Diabetes affects approximately 26 million people in the United States and that number is growing rapidly due to the problem with overeating and obesity. The relationship between a person's oral health and his or her diabetes is of utmost concern to health care professionals but especially dentists.
Patients living with Diabetes have an elevated risk of oral health issues due to improperly controlled blood sugar levels. Diabetes impairs white blood cells, which are the body's main defense against bacterial infections. These bacterial infections can affect everything in the mouth as well as the rest of the body.
Diabetes is associated with a number of disorders of the mouth. The association between periodontal disease and diabetes has been studied at length with a definite link between the two.
The most common oral health issues facing Diabetic patients include:
*Increased Tooth Decay. There has been no study to effectively correlate this relationship. But anecdotal evidence leads me to believe this is a real problem for Diabetic patients without good control over their blood glucose levels. Patients who are type 2 diabetics(meaning that it is not genetically caused but caused by diet) tend to eat more carbohydrates and sugary foods enhancing the possibility of increased caries rate. Also some patients experience xerostomia, which is more commonly referred to as "dry" mouth. I usually recommend Biotene for patients.Biotene has the added benefit of containing a bio-active salivary enzyme protein system that actively combats bacteria, reducing bad breath, improving oral hygiene and relieving oral dryness. Some of the salivary dysfunction is caused by medications and age as well.
*Oral Mucosal Disease and other infections. Different types of oral disease are found, including lichen planus and recurrent aphthous stomatitis. People with diabetes that are often taking antibiotics to fight off infections are prone to developing Oral candidiasis(a fungal infection of the mouth and tongue). Oral candidiasis is found more frequently in patients with diabetes. Candidiasis occurs due to a patient being in a weakened immune state as well as a secondary response to the "dry" mouth mentioned above. This particular fungus thrives on the high levels of sugar in the saliva of people with uncontrolled diabetes. This fungus results in a burning sensation in areas of the mouth and sometimes a loss or change in taste.
*Periodontal Disease(gingivitis and periodontitis) have been shown to have a direct link to Diabetes. It has been noted that elevated levels of Periodontal disease also lead to complications in management of blood glucose levels. This disease tends to be more prevalent and