Diabetes & Dental Health

Diabetes and dental health are closely linked.  Periodontal disease, in particular, has been connected to diabetes, and several studies have proven that these two medical conditions can contribute to and enhance the effects of the other.  If you have diabetes, prevention is the best way to avoid problems related to your oral and overall health.  Patients with diabetes should inform their dentist about their condition.  This information may play a vital role for you in maintaining your teeth and gums.  Also inform your dentist of all medications you are using to manage your diabetes.

Common dental problems associated with diabetes include:

  • Salivary gland dysfunction – this can lead to dry mouth, and increases your risk of developing tooth decay.
  • Tooth loss due to gum infection and resulting bone loss.
  • A slower rate of healing following oral surgery (such as tooth extraction, implant placement, or gum surgery)
  • Burning mouth syndrome and taste impairment
  • Yeast infection (oral candidiasis) and mouth ulcers (lichen planus)

To help protect your teeth and gums, we recommend that you:

  • Brush often. You should brush your teeth at least twice a day, and floss daily.
  • Meet with your dentist frequently. You should have your teeth checked at a routine appointment at least once every six months, though your dentist may recommend more frequent visits if necessary.  Regular appointments will allow your dental problems to be diagnosed and treated early, when treatment is most effective.
  • If you have problems with your teeth, gums, jaw, or mouth, contact your dentist to set up an appointment immediately. Remember to remind your dentist that you have diabetes, especially if you have recently changed dentists.
  • Speak with your dentist about home control. You can use a red “disclosing tablet” to make plaque easier to see while performing your at-home oral care.  These tablets can be purchased at grocery stores or pharmacies.

Other oral problems linked to diabetes include:

  • Thrust (Oral Candidiasis) – this is a fungus infection caused by the overgrowth of Candida albicans, a yeast-fungus that thrives on high levels of glucose in saliva. The overgrowth of this disease is most often caused by smoking and wearing dentures.  Thrush can be prevented or minimized by tight glucose control, avoiding smoking and tobacco use, and removing your dentures daily for thorough cleaning.
  • Dry Mouth – Saliva is an automatic cleaner within your mouth which removes bacteria and food buildup and contribute to plaque and tooth decay. If you have a dry mouth, you may develop soreness, ulcers, infections, and decay due to the lack of saliva in your mouth.  Dry mouth may also be a side effect of mediation.  There are more than 400 over-the-counter and prescription drugs that can cause dryness of the mouth, including cold medicine and medication for high blood pressure and depression.  If your mouth feels too dry, let your dentist or general doctor know.  An alternative medication or an “artificial saliva” can be provided to help keep your mouth moist and your teeth protected.

Why does diabetes affect oral health and contribute to periodontal disease?  
Diabetes and periodontal disease can contribute to each other in a number of ways.  Diabetes raises the risk of infection due to poor blood supply and increased levels of glucose in the blood.  Poor sugar control increases the risk of developing periodontitis, and makes gum disease more difficult to treat.  Diabetic treatment for individuals with well-controlled blood sugar have the same chance of developing and managing periodontal disease that people without diabetes have.

Diabetes changes the blood vessels, thickening them and reducing the flow of oxygen and nutrients to your gums.  This also slows the process of clearing away waste products from your mouth.  This weakens the resistance of the gum tissue and bone structure, and can lead to infection.  A lack of regular oral hygiene (including both at-home and professional dental care) can leave sugary food particles on the teeth, which then becomes plaque and tartar, irritating the gums and eventually leading to an increase in periodontal disease and decay.

Other factors that may contribute to diabetes and periodontal disease include a poor diet, which increases the risk of diabetes as well as harming your overall well-being, and smoking.  People who smoke or use tobacco products are five times more likely that nonsmokers to develop gum disease.  Diabetic smokers age 45 and older are approximately 20 times more likely to develop severe gum disease.

Your dentist may recommend several types of treatment to help manage periodontal disease.  This may include the removal of plaque through a deep cleaning treatment known as scaling and root planing, an antibiotic or special mouthwash, or periodontal surgery.

What can diabetics do to better manage their oral health? 
There are several steps you can take to manager your condition and your oral health.  These include:

  • Receiving regular screenings for diabetes.
  • Take all medications to manage your medical conditions as directed.
  • Know your personal degree of diabetic control, and provide this information to your dentist at each visit to your dentist’s office.
  • If periodontal treatment is needed, consult with your physician and your dentist about your overall medical condition and any medications you take.
  • Acute infections in your mouth, such as an abscess, are an emergency. Seek treatment right away, regardless of any difficulties you might have with controlling your glucose levels.
  • Seek treatment for periodontal disease. Successful treatment can make it easier to control your blood sugar.
  • Practice good oral hygiene. Regular brushing and flossing keeps the levels of bacteria in your mouth low and removes sugars from your mouth.
  • Avoid dry mouth. Staying hydrated is the best way to do this.  Chewing sugar-free gum can also help stimulate the flow of saliva in your mouth.
  • Make sure that your denture or partial denture fits well. This will help you avoid irritation and infection.
  • Eat a healthy meal in the morning and take any required insulin before your dental appointments. Discuss your condition with your dentist in advance whenever possible.
  • Maintain a balanced, nutritious diet. This includes Vitamin C, which has been shown to improve collagen formation and promote healing, especially in cases of gum surgery.
  • It is recommended that patients with diabetes should schedule appointments first thing in the morning. This will allow time for anesthetic to wear off, and avoid disrupting your mealtimes.
  • Discuss saliva substitutes and fluoride rinses with your dentist to determine if they are an appropriate option for you.