Diabetes

Diabetes affects about 15.7 million Americans and nearly 800,000 new cases are diagnosed each year. If you have been diagnosed with diabetes, you may know that the disease can cause problems with your eyes, nerves, kidneys, heart and other parts of your body. Diabetes can lower your resistance to infection and can slow the healing process.

What information do I need to give my dentist about my diabetes?

It’s important to keep your medical records up-to-date. Let your dentist know:

• if you have been diagnosed with diabetes;

• if the disease is under control;

• if there has been any other change in your medical history, and;

• the names of all prescription and over-the-counter drugs you are taking.

What oral health problems can be associated with diabetes?

The most common oral health problems associated with diabetes are:

• tooth decay;

• periodontal (gum) disease;

• salivary gland dysfunction;

• fungal infections;

• lichen planus and lichenoid reactions (inflammatory skin disease);

• infection and delayed healing;

• taste impairment.

What should I know about diet and tooth decay?

Your teeth are covered with plaque, a sticky film of bacteria. After you have a meal, snack or beverage that contains sugars or starches, the bacteria release acids derived from dietary sugars that attack tooth enamel. Repeated attacks can cause the enamel to break down and may eventually result in cavities.

When diabetes is not controlled properly, high glucose levels in saliva may help bacteria thrive. Brushing twice a day with fluoride toothpaste and cleaning once a day between your teeth with floss or an interdental cleaner helps remove decay-causing plaque.

Plaque that is not removed can eventually harden (calcify) into calculus, or tartar. When tartar collects above the gumline, it becomes more difficult to thoroughly brush and clean between teeth. This can create conditions that lead to chronic inflammation and infection in the mouth.

Is there a connection between diabetes and periodontal (gum) disease?

Because diabetes reduces the body’s resistance to infection, the gums are among the tissues likely to be affected. Periodontal diseases are infections of the gum and bone that hold your teeth in place.

Periodontal disease is often linked to the control of diabetes. For example, patients with inadequate blood sugar control appear to develop periodontal disease more often and more severely, and they lose more teeth than persons who have good control of their diabetes. It is possible to have periodontal disease and not have all of the warning signs. If you notice any of the warning signs of gum disease, see your dentist immediately.

Because of lowered resistance and a longer healing process, periodontal diseases often appear to be more frequent and more severe among persons with diabetes. That’s why good maintenance of blood sugar levels, a well-balanced diet that meets your needs, good oral care at home, regular dental checkups and periodontal examinations are important.

What else can I do to help prevent oral health problems?

Preventive oral health care, including professional cleanings at the dental office, is important if you are to control the progression of periodontal disease and other oral health problems. Regular dental checkups and periodontal screenings are important for evaluating overall dental health and for treating dental problems in their initial stages. Your dentist may recommend more frequent evaluations and preventive procedures, such as teeth cleaning, to maintain good oral health.

What should I do if my mouth frequently feels dry?

Saliva helps wash away food particles and keeps the mouth moist. Without adequate saliva, bacteria continue to colonize. Xerostomia, or dry mouth, is a common complaint among diabetic dental patients and patients undergoing radiation of the head and neck for cancer therapy. Constant dryness irritates the soft tissues in the mouth, often making them inflamed and painful. This condition greatly increases the risk of tooth decay and periodontal diseases.

Your dentist may recommend a saliva substitute that can be used for relief from dry mouth discomfort. Your dentist may also recommend rinsing with a fluoride mouthrinse or having a topical application of fluoride at home and in the dental office to help prevent rampant tooth decay. These products are sold over-the-counter at pharmacies.

Using sugarless gum, sugarless mints, taking frequent sips of water or using melting ice chips may help alleviate a dry mouth. Restricting intake of caffeine and alcohol also can help.

What other some other oral conditions that can be associated with diabetes?

Oral candidiasis, a fungal infection in the mouth, appears to occur more frequently among persons with diabetes including those who wear dentures. Your dentist may prescribe antifungal medications to treat this condition. Good oral hygiene is critical.

Lichen planus is a skin disorder that produces lesions in the mouth. A more severe type of Lichen planus involves painful ulcers that erode surface tissue. Although there is no permanent cure, your dentist may prescribe a topical anesthetic or other medication to reduce and relieve the condition.

Some diabetics have reported that their taste for sweets is diminished, although the taste impairment is usually not severe. Altered taste sensations, barely perceptible to most diabetic patients, may influence their food choices in favor of sweet tasting foods with highly refined carbohydrate content. This may worsen the diabetic patient’s dental health and overall health.

What if I need oral surgery?

Infection is a risk for the diabetic patient and can make it more difficult to control blood glucose levels. If you are having extensive oral surgery, your dentist may prescribe antibiotics to minimize the risk of infection. To help the healing process, keep your blood glucose levels under control before, during and after surgery.