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.

Dental Health and Exercise

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Heart healthy habits such as diet and exercise were found to be beneficial to good dental health, according to a study published in the Journal of Periodontology. According to the researchers, while advances in dental medicine saw more people keeping their teeth as they grew older, there was still a need to understand the ways to prevent the gum disease periodontitis, the infection of the gums which could lead to diabetes, heart disease, and preterm labor. Curious whether the same factors which prevent heart disease and lower the risks for diabetes might also impact oral health, they examined the cumulative relationship between weight, exercise, nutrition and dental disease in the US population.

Researchers from Case Western Reserve University examined data from 12,110 individuals who participated in the National Health and Nutrition ExaminationSurvey (NHANES III). In this study, it was found that those individuals who participated in physical activities, had healthy eating habits and maintained a normal weight were 40% less likely to develop periodontitis, leading to loss of the teeth. The findings were reported in the article, "Periodontitis and Three Health-Enhancing Behaviors: Maintaining Normal Weight, Engaging in Recommended Level of Exercise and Consuming a High-Quality Diet."

Information about weight, nutrition and exercise were collected and the participants were monitored for 24 hours on their food intake and asked questions about 9 physical activities: walking a mile or more without stopping, jogging/running, bicycling, aerobic dancing/exercise, dancing, swimming, calisthenics, gardening/yard work, and weight lifting. If they reported 5 or more moderate activities or 3 intensives per week, it was considered healthy. An individual's weight was considered within a normal range if it fell within the Body Mass Index (BMI) of 18.5 to 24.9 kg/m². Based upon the research, it was concluded that healthy behaviors such as exercise and diet which lowers the risks of diabetes could also lower the risk factors associated with periodontitis. Physical activities was also cited with reducing the C-reactive protein in the blood associated with inflammation in the heart and periodontal disease. Healthy eating habits, which builds the body's defenses against disease, could also reduce plaque biofilm, the primary cause of periodontal disease. Combating periodontal disease may mean addressing these multiple risk factors, in addition to simply targeting the disease. Because dentists may see a patient between two to four times a year, it is an opportunity for them to promote these healthy behaviors. This page discusses some of the physical activities mentioned above in more depth.

Physical exercise is important for maintaining physical fitness and helps to contribute to maintaining a healthy weight, bone density, muscle strength, and joint mobility; promoting physiological well-being, while reducing surgical risks and strengthening the immune system. Categories of physical activities include: aerobics, an aerobics, strength training, and agility training. Sometimes the terms 'dynamic' and 'static' are in conjunction with the activity. Dynamic activities such as steady running, which improves the blood flow, tends to lower the diastolic blood pressure during physical activities, while a static activities such as weight lifting causes the systolic pressure to rise.

• Aerobic - activities refers to moderate intensity physical activities that are performed for a long duration. The word aerobic means "with oxygen", and refers to the use of oxygen in a muscle's energy-generating process. Many types of aerobic activities are performed at moderate levels of intensity for extended periods of time. Activities like walking, running, swimming, and cycling require a great deal of oxygen to generate the energy needed for prolonged exercise. An effective aerobic activity should involve 5-10 minutes of warming up at an intensity of 50-60% of maximum heart rate, followed by at least 20 minutes of exercise at an intensity of 70-80% of maximum heart rate, ending with 5-10 minutes of cooling down at an intensity of 50-60% of maximum heart rate. Frequent and regular aerobic activities has been shown to help prevent or treat serious and life-threatening chronic conditions such as high blood pressure, obesity, heart disease, Type 2 diabetes, insomnia, and depression. Strength training appears to have continuous energy-burning effects that persist for about 24 hours after the training, though they do not offer the same cardiovascular benefits as aerobic activities. Physical activities has also been known to increase energy and raise one's threshold for pain.
• Anaerobic - activities are typically used by athletes in non-endurance sports to build power and by body builders to build muscle mass. Muscles that are trained under anaerobic conditions develop differently biologically and show greater performance in short duration-high intensity activities.
• Strength Training - is the use of resistance to muscular contraction to build the strength, anaerobic endurance and size of skeletal muscles. There are many different types of strength training, the most common being the use of gravity or elastic/hydraulic forces to oppose muscle contraction. Strength training and resistance training are terms often used interchangeably.
• Agility Training - has traditionally centered around the skills needed for the body to efficiently change direction at speed. This requires a combination of balance, coordination, speed, reflexes, and strength. Dodging requires agility, such as jumping out of the way of an oncoming car or avoiding an unexpected hole. If you ever need to run down a crowded street to catch a bus or escape an assailant, agility will help you avoid knocking yourself out on a utility pole or tripping over a dog leash.

There is conflicting evidence as to whether vigorous activities are more or less beneficial than moderate ones. Some studies have shown that vigorous activities executed by healthy individuals can effectively increase endorphins, a naturally occurring opiate that in conjunction with other neurotransmitters is responsible for an exercise induced euphoria and positively influence hormone production - benefits not yet seen with moderate exercise. Exercise has been shown to improve cognitive functioning and both aerobic and anaerobic activities also work to increase the mechanical efficiency of the heart.

Not everyone benefits equally from participating in physical activities. There is tremendous variation in individual response to training. Most people will see a moderate increase in endurance from aerobics, while others will receive no benefit at all. Similarly, only a minority of people will show significant muscle hypertrophy after prolonged weight training, while a larger portion will see an improvement in strength. This genetic variation in improvement from training is one of the key physiological differences between elite athletes and the larger population.

