Hi everyone,
Apologies again for this late post - I have been ultra busy lately! This entry is about diabetes and dentistry and how one affects the other. Issues such as this are important for people who suffer from the disease and also drug developers and manufacturers who need to take into account problems such as side effects in different individuals. The importance of dental care with diabetes
- Diabetes is a disease which can affect the whole body, including the mouth
- Diabetics face a higher than normal risk of oral health problems due to poorly controlled blood sugars
- The less well controlled the blood sugar, the more likely oral health problems are to arise – this is because uncontrolled diabetes impairs white blood cells, which are the body’s main defence against bacterial infections that can occur in the mouth
- Diabetics face a higher than normal risk of oral health problems due to poorly controlled blood sugars
- The less well controlled the blood sugar, the more likely oral health problems are to arise – this is because uncontrolled diabetes impairs white blood cells, which are the body’s main defence against bacterial infections that can occur in the mouth
Dental Problems which diabetics are more at risk of developing
- Dry mouth, xerostomia (dry mouth due to lack of saliva) and salivary gland dysfunction
- Caries
- Increased susceptibility to bacterial, viral and fungal (including oral candidiasis - thrush) infections
- Periodontitis (untreated gum disease) and loss of teeth
- Burning mouth syndrome
- Gingivitis (gum disease)
- Caries
- Increased susceptibility to bacterial, viral and fungal (including oral candidiasis - thrush) infections
- Periodontitis (untreated gum disease) and loss of teeth
- Burning mouth syndrome
- Gingivitis (gum disease)
Dry Mouth
- Uncontrolled diabetes can decrease saliva flow and thus result in dry mouth which can further lead to sores, ulcers, infections and tooth decay
- Dry mouth can cause difficulties in tasting, chewing, swallowing and speaking
- It can also increase chances of developing dental decay and other infections in the mouth
- Dry mouth may be a sign of some diseases and conditions
- It may also be cause by certain medications or medical treatments
- Symptoms include: A sticky and dry feeling in the mouth, trouble chewing, swaalowing, tasting or speaking, a burning feeling in the mouth, a dry throat, cracked lips, a dry, togh tongue, mouth sores and infections and decay when there is not an adequate supply of saliva (this causes the rate of tooth decay to increase rapidly)
- Dry mouth can cause difficulties in tasting, chewing, swallowing and speaking
- It can also increase chances of developing dental decay and other infections in the mouth
- Dry mouth may be a sign of some diseases and conditions
- It may also be cause by certain medications or medical treatments
- Symptoms include: A sticky and dry feeling in the mouth, trouble chewing, swaalowing, tasting or speaking, a burning feeling in the mouth, a dry throat, cracked lips, a dry, togh tongue, mouth sores and infections and decay when there is not an adequate supply of saliva (this causes the rate of tooth decay to increase rapidly)
Dry mouth – Treatment
- High fluoride toothpaste such as Colgate prevident 5000+ in order to help reduce decay
- Biotene – an oral rinse used to relieve symptoms of dry mouth
- Salagen (Pilocarpine) – These pills have been shown to provide significantly increased saliva flow whilst relieving dry mouth BUT Salagen may cause fluctuations in blood pressure so will need to be taken under the supervision of a doctor
- Chewing gum and sour candy in particular products with Xylitol (natural sugar alternative) – chewing this type of gum for five minutes after every meal has been shown to reduce the incidence of tooth decay by up to 62%
- Biotene – an oral rinse used to relieve symptoms of dry mouth
- Salagen (Pilocarpine) – These pills have been shown to provide significantly increased saliva flow whilst relieving dry mouth BUT Salagen may cause fluctuations in blood pressure so will need to be taken under the supervision of a doctor
- Chewing gum and sour candy in particular products with Xylitol (natural sugar alternative) – chewing this type of gum for five minutes after every meal has been shown to reduce the incidence of tooth decay by up to 62%
Salivary Gland Dysfunction
- The average person creates about 1 litre of saliva per day
- If saliva production is reduced, an individual’s oral bacteria level can increase 10 fold (compared to normal levels)
- In patients with diabetes; there may be xerostomia (dry mouth)and SGD which may be due to polyuria (excessive production of urine) or an underlying metabolic or endocrine problem
- When the normal environment of the oral cavity is altered due to a decrease n salivary flow/change in salivary composition, a healthy mouth can become susceptible to dental caries and tooth deterioration
- If saliva production is reduced, an individual’s oral bacteria level can increase 10 fold (compared to normal levels)
- In patients with diabetes; there may be xerostomia (dry mouth)and SGD which may be due to polyuria (excessive production of urine) or an underlying metabolic or endocrine problem
- When the normal environment of the oral cavity is altered due to a decrease n salivary flow/change in salivary composition, a healthy mouth can become susceptible to dental caries and tooth deterioration
Dental caries – AKA: Cavities
- Occur when teeth are frequently exposed to foods containing carbohydrates such as starches and sugars
- Such cavities have been identified as bacterial infections
- Bacteria inhabit the plaque and form up to 500 different products including acid
- Plaque interacts with food deposits on the teeth to produce acid which slowly dissolves the calcium in teeth – with regard to the fact that enamel is 97% calcium, this acid causes teeth to decay and may cause gum disease and bad breath
