Diabetes and Dental Health
Prevention beats problems every time especially if you have diabetes, the
disease that harms your eyes, nerves, kidneys, heart and other important
systems in the body. Your mouth is not immune to the effects of diabetes, either.
It's a "catch-22"
Glucose control, please. Poor control? Expect poor teeth and gums. Poor
teeth and gums? Expect poor control. That's the way it is. If you
have poor sugar control, you have a greater chance of getting periodontitis,
and odds are that it will be worse if you are diabetic. This means periodontitis
is harder to treat and you'll lose more teeth. Diabetics with well-controlled
blood sugar have no greater chance of periodontal disease than people
without diabetes. And this includes those with type 1.
The tough thing about periodontitis (chronic infection of any area around
the tooth) is the inflammation is often hidden from view. That's one
of the things that make it a significant problem, because when advanced,
it causes painful chewing, bone loss, and loosened and weak teeth, allowing
them to decay and require removal.
- Blood vessel changes - When diabetic blood vessels thicken, the flow of
oxygen and nutrients to the gums is reduced. The reduced flow also slows
the clearing of waste products. The combination weakens the resistance
of gum tissue and bone structure to an infection.
- Bacteria - Elevated blood sugar is associated with a higher sugar content
in the saliva in your mouth. This increased "sweetness" helps
bacteria grow, overpower the resistance to infection, and cause gum and
Smoking - The plain facts about smoking and gum disease are:
- Smokers are five times more likely than nonsmokers to have gum disease.
- Diabetic smokers, age 45 or older, are 20 times more likely to get severe
Gingivitis - Improper dental hygiene, the fancy term for poor brushing and flossing
habits, causes buildup of plaque on your teeth. Plaque is the sticky,
whitish, yellow film of germs and broken down food particles you'll
first notice between your teeth and along the gum-line below your teeth.
When germs are held in the area by the plaque, they grow between the tooth
and gum, causing redness, swelling, pain and occasional bleeding around
your teeth when you brush or floss. This gum inflammation is gingivitis,
the first stage of periodontal disease.
Daily brushing and flossing, along with regular cleaning by the dentist,
can usually reverse gingivitis, and prevent its return. Gingivitis can
develop into the more serious gum disease, periodontitis, if you continue
poor oral hygiene techniques.
Periodontitis - The longer plaque remains in place, the thicker and harder it gets.
Eventually a hard substance called scale forms under the gums. Scale separates
the gums from your tooth, forming a pocket between the two. The pocket
becomes a site of infection unless cleaned out early. If not, the infection
eats away the bone socket, weakens the tooth and may result in the tooth
having to be removed, or breaking or falling out while chewing. Obviously,
waiting until you feel pain or develop an abscess is too late for regular
brushing and flossing. Periodontitis requires treatment by a gum specialist
called a periodontist or a dentist with special training in treating gum
Taking care of your dental health
Plaque or scale removal - Whatever stage of periodontitis has affected your mouth, if you want
to keep your own teeth, the plaque or scale must be removed. If you've
got an early stage of plaque, your dental hygienist, dentist or periodontist
will use deep cleaning to remove hardened plaque and infected tissue under
the gum and smooth the damaged root surfaces of teeth. This cleaning and
smoothing can allow the gum to re-attach to the teeth. Sometimes, your
dentist will tell you to use a special mouthwash or take an antibiotic
to help control the infection. To keep plaque from returning, brush and
Periodontal surgery - When periodontitis has advanced to the point of destroying too much tissue,
the dentist or periodontist cleans out the infected pocket, and reshapes
or replaces the damaged tooth-supporting tissues.
As a diabetic:
- Know your degree of diabetic control and tell your dentist each visit.
- If you need treatment for periodontal disease, ask your diabetes doctor
to talk to the dentist or periodontist about your overall medical condition.
- Pay attention to your meal schedule and the timing and dosage of your insulin
if oral surgery is planned. You may have to fast prior to surgery.
- Acute infections, such as abscesses, are considered an emergency and should
be treated right away, regardless of glucose control difficulties. An
abscess may be why control is poor.
