Diabetes and oral health

Dr Vanya Vasudeva
Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose gets into your cells to give them energy.
With type 1diabetes, your body does not make insulin. DM is classified according to its etiology as type 1 (T1D), type 2 (T2D), gestational diabetes (GDM) .T1D results from the destruction of beta-cells within the islets of Langerhans of the pancreas, which results in a complete insulin deficiency; it can be immune-mediated or have an idiopathic etiology. T2D ranges from an insulin resistance which progresses into an insulin deficiency due to a secondary failure in the pancreatic beta-cells. GDM is high blood sugar (glucose) that develops during pregnancy and usually disappears after giving birth. It can happen at any stage of pregnancy, but is more common in the second or third trimester.
People with diabetes more likely to develop oral health problems: The link between diabetes and oral health problems is high blood sugar. If blood sugar is poorly controlled, oral health problems are more likely to develop. This is because uncontrolled diabetes weakens white blood cells, which are the body’s main defense against bacterial infections that can occur in the mouth. Controlling blood sugar levels lowers the risk of major organ complications of diabetes – such as eye, heart, and nerve damage – so diabetes control protect against the development of oral health problems.
What are the oral health problems: 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 weakening white blood cells, another complication of diabetes is that it causes blood vessels to thicken. This slows the flow of nutrients to and waste products from body tissues, including the mouth. When this combination of events, the body loses its ability to fight infections. Since periodontal disease (the infection of supporting structures of teeth which include gums, periodontal ligaments and alveolar bone) is a bacterial infection, people with uncontrolled diabetes might 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 damaged.
Thrush: People with diabetes who frequently take antibiotics to fight various infections are especially prone to developing a fungal infection of the mouth and tongue. The fungus thrives on the high glucose levels in the saliva of people with uncontrolled diabetes. Wearing dentures (especially when they are worn constantly) can also lead to fungal infections.
Burning mouth and/or tongue: This condition is caused by the presence of thrush. 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
Do people with diabetes lose their teeth more often and sooner than people without diabetes?
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 oral hygiene. brushing at least twice daily (or preferably after every meal) with a toothpaste that contains fluoride, flossing daily, and keeping blood sugar levels under control – the potential for infection from periodontal disease will be greatly reduced or eliminated, and so will the risk of tooth loss.
Prevention: Since people with diabetes are more prone to conditions that might harm their oral health, follow good oral hygiene, pay special attention to any changes in your oral health, and to consult your dentist immediately if such changes occur. To prevent or reduce oral health problems include:
Keep your blood sugar as close to normal as possible. At every dental visit, tell your dentist the status of your diabetes. Know your glycosylated hemoglobin (HgA1C) level. If you’ve had an episode of low blood sugar (also called an insulin reaction) in the past, 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 insulin).
See your doctor before scheduling treatment for periodontal disease (infections of the structures around the teeth). If oral surgery is planned, your dentist will tell you if you need to take any pre-surgical antibiotics, if you need to change your meal schedule or the timing and dosage of your insulin
Bring your dentist a list of all the names and dosages of all medicines you are taking your dentist will need to know this information to prescribe medicines least likely to interfere with the medicines you are already taking. If a major infection is being treated, your insulin dose (for those taking insulin) might need to be adjusted.
Postpone non-emergency dental procedures if your blood sugar is not in good control. However, acute infections (infections that develop quickly), such as abscesses, should be treated right away.
Keep in mind that healing might take longer in people with diabetes. Follow your dentist’s post-treatment instructions closely.
Consult your dentist immediately if a wire or bracket (such as those in braces) cuts your tongue or mouth.
Other oral hygiene tips for people with diabetes:
* Have your teeth and gums cleaned and checked by your dentist twice a year.
* Prevent plaques 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.


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