Diabetes can cause serious and often underestimated oral and dental problems. These problems, such as cavities, gingivitis and periodontitis, can in turn lead to mouth infections and even tooth loss.
We often think of cavities and periodontal disease as consequences of a sugar-rich diet and inadequate brushing and flossing. However, diabetes and other health factors can also have a negative impact on oral health.
Are people with diabetes more negligent?
Did you know that:
- Only a third of individuals with diabetes have their teeth cleaned and examined once a year
- 1 of 2 diabetes patients has periodontal disease
- People with diabetes are 3 times more likely to suffer from periodontal disease
- Only 50% of individuals living with diabetes acknowledge the importance of a proper dental follow-up.
Why is that?
Perhaps it is because of the already higher medical expenses that come with living with diabetes; it could also be explained by the fact that dental costs are not covered by universal health care.
Impact on blood sugar control
New studies are suggesting that the link between oral and dental problems and the development of diabetes is a two-way process. People with diabetes are more at risk of developing gum disease which increase the effects of diabetes by disrupting glycemic (blood sugar) levels.
Oral and dental problems
Problems brought on by diabetes can go undetected because they tend to be painless and symptomless. It does not mean that they should not be taken seriously. If left untreated, they will lead to more serious troubles. To avoid being stuck in that vicious circle, it is better to know what signs to look for and how to prevent them.
The most common problems are fungal infections (e.g., yeast infections), cavities, gingivitis, and periodontitis-caused bone deterioration.
Gingivitis happens when bacteria (plaque) builds up at the neck of the tooth and causes the gums around it to become inflamed. That most often translates into red, swollen gums that bleed easily when brushing and flossing.
A consequence of diabetes is the inflammation of blood vessels. That means there is a decrease in blood flow to the very small blood vessels in the gums which then do not get the nutrients needed to heal lesions.
The good news is that gingivitis can be completely reversed with proper brushing and flossing as well as with dental treatments, e.g., scaling (removal of plaque and tartar buildup) and root planing (smoothing of rough root surfaces).
Periodontitis is an inflammation of the gums that has spread to the bone and tissue surrounding the teeth. It is caused by an accumulation of plaque underneath the gums that grows into pockets of bacteria buildup. Thus, there is an increase in the space between the teeth and gums and a weakening of the tissue supporting the teeth. When the gums recede, teeth become looser and can even be uprooted completely.
The fact is that the collagen levels in the gums of people who suffer from diabetes tend to drop at a faster rate than normal, which leads to an increase in the damage sustained by the periodontal area. This matters because collagen is an essential protein found in the tissue that supports gums, teeth, tendons and bones.
The goal of periodontal treatment is to stop the irreversible process of bone and tissue loss. Regular procedures, e.g., scaling and root planing, then become necessary.
These treatments will reduce the number of pathogens found in the infected periodontal area and remove the buildup that triggers bacterial colonisation. Since bacteria causes more damage after 90 days, it is recommended that people with diabetes get a dental checkup and treatment every 3 months.
The increased risk of cavities in diabetics is a problem for many different reasons. It is the combination of bacteria, acids and food residue that destroys enamel and dentine and leads to cavities.
Side effects of medication and mouth dryness brought on by a metabolic imbalance can also cause cavities. According to studies, the mouths of diabetes sufferers tend to reveal an under-cleaned environment that contains too much sugar, then a precursor of plaque and fungi.
Dryness of the mouth
Xerostomia refers to the dry state of the mouth caused by a diminished salivary secretion. In diabetics, the increase of sugar in the saliva leads to a decrease in its production by the salivary glands.
Because saliva plays an active role in the cleaning process, having a dry mouth can cause a variety of problems, including the development of cavities. In addition, a lack of moisture means ulcers and fungal infections for the patient who will also have a harder time wearing dental prosthetics. One of the best ways to treat xerostomia and the accompanying burning sensation is to drink water frequently.
“Oral thrush” is a fungal (yeast) infection of the mouth that occurs in individuals who are immunocompromised, including those with diabetes. It is also common in people who have an iron deficiency or eat a carbohydrate-heavy diet.
Oral thrush consists of a layer of creamy white bumps that appear on the tongue’s surface and other mucous membranes of the mouth. These lesions can look like dairy residue sitting on top of a red and sometimes bleeding base. Oral candidosis can be treated with antifungal medication, such as nystatin, taken in the form of lozenges.
Tips for people living with diabetes
Individuals with diabetes have very specific dental needs. Open and honest communication with the dentist will ensure they can adapt their treatment to the disease.
- Let the dentist know about your diabetes and medication
- Bring your latest HbA1c (glycosylated hemoglobin) levels with you to your appointment
- Schedule short appointments, preferably in the morning
- Keep up your normal mealtime and insulin routine
- Treat any infection or abscess immediately
- Allow for a longer healing period after a dental treatment
- Make sure you maintain proper follow-up after an intervention
- Avoid surgery if you do not have your blood sugar levels under control
- Go to the dentist twice a year, even if you do not have any symptoms.
Even if they have no symptoms, people with diabetes need to pay close attention to their feet, teeth and gums. Dental problems can be due to an imbalance that will aggravate hyperglycaemia (high blood sugar).
It is therefore very important that you keep the dental assistant and the dentist updated with any changes to your health status. It is when they are properly informed that Drs. Martin Dubois and David Côté can best help you.