- Postpone non-emergency dental procedures if your blood sugar is not in
- Because of diabetes, healing may take more time.
- Once the periodontal infection is successfully treated, it is often easier
to control blood sugar.
Other oral problems linked to diabetes
Dental cavities - Diabetics who are careful with their diets and blood glucose control
tend to have no more frequent cavities than people without the condition.
Thrush - Also called oral Candidiasis, this is a fungus infection caused by the
overgrowth of Candida albicans, a yeast-fungus that thrives on high glucose
levels in saliva. Two behaviors that contribute to the overgrowth are
smoking and wearing dentures (especially all the time). Exercising tight
glucose control, not smoking, and if you wear dentures, daily removal
and cleaning can help prevent thrush.
Dry mouth - Often one of the symptoms of undetected diabetes, it's not just
an uncomfortable feeling. Soreness, ulcers, infections and tooth decay
are more common occurrences because of having little or no saliva to lubricate
the mouth and help remove bacteria and food buildup that causes plaque
and tooth decay.
Dry mouth is frequently a side effect of medication. More than 400 over-the-counter
and prescription drugs cause dryness of the mouth. These medications include
ones for colds, high blood pressure and depression. These also happen
to be some of the most widely used and prescribed medications. Let your
health practitioner or dentist know if you feel your mouth is too dry.
Perhaps a different drug or using "artificial saliva" will help
keep your mouth moist and protect your teeth.
Work hard to keep your teeth
Ongoing serious periodontal disease costs more than losing your teeth.
Any tooth loss causes changes in the shape of your gums and jawbone, interferes
with the proper fitting of dentures, and causes painful irritation. Persistent
irritation leads to pain, ulcers and infections. Painful chewing when
eating certain foods will make you select different, easier to chew foods,
which might affect your blood sugar control. Isn't it best to avoid
these problems by keeping your natural teeth and gums healthy?
Tips to protect your teeth and gums
Brushing - The single most successful way to keep your natural teeth is to brush
them twice a day and use dental floss either before or after you brush.
- Use a fluoride toothpaste to protect teeth from decay.
- Gently brush teeth with a SOFT nylon brush with rounded ends on the bristles.
- Use small circle motions and short back-and-forth motions.
- Avoid hard back-and-forth scrubbing.
- Gently brush your tongue.
- Rinse your mouth with water.
- Avoid using mouthwash that contains sugar or alcohol. Make sure to read
the label if you're not certain.
Flossing - Removing food particles from between your teeth, even after
you brush, can be done by:
- Using a piece of dental floss about 18 inches long.
- Wrap an end of the floss around the first finger of each hand, leaving
a short segment between your fingers.
- Using a back-and-forth sawing motion, gently bring the floss through the
tight spaces between your teeth.
- Do not snap the floss down the tooth against the gums.
- Curve the floss around each tooth and gently scrape from below the gum
to the top of the tooth several times.
- Carefully unwrap the floss from either finger and gently pull it through
the space between the teeth to avoid pulling it up and snapping off dental
work such as caps, crowns or fillings.
- Rewrap the free end around your finger, and move to the next space. Repeat
the process throughout your mouth.
- Rinse your mouth after flossing.
Checking yourself - Plaque (whitish build up along the base of the teeth) is hard to see
unless it is old and stained. At that point, it's a hard deposit,
or crust called "scale", and should be removed by your dentist
or dental hygienist. Plaque can easily be seen after you chew a red "disclosing
tablet" available at grocery or drug stores. If you can't find
the tablets, use a cotton swab to smear green food coloring along the
base of your teeth. The plaque will show up bright green. Extra flossing
and brushing will remove the now green plaque.
Checking in with your dentist - Anyone, including people with diabetes, should have their teeth checked
at least every six months, or more frequently as your dentist advises.
- If you have any problem with your teeth, gums, jaw or mouth, don't
wait for your next appointment. Make sure to see your dentist.
- Remind your dentist at each visit that you have diabetes.
- If you change your dentist, make sure to let your new dentist know you
- Frequent dental check-ups will find problems early, when treatment is most