Diabetes affects all aspects of your health, including your oral health. It’s important to have a dentist on your diabetes care team and visit at least twice a year for cleanings or as often as your dentist recommends.
Side effects of uncontrolled diabetes on your oral health can include: xerostomia (dry mouth); burning sensation in the mouth (caused by diabetic neuropathy); impaired/delayed wound healing; increased incidence and severity of infections; secondary infection with candidiasis (thrush); parotid salivary gland enlargement; gingivitis; and/or periodontitis.
Let’s look at these a little more in depth.
- Dry mouth (xerostomia). Some people with diabetes also experience a lack of saliva, a condition commonly known as dry mouth. Without saliva to keep your mouth moist and bathe your teeth, you could be at risk of tooth decay, gum disease and thrush
- Tooth decay (cavities). Your mouth naturally contains many types of bacteria. When starches and sugars in foods and beverages interact with these bacteria, a sticky film known as plaque forms on your teeth. The acids in plaque attack the surfaces of your teeth (enamel and dentin). This can lead to cavities and gum disease. The higher your blood sugar level, the greater the supply of sugars and starches — and the more acid wearing away at your teeth.
- Thrush. People with diabetes may be more likely to develop thrush, which is a fungal infection caused by the yeast Candida albicans. Signs of thrush include painful white or red patches inside your mouth. Practicing good oral hygiene can help you avoid thrush.
- Early gum disease (gingivitis). Diabetes reduces your ability to fight bacteria. If you don't remove plaque with regular brushing and flossing, it'll harden under your gumline into a substance called tartar (dental calculus). The longer plaque and tartar remain on your teeth, the more they irritate the part of your gums around the base of your teeth, called the gingiva. In time, your gums become swollen and bleed easily.
- Advanced gum disease (periodontitis). Left untreated, gingivitis can lead to a more serious infection called periodontitis, which destroys the soft tissue and bone that support your teeth. Eventually, periodontitis causes your gums and jawbone to pull away from your teeth, which in turn causes your teeth to loosen and possibly fall out. Periodontitis can't be reversed and can't be treated with brushing and flossing alone. Your dentist will have to get involved. You may need gum surgery to save your teeth and will need to see a specialist called a periodontist. In the worst case, you might lose your teeth.
Periodontitis tends to be more severe among people who have diabetes because diabetes lowers the ability to resist infection and slows healing. An infection such as periodontitis may also cause your blood sugar level to rise, which in turn makes your diabetes more difficult to control. Preventing and treating periodontitis with regular dental cleanings can help improve blood sugar control.
If you have diabetes, be sure to take time to check your mouth regularly for any problems. If you notice that your gums appear swollen and bleed when you brush and floss, suffer from dryness, soreness, white patches, or a bad taste in your mouth schedule an appointment with your dentist.
Good blood glucose control is key to controlling and preventing mouth problems. People with poor blood glucose control get gum disease more often and more severely than people whose diabetes is well controlled. If you have diabetes, be sure to:
- Control your blood glucose.
- Brush twice a day and floss regularly.
- Visit your dentist for routine check-ups. Be sure to tell your dentist that you have diabetes.
- Tell your dentist if your dentures (false teeth) do not fit right, or if your gums are sore.
- Quit smoking. Smoking makes gum disease worse. Your physician or dentist can help you quit.
- Make sure to give your dentist your doctor’s name and phone number. This information will then be easily available to your dentist should any questions or concerns arise.
- 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.
Here are some questions your dentist should ask you.
- How old were you when you were diagnosed with diabetes and what type of diabetes do you have?
- What medications do you take?
- How do you monitor your blood sugar levels?
- How often do you see your doctor about your diabetes? When was your last visit to the doctor?
- What was your most recent HbA1c (A1C) result?
- Do you ever have episodes of very low (hypoglycemia) or very high blood sugar (hyperglycemia)?
- Do you ever find yourself disoriented, agitated, and anxious for no apparent reason?
- Do you have any mouth sores or discomfort?
- Does your mouth feel dry?
- Do you have any other medical conditions related to your diabetes, such as heart disease, high blood pressure, history of stroke, eye problems, limb numbness, kidney problems, delays in wound healing, history of gum disease?
In general, morning appointments are better for patients with diabetes since endogenous cortisol levels are typically higher at this time. Because cortisol increases blood sugar levels, the risk of hypoglycemia is less. For patients using short- and/or long-acting insulin therapy, appointments should be scheduled so they do not coincide with peak insulin activity, which increases the risk of hypoglycemia. It is important to eat normally prior to your appointment and has take all scheduled medications. If a procedure is planned with the expectation that you will need to alter normal eating habits ahead of time (e.g., conscious sedation), diabetes medication dosing may need to be modified. Check with your doctor to see how to handle this situation. If your food consumption will be affected after oral or dental surgery, consult your doctor in advance to establish a plan to balance your diabetes medications and expected food intake while recovering.
Like many other things, your oral care is complicated by your diabetes. However, it pays to take the extra time to care for your teeth and gums so they will serve you your whole life without pain or problems.