabetes at greater risk for dental cavities?

There are two schools of thought on this topic. One school believes that high levels of sugar in the saliva of people with uncontrolled diabetes helps bacteria thrive, which leads to the development of cavities as well as sets the stage for gum disease. Also, the fact that diabetic patients tend to eat smaller, more frequent meals throughout the day may mean there is a greater chance for bacteria to grow and lead to the development of cavities. The other school of thought is that because people with diabetes are more knowledgeable about what they eat and the need to closely monitor their sugar intake, they don't eat many foods that contain cavity-causing sugar.

The fact is that people whose diabetes is well controlled have no more tooth decay or periodontal disease than persons without diabetes. Good oral hygiene and maintenance of blood sugar within the accepted range are the best protections against cavity formation and periodontal disease.

I've heard that people with diabetes can expect to loose their teeth more often and sooner than people without diabetes. Is this true?

Many factors play a role in the loss of teeth in people with diabetes. First, people with uncontrolled diabetes are more prone to the development of gingivitis and periodontal disease. If the infection persists, it can spread to the underlying bone that anchors the teeth. Complicating this situation is the fact that infections don't resolve as quickly in people with diabetes.

The good news for people with diabetes is that by practicing good dental care and oral hygiene habits -- brushing at least twice daily (or preferably after every meal) with a fluoride-containing toothpaste and flossing daily -- and by keeping blood sugar levels under control, the potential for infection from periodontal disease will be greatly reduced or eliminated as will the risk of tooth loss.

If I need oral surgery, am I more at risk for problems?

With close medical care and self care that keeps blood sugar as close to normal as possible and good personal and professional dental care, problems after surgery are no more likely in people with diabetes than in those without the disease.