- When a substantial amount of calcium has dissolved from the surface of a tooth, the surface may break and form a hole – this is the basis for the formation of a cavity – an active lesion can be diagnosed based upon colour, surface texture and x-rays (e.g. white spots can be active lesions if they are not glossy and feel rough
- An area of decay may take from 6 months to 8years to dissolve the tooth enamel – a “cavity” is caused when the outer layer collapses and produces a whole which cannot repair itself
- Such cavities have been identified as bacterial infections
- Bacteria inhabit the plaque and form up to 500 different products including acid
- Plaque interacts with food deposits on the teeth to produce acid which slowly dissolves the calcium in teeth – with regard to the fact that enamel is 97% calcium, this acid causes teeth to decay and may cause gum disease and bad breath
- When a substantial amount of calcium has dissolved from the surface of a tooth, the surface may break and form a hole – this is the basis for the formation of a cavity – an active lesion can be diagnosed based upon colour, surface texture and x-rays (e.g. white spots can be active lesions if they are not glossy and feel rough
- An area of decay may take from 6 months to 8years to dissolve the tooth enamel – a “cavity” is caused when the outer layer collapses and produces a whole which cannot repair itself
Decay which is unique to adults
- Root cavities: As people age, their gums can recede and leave parts of the teeth exposed – tooth roots become exposed and may decay easily – many people over 60 have root cavities as a result of gum disease
- It has been found that gum recession occurs more frequently in moderate and poorly controlled diabetic patients (this is due to plaque responding differently and creating more harmful products in the gums)
- Repeated decay around existing fillings: Decay can form around existing fillings and crowns as these areas aren’t as smooth as a natural tooth surface and can decay easier
- Cavities due to dry mouth
- It has been found that gum recession occurs more frequently in moderate and poorly controlled diabetic patients (this is due to plaque responding differently and creating more harmful products in the gums)
- Repeated decay around existing fillings: Decay can form around existing fillings and crowns as these areas aren’t as smooth as a natural tooth surface and can decay easier
- Cavities due to dry mouth
Bacterial, Viral and Fungal infections
- Thrush (oral candidiasis) is an infection caused by a fungus that grows in the mouth and people with diabetes are at risk of thrush because the fungus thrives on high glucose levels in saliva
- Smoking, taking antibiotics often and wearing dentures (especially ones which are worn constantly) may lead to thrush although medication is available to treat this infection
- Good diabetic control, not smoking and removing and cleaning dentures daily can help prevent thrush
- Smoking, taking antibiotics often and wearing dentures (especially ones which are worn constantly) may lead to thrush although medication is available to treat this infection
- Good diabetic control, not smoking and removing and cleaning dentures daily can help prevent thrush
Periapical Abscesses
- A dental abscess is an infection of the mouth, face, jaw or throat that begins as a tooth infection or cavity
- These infections can be caused by poor dental health and can result from lack of proper and timely dental care, they may also occur in people who have other conditions that weaken the immune system (such as diabetes, chemotherapy cancer care)
- Dental abscesses can also be triggered by minor trauma in the oral cavity
- These infections can be caused by poor dental health and can result from lack of proper and timely dental care, they may also occur in people who have other conditions that weaken the immune system (such as diabetes, chemotherapy cancer care)
- Dental abscesses can also be triggered by minor trauma in the oral cavity
Periodontitis
- Diabetics are more prone to the development of gum disease (periodontal disease) from gingivitis that is caused by the presence of bacteria in plaque
- Plaque is the white sticky film that accumulates on teeth below and above the gum line that may harden into a rough yellow or brown deposit called tartar or calculus
- Without regular dental checkups periodontal disease may result if gingivitis is left untreated
- It could also cause inflammation and destruction of tissues surrounding and supporting teeth, gums, bone and fibres which hold the gums to the teeth
- Gum infections can make it difficult to control blood sugar and severe infections can cause teeth to loosen or fall out
- PERIODONTAL OR GUM DISEASE IS THE MAIN CAUSE OF TOOTH LOSS IN ADULTS!!!
- Simple things which help prevent periodontal disease:
* Changes in diet and exercise
* Brushing teeth after every meal
* Flossing daily
* Using a tongue scraper to scrape the tongue
* Being aware of blood sugar levels and informing medical and dental professionals of any changes in the oral cavity such as white patches in the mouth
- Plaque is the white sticky film that accumulates on teeth below and above the gum line that may harden into a rough yellow or brown deposit called tartar or calculus
- Without regular dental checkups periodontal disease may result if gingivitis is left untreated
- It could also cause inflammation and destruction of tissues surrounding and supporting teeth, gums, bone and fibres which hold the gums to the teeth
- Gum infections can make it difficult to control blood sugar and severe infections can cause teeth to loosen or fall out
- PERIODONTAL OR GUM DISEASE IS THE MAIN CAUSE OF TOOTH LOSS IN ADULTS!!!
