Oral Health Problems and Diabetes

Why are people with diabetes more likely to develop oral health problems?

The link between diabetes and oral health problems is high blood sugar. If blood sugar isn’t well managed, oral health problems are more likely to develop. This is because unmanaged diabetes weakens white blood cells, which are the body’s main defense against bacterial infections that can occur in the mouth.

Just as studies have shown that regulating blood sugar levels lowers the risk of major organ complications of diabetes — such as eye, heart, and nerve damage — so to can diabetes protect against the development of oral health problems.

What oral health problems are associated with diabetes?

People with diabetes face a higher risk of:

• Dry mouth: Unmanaged diabetes can decrease saliva (spit) flow, resulting in dry mouth. Dry mouth can further lead to soreness, ulcers, infections and tooth decay.
• Gum inflammation (gingivitis) and periodontitis: Besides weakening white blood cells, another complication of diabetes is that it causes blood vessels to thicken. This slows the flow of nutrients to and waste products from body tissues, including the mouth. When this combination of events, the body loses its ability to fight infections. Since periodontal disease is a bacterial infection, people with unmanaged diabetes might experience more frequent and more severe gum disease.
• Poor healing of oral tissues: People with unmanaged diabetes do not heal quickly after oral surgery or other dental procedures because blood flow to the treatment site can be damaged.
• Thrush: People with diabetes who frequently take antibiotics to fight various infections are especially prone to developing a fungal infection of the mouth and tongue. The fungus thrives on the high glucose levels in the saliva of people with unmanaged diabetes. Wearing dentures (especially when they are worn constantly) can also lead to fungal infections.
• Burning mouth and/or tongue: This condition is caused by the presence of thrush.

People with diabetes who smoke are at an even higher risk — up to 20 times more likely than non-smokers to develop thrush and periodontal disease. Smoking also seems to impair blood flow to the gums, which might affect wound healing in this tissue area.

If I have diabetes, how do I prevent oral health problems?

Since people with diabetes are more prone to conditions that might harm their oral health, it’s vital to follow good oral hygiene practices, pay special attention to any changes in your oral health, and to call your dentist immediately if such changes occur. Suggestions to prevent or reduce oral health problems include:

• Keep your blood sugar as close to normal as possible. At each dental visit, tell your dentist the status of your diabetes. For instance, know your glycosylated hemoglobin (HgA1C) level. (Good management is indicated by a level under 7%). If you’ve had an episode of low blood sugar (also called an insulin reaction) in the past, you are at increased risk to have another one. Tell your dentist when your last episode was, how frequently such episodes occur, and when you took your last dose of insulin (if you take insulin).
• See your doctor before scheduling treatment for periodontal disease. Ask your doctor to talk to your dentist or periodontist about your overall health condition If oral surgery is planned, your doctor or dentist will tell you if you need to take any pre-surgical antibiotics, if you need to change your meal schedule or the timing and dosage of your insulin (if you take insulin).
• 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 nonemergency dental procedures if your blood sugar isn’t well managed. However, acute infections (infections that develop quickly), such as abscesses, should be treated right away.
• Keep in mind that healing might take longer in people with diabetes. Follow your dentist’s post-treatment instructions closely.
• Call your orthodontist immediately if a wire or bracket (such as those in braces) cuts your tongue or mouth.

Other oral hygiene tips for people with diabetes:

• Have your teeth and gums cleaned and checked by your dentist at least twice a year. Talk to your dentist to determine how often you will need checkups.
• Prevent plaque buildup on teeth by using dental floss at least once a day.
• Brush your teeth after every meal. Use a soft-bristled toothbrush.
• If you wear dentures, remove them and clean them daily.
• If you smoke, talk to your doctor about ways to quit.

What are misconceptions about oral health problems and diabetes?

People with diabetes are at greater risk for dental cavities

There are two schools of thought on this topic. One school believes that high glucose levels in the saliva of people with unmanaged diabetes helps bacteria thrive. This leads to the development of caries (tooth decay or cavities) and gum disease. Also, people with diabetes tend to eat smaller, more frequent meals throughout the day. This increases the chance for bacteria to grow and cavities to develop.

The other school believes that people with diabetes know more about what to eat and the need to closely monitor their sugar intake. They don't eat many foods containing cavity-causing sugar.

The fact is that people whose diabetes is well-managed have no more tooth decay or periodontal disease than people without diabetes. Good oral hygiene and good blood sugar regulation are the best protections against cavity formation and periodontal disease.

People with diabetes lose their teeth more often and sooner than people without diabetes

Many factors play a role in the loss of teeth in people with diabetes. First, people with unmanaged diabetes are more prone to the development of gingivitis and periodontal disease. If the infection persists, it can spread to the underlying bone that anchors the teeth. Complicating this situation is the fact that infections don’t resolve as quickly in people with diabetes.

The good news for people with diabetes is that by practicing good oral hygiene habits — brushing at least twice daily (or preferably after every meal) with a toothpaste that contains fluoride, flossing daily and keeping blood sugar levels well managed — the potential for infection from periodontal disease will be greatly reduced or eliminated, and so will the risk of tooth loss.

If I need oral surgery, I am more at risk for post-surgical problems, including infections, because these are more common in people with diabetes

With close medical care and self-care that keeps blood sugar as close to normal as possible, and good personal and professional dental care, problems after surgery are no more likely in people with diabetes than in those without the disease.