What is diabetes?
More than 30 million Americans and about 3 million Canadians today are living with diabetes. Even more are pre-diabetic and may or may not know that they have an increased like-hood of developing the disease. As diabetes takes a toll on the rest of your body, it also visibly changes the health of your mouth. Often, your dentist might be the first person to detect these changes and get your blood sugar assessment done or refer you for an evaluation with your medical doctor. Classified as type 1 and type 2 diabetes.
Type 1 Diabetes:
Type 1 Diabetes tends to happen mostly earlier on in age, although can happen at any age and has a more sudden onset. The underlying pathology is caused by the body’s inability to produce enough insulin, a hormone that helps sugar absorb into your body to produce energy. This results in excessive blood glucose circulating in blood without being utilized.
Type 2 Diabetes:
This happens mostly later in life and onset is gradual. The underlying pathology is the body’s inability to utilize the insulin being produced to help absorb the glucose into your body. This results in excessive blood glucose circulating in blood without being utilized.
How does diabetes affect my oral health?
Individuals living with diabetes often complain of dry mouth because of decreased production of saliva. Besides lubrication, saliva also helps protect teeth by `washing –away` effect on food particles and bacteria. This is why if you have dry mouth due to diabetes or as a side effect of certain medication, you are at a higher risk of cavities and tooth infection.
Gums in diabetic individuals often become inflamed and bleed, this phenomenon is due to a confluence of factors and is commonly referred to by your dentist as gingivitis. Gums may appear dusky red and swollen and bleed on brushing. Taste, in such individuals, is often altered or absent altogether. Wound healing, like the rest of the body, will be delayed in the mouth and therefore more chances of infection.
Children, particularly in type 1 diabetes may have their teeth erupt earlier than normal if living with diabetes.
What other problems can diabetic individuals face?
Abscess formation:
Since diabetics are more prone to infections and healing is poor, often the body’s own healing process fails and even minor trauma, root infections, and obstructions can cause an abscess formation. This is seen less often in non-diabetic individuals.
Poor wound healing:
A known occurrence in diabetics is that of poor wound healing, be it in the skin or the rest of the body or just the mucosa of the mouth. Wound cause, in this case, is irrelevant, although size, location, and cleanliness play an important role in the overall healing process.
Burning sensation in the mouth:
Dryness due to lack of saliva, overall sensitivity and swelling of the mucosa lining the mouth may give a false sensation of burning in some individuals. This is because mucosa is lubricated by saliva and is relatively more sensitive than the skin, the absence of the lubricating saliva due to dry mouth in diabetics produces a burning sensation. It can be managed by the dentist through prescription drugs and pastes.
More frequent and severe infections:
The mouth is a vulnerable environment for infections because of the constant exposure to microbes and nutrition. It serves as a breeding ground for many bacterial organisms and in compromised individuals such as diabetics, the body’s defense mechanism fails to fight off infections by these organisms. More-so healing is delayed. This results in more frequent infections and severe infections than those individuals who are not compromised.
Thrush (oral yeast infection):
A fungal infection seen in immune-compromised and diabetic individuals causes white rash-like lesions. It can be cured with prescription medication from your dentists.
Parotid salivary gland enlargement:
Diabetics often see neuropathic complications of the disease in their body. One such occurrence in the mouth causes salivary gland enlargement. It can also be due to a medication side effect or infection so cause has to be determined before the treatment plan can be decided by your dentist.
Why are diabetics more prone to gum disease?
Individuals living with diabetes are three times more likely to have gum and gum related issues than individuals without diabetes. This is because high blood sugar decreases the blood supply to the gums and increases the likelihood of infections. Healing is poor and increases bacterial load aids in the overall damage the disease causes to the gums. The decrease in saliva production may also be a factor adding to the ordeal. In severe cases, periodontal disease, the disease of gums and underlying ligaments may develop which results in bone resorption, loss of support of the tooth and eventually mobility of tooth due to lack of support from the bone. In fact, many studies show a direct relationship between periodontal disease and uncontrolled diabetes. Such that managing periodontal disease in individuals with poor diabetes control is hard and vis versa.
How can your dentist help you manage your diabetes?
Several studies in patients with gum or periodontal disease show a high risk of developing diabetes and vise versa. Since this relationship is bi-directional, addressing oral health issues can result in better glycemic control. Your dentist can help by working with your primary physician and/or your endocrinologist to manage and monitor this.
Plaque control:
Your dentist will recommend a schedule for cleaning based on your oral health to help achieve plaque control. Professional intervention for keeping your teeth clean, your plaque levels low helps keep any gum disease or periodontal problems from developing and so maintaining good glycemic control.
Dietary modification:
Your dentist will work with your primary provider or endocrinologist to understand your diet and see what modifications are needed to improve your oral and systemic health. Dietary modification plays an important role in managing early diabetes besides pharmacological intervention. Certain foods contain a much higher content of glucose than others and regulating dietary intake, regular exercise are as important as the medication in managing diabetes.
Monitoring of blood glucose:
With every visit to your dentist’s office, your blood glucose may be monitored. This helps your dentist determine the risk and benefit of the dental procedure. It also helps estimate how easy the healing process might be, post-procedure and if there are any special considerations the dentist needs to take.
Action Plan
Diabetes is a life-long disease that may adversely affect all or any organ of your body, including the mouth. To improve the longevity of the health of your organs, it is essential to keep intake a few prophylactic measures. For oral health, it is essential to work with your dentist in managing your oral hygiene which in-turn affects oral health.
