Diabetes and Dental

People with diabetes who keep their blood glucose levels in a target range have no more dental problems than the rest of the population. However, those with poorly managed blood glucose levels have a decrease in saliva and an increase in salivary sugar, which leads to dry mouth, ulcers, fungal infections, increased tooth decay, loss of teeth, and difficulty wearing dentures,” says Dr. Carol Alexopoulos, a dentist who practices in Toronto, Ontario.
Insufficient moisture can cause both dry mouth and a burning sensation on your tongue. This lack of moisture can eventually lead to an irritation of the entire lining of the mouth, since normal volumes of saliva actually protect your teeth from cavities and make chewing and speech comfortable. If you wear dentures and develop a feeling of dry mouth, you may find them irritating and more difficult to wear.
In addition, poorly managed blood glucose levels can lead to:

• Severe toothaches due to impaired circulation to your teeth. If you cannot eat solid food because chewing is difficult, try alternatives such as milk, soup, cereals, pudding, or fruit juices to replace your carbohydrate allowance.
• More severe gum disease and at an earlier age.
• Thickening of the small blood vessels of the gingiva (gums) which can lead to infection of the gum and bone tissues.
• Periodontal disease that, in turn, can make it hard to manage blood glucose levels. Because periodontal disease is an infection, bacteria produce toxins that affect the carbohydrate metabolism in individual cells. It is also thought that the host response to periodontal bacteria can increase insulin resistance and, therefore, blood glucose levels.

At Home

Dental health is important for everyone.
The most important part of dental care is to brush and floss your teeth regularly (at least twice a day, better yet after every meal or snack) based on the advice of your dentist. This will help prevent acid attack to your teeth and help avoid plaque formation.
Remember:

1. Food particles left between your teeth will break down and become acidic. Food does not have to be sugary or sweet to cause a cavity.
2. Gum disease can reach an advanced and serious stage before you feel any pain or notice any bleeding during brushing.

At the Dental Office

With very few exceptions, people with diabetes can be treated by dentists the same way as those without diabetes.

• Your teeth may be cleaned by removing all deposits formed in between teeth as well as under the gum line. If this is uncomfortable, ask your dentist for “freezing”. Your dentist should do everything he or she can to eliminate pain during treatment.
• If you take insulin, your dentist should be told. The dental staff can then confirm with you that you took your usual insulin dosage and will ask you to let them know if any signs of insulin reaction occur.
• During a dental appointment, stressed patients release hormones that can affect insulin uptake and blood glucose levels. It is very important that you take insulin/medications at the appropriate time and follow your meal plan to keep your blood glucose levels stable.

If gum surgery or tooth extraction is required, or if implants are to be placed, a very careful follow-up should be planned. This will include special dietary instructions and very close observation of the healing process. You may be asked to measure your blood glucose level more frequently and to test your urine for ketones.
You may also be prescribed antibiotics. If you take any oral diabetes medications, you should speak with your doctor to ensure that there will be no reaction between your diabetes medication and the suggested antibiotic.

Final Thoughts

Floss and brush only the teeth you want to keep!
Regular dental checkups are important. In the fight to control and stop gum disease from advancing quickly, the time between dental visits should not exceed three months.
Periodontists (gum specialists) have discovered that if you wait longer than 90 days between professional cleanings, a worsening of periodontal (gum) disease occurs because the bacteria become more aggressive and more damaging to the gums surrounding your teeth.
If you suspect a problem, call your dental office as soon as possible. Your dentist will always make time for you, especially if there is a problem.
Unlike teeth, dental problems do not go away if ignored.
This article was reviewed by Carol Alexopoulos DDS, a dentist who practices in Toronto, Ontario.