- Simple things which help prevent periodontal disease:
* Changes in diet and exercise
* Brushing teeth after every meal
* Flossing daily
* Using a tongue scraper to scrape the tongue
* Being aware of blood sugar levels and informing medical and dental professionals of any changes in the oral cavity such as white patches in the mouth
Lichen Planus
- This is a relatively common disease of unknown cause – may be due to an allergic or immune reaction
- This disorder has been known to develop after exposure to potential allergens such as medications, dyes and other substances
- Generally considered to involve a hypersensitivity reaction on microscopic level
- Appears as lacy white matches on the inside of the cheeks or on the tongue
- The link with diabetes and oral lichen planus is suggests that it is an adverse effect of the drug therapy used to treat diabetes
- Mild symptoms should be examined regularly so as to see if any further treatment is required (such treatments may include corticosteroids, medicated mouth wash or immunosuppressant medications)
- This disorder has been known to develop after exposure to potential allergens such as medications, dyes and other substances
- Generally considered to involve a hypersensitivity reaction on microscopic level
- Appears as lacy white matches on the inside of the cheeks or on the tongue
- The link with diabetes and oral lichen planus is suggests that it is an adverse effect of the drug therapy used to treat diabetes
- Mild symptoms should be examined regularly so as to see if any further treatment is required (such treatments may include corticosteroids, medicated mouth wash or immunosuppressant medications)
Burning mouth syndrome (BMS)
- Patients usually show no clinically detectable lesions although symptoms of pain and burning may be intense
- BMS is a complex condition in which a burning pain occurs on the tongue or lips, or over a widespread area involving the whole mouth without any obvious reasoning
- Symptoms of BMS include: A burning sensation in the tongue, lips, gums, palate or throat (as if the patient had been burned with a hot liquid). Other symptoms include dry mouth, sore mouth, tingling/numb sensation in the mouth or tip of tongue and a bitter r metallic taste
- BMS may be caused by: Dry mouth, oral thrush, depression, heartburn, bruxism, diabetes, menopause, some medications and allergies
- Treatment is available when doctors understand the underlying cause of the condition – if this doesn’t happen, oral thrush medications, vitamins or antidepressants may be prescribed, as such medications have proved effective in treating BMS
- BMS is a complex condition in which a burning pain occurs on the tongue or lips, or over a widespread area involving the whole mouth without any obvious reasoning
- Symptoms of BMS include: A burning sensation in the tongue, lips, gums, palate or throat (as if the patient had been burned with a hot liquid). Other symptoms include dry mouth, sore mouth, tingling/numb sensation in the mouth or tip of tongue and a bitter r metallic taste
- BMS may be caused by: Dry mouth, oral thrush, depression, heartburn, bruxism, diabetes, menopause, some medications and allergies
- Treatment is available when doctors understand the underlying cause of the condition – if this doesn’t happen, oral thrush medications, vitamins or antidepressants may be prescribed, as such medications have proved effective in treating BMS
Gingivitis
- Characterised by inflamed and bleeding gums – it can be a precursor to chronic periodontitis and do needs to be treated - Gingivitis results from bacterial plaque accumulation at the gum margin and in the sulcus between the margin and the tooth
- Thickening of blood vessels is a complication of diabetes that may increase the risk of gum disease – diabetes causes blood thickening which slows the flow of nutrients to the mouth and therefore slows the removal of harmful substances from the mouth
- High glucose levels in the mouth fluids may help germs grow and set the stage for gum disease
- Smoking increases the risk of gum disease – A 45 year old diabetic smoker is 20 times more likely to develop gum disease (and consequently bone and tooth loss) than a 45 year old without such risk factors
- Simple lifestyle changes can be made as mentioned above under ‘Periodontitis’
When is the best time for diabetic patients to receive dental care?
- Dental procedures should be as short and stress free as possible
- Morning appointments are preferred as blood glucose levels tend to be better controlled at this time of day
- Take medications as directed when you schedule an appointment
- Test blood sugar levels and take blood pressure and take these results with you to your appointment
- Keep your dentist informed of any changes in your health regularly and visit the dentist every 3-4 months
- Postpone non-emergency dental procedures if the blood sugar is not in good control (NOTE: Abscesses should be treated right away)
- Be aware that healing time will generally take longer in diabetic patients
- Morning appointments are preferred as blood glucose levels tend to be better controlled at this time of day
- Take medications as directed when you schedule an appointment
- Test blood sugar levels and take blood pressure and take these results with you to your appointment
- Keep your dentist informed of any changes in your health regularly and visit the dentist every 3-4 months
- Postpone non-emergency dental procedures if the blood sugar is not in good control (NOTE: Abscesses should be treated right away)
- Be aware that healing time will generally take longer in diabetic patients
I hope that you have found this post interesting and I know that many of you will be able to relate to the issues raised as you may suffer or know someone who suffers from diabetes.
All the best
Zahra :) x x x
