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Oral health and Diabetes

By Dr Syed Iftikhar Ali

People with diabetes have increased risk of inflammation of the gums (periodontitis) or gingival hyperplasia if blood glucose is not properly managed.

Periodontitis or gum disease is a major cause of tooth loss and is associated with an increased risk of CVD.

Other diabetes-related oral conditions include dry mouth, dental decay, candidiasis, lichen planus, neurosensory disorders (burning mouth syndrome), salivary dysfunction and xerostomia, and taste impairment.

Diabetes patients may have a higher prevalence of mucosal disorders possibly associated with chronic immunosuppression, delayed healing, and/or salivary hypofunction.

What causes people with diabetes to have gum disease?

Glucose (sugar) is present in your saliva--the fluid in your mouth that makes it wet. When diabetes is not controlled, high glucose levels in saliva makes harmful bacteria grow. These bacteria combine with food to form a soft, sticky film called plaque. Some types of plaque cause tooth decay or cavities. Other types of plaque cause gum disease and bad breath.

High blood sugar is also a stimulus for bone resorption, inhibition of osteoblast differentiation, and a reduced capacity for bone recovery[1]. It has been observed that the removal of periodontal inflammation can reduce the dose of insulin required for the patient’s glycemic control.[2]

Symptoms of gum disease

  • Red, swollen, tender, bleeding gums
  • A persistent discharge (pus) coming from the gums
  • Gums that are loose and pull away from the teeth
  • A bad taste or bad breath
  • Loose teeth – this can change the ‘feel’ of your bite when your teeth are placed together or may make dentures fit differently
  • Spaces opening between teeth
  • Changes in the way your teeth fit when you bite

What is Dry Mouth?

You may notice that you have a dry mouth at times. This may be caused by medicines you take or if you have uncontrolled blood sugar. A dry mouth can increase your risk of cavities because there is less saliva to wash away germs and take care of the acids they create. Dry mouth can also cause other problems, such as salivary gland infections. If you have dry mouth, try drinking more sugar-free fluids, chewing sugarfree gum, or eating sugar-free candy to help keep the saliva flowing.

What is Thrush?

Another oral problem associated with diabetes is thrush. Thrush is an infection caused by fungus that grows in your mouth. To control thrush, maintain good blood glucose levels and avoid smoking. If you wear dentures, remove and clean them daily.

What is Burning Mouth Syndrome?

Burning mouth syndrome (BMS) is characterized by a burning sensation in the oral mucosa and an absence of clinical signs. Its etiology includes systemic, local, and psychological factors (stress, anxiety and depression). It is more common in women. Patients with diabetes often have burning mouth syndrome, but a clear relationship between Diabetes and Burning Mouth Syndrome has not been identified.

How can diabetes cause Taste disturbance:

Taste detection follows a hereditary pattern, but can be influenced by the appearance of neuropathies (microvascular complications caused by diabetes). When this sensory dysfunction occurs, it can inhibit the ability to maintain a proper diet and can lead to poor glucose control. Taste alteration has been associated with diabetes and the development of obesity[3].

Diabetes Dental Health Action Plan

  • The regular use of toothbrush and a strict dental maintenance schedule are important in long-term oral health and for the prevention of complications
  • Brush and floss at least twice a day. Rinse with an antiseptic mouthwash daily
  • Regular oral check-ups should be established to ensure early diagnosis especially among previously undiagnosed diabetes patients and prompt management of any oral complications among patients with diabetes
  • Annual visits are recommended for symptoms of gum disease such as bleeding when brushing teeth or swollen and red gums
  • To improve oral health, salivary function must be maintained
  • Common dry or burning sensation in the mouth among people with diabetes can be a side effect of medication use which can be managed by modifying drug scheduling, dose adjustment, changing medications or simply by chewing sugar-free gum
  • A high fluid intake should be encouraged. Patients should avoid bulky, spicy or acidic foods, alcoholic and carbonated beverages, and tobacco use
  • The use of mouthwashes, that are specific to the treatment of dry mouth and alcohol free may also alleviate the oral discomfort
  • Quit Smoking: People with diabetes who smoke are at an even higher risk — up to 20 times more likely than non-smokers to develop thrush and periodontal disease. Smoking also seems to impair blood flow to the gums, which might affect wound healing in this tissue area

 Conclusion:

Diabetes leads to multiple complications, which increase when glycemic control of the patient is inadequate. This makes management and prevention important.

Research suggests that treating gum disease can help improve blood sugar control in patients living with diabetes, decreasing the progression of the disease. Practicing good oral hygiene and having professional deep cleanings done by your dentist can help to lower your HbA1c and manage your diabetes well.

(Dr Syed Iftikhar Ali is a doctor by profession. He completed his MBBS from King George Medical University, Lucknow and MS in general surgery from Jhansi Medical College in 2013. He has more than 7 years of work experience in the field of medicine.)

[1] Lima SMF, Grisi DC, Kogawa EM, Franco OL, Peixoto VC, Gonçalves-Júnior JF, et al. Diabetes mellitus and inflammatory pulpal and periapical disease: A review. Int Endod J. 2013;46:700-9

[2] Bender IB, Bender AB. Diabetes mellitus and the dental pulp. J Endod. 2003;29:383-9.

[3] Leite RS, Marlow NM, Fernandes JK. Oral health and type 2 diabetes. Am J Med Sci. Elsevier Masson SAS; 2013;345:271-3

Tags: diabetes, dental health, oral health, gum disease

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