Some myths associated with exercise include the following:

Excessive physical activities can cause immediate death. This statement has some small basis in fact. Water intoxication can result from prolific sweating combined with consumption of large amounts of plain water and insufficient replenishment of electrolytes. It is also possible to die from a heart attack or similar affliction if overly intensive activities are performed by someone who is not in a reasonable state of fitness for that particular activity. A doctor should always be consulted before any radical changes are made to a person's regimen. Other common dangers may occur from extreme overheating or aggravation of a physical defect, such as a thrombosis or aneurysm.

Weightlifting makes you short or stops growth. Heavy weight training in adolescents can damage the epiphyseal plate of long bones.

It is a common belief that exercise and training a particular body part will preferentially shed the fat on that part; for example, that doing sit-ups is the most direct way to reduce subcutaneous belly fat. This belief is false. A person cannot reduce fat from one area of the body to the exclusion of others. Most of the energy received from fat gets to the muscle through the bloodstream and reduces stored fat in the entire body, from the last place where fat was deposited. While sit-ups may improve the shape and size of abdominal muscles, it cannot specifically target belly fat for loss. Sit ups might help to reduce the overall body fat content and shrink the size of fat cells. Actually, there is a very slight increase in the fat burnt at the area being exercised compared with the rest of the body, due to the extra blood flow at this area.

Some people incorrectly believe that muscle tissue will turn into fat tissue once a person stops exercising; this is not literally true -- fat tissue and muscle tissue are fundamentally different -- but the common expression "muscle will turn to fat" is truthful in the sense that catabolism of muscle fibers for energy can result in excess glucose being stored as fat. Moreover, the composition of a body part can change toward less muscle and more fat. This is not muscle "turning to fat" however, it is simply a combination of muscle atrophy and increased fat storage in different tissues of the same body part. Another element of increased fatty deposits is that most individuals do not reduce the amount of their food intake to compensate for the lack of physical activities.

Inappropriate exercise can do more harm than good. Exercise is a stressor and the stresses of physical activities have a catabolic effect on the body - contractile proteins within muscles are consumed for energy, carbohydrates and fats are similarly consumed and connective tissues are stressed and can form micro-tears. For many activities, especially running, there are significant injuries that occur with poorly regimented schedules. However, given adequate nutrition and sufficient rest to avoid over training, the body's reaction to this stimulus is to adapt and replete tissues at a higher level than that which existed prior to engaging in a physical activity. The results are all the training effects of regularly exercise - increased muscular strength, endurance, bone density and connective tissue toughness. In extreme instances, over-exercising induces serious performance loss, as the overexertion of muscles can lead to muscle damage. Other dangers include over training in which the intensity or volume of training exceeds the body's ability to rest or lacking proper nourishment.

Exercise bulimia is a subset of the psychological disorder bulimia in which a person is compelled to participate in a strenuous activity in an effort to burn calories of food energy and fat reserves to an excessive level that negatively affects their health. The damage normally occurs due to not giving the body adequate rest for recovery compared to the level of activity. If the person eats a normally healthy and adequate diet but participates in activities which require higher levels of nutrition, this can also be seen as a form of anorexia.

Exercise bulimia is classified as a nonpurging form of bulimia - the sufferer does not regularly engage in self-induced vomiting or the misuse of laxatives, diuretics or enemas to rid themselves of the food ingested, but only uses exercise as a method of compensation. This type of bulimia is especially common in those who find it difficult to purge, and in men with eating issues. It is often seen as a 'healthy' method of compensation. However, the psychological and physical effects of excessively participating in strenuous activities should not be underestimated, nor should it be used as an alternative to those individuals tackling eating issues. Most sufferers present a wide variety of symptoms, and it is not unheard of for people to suffer the full range of symptoms of the three disorders (bullemia, anorexia, exercise bullemia) at different stages in their lives, or at the same time (e.g. an anorexic may fast, vomit, exercise obsessively, and occasionally binge). It is also possible, although rare, for an eating disorder to be unclassifiable (i.e. containing a variety of contradictory symptoms) and in these cases it can be more difficult to see the damaging effects of exercise, especially if someone is seen to be eating a 'healthy' diet containing all food types, and exercising often. People who are compulsive about exercising will often schedule their lives around this activity and engage in such behaviors as missing work or engagements in order to work out, working out while injured or sick, becoming depressed if they are unable to work out, and working out for hours every day.

The bottom line is that too much physical activity can be harmful. The body part that is worked on needs at least a day of rest, which is why some health experts say one should participate in physical activities every other day or 3 times a week. Without proper rest, the chance of stroke or other circulation problems increases, and muscle tissue may develop slowly. Exercise should be controlled by each body's inherent limitations. While one set of joints and muscles may have the tolerance to withstand multiple marathons, another body may be damaged by 20 minutes of light jogging. This must be determined by each individual. In the long term, exercise, if done correctly, is beneficial to the brain by increasing the blood and oxygen flow to the brain, increasing growth factors that help create new nerve cells and increasing chemicals in the brain that help cognition. Too much exercise can cause a multitude of problems including injuries, low body fat, fatigue, dehydration, osteoporosis, arthritis, reproductive problems, heart problems and death. So take the proper precautions when participating in physical activities. Not only are you improving your physical health, but your dental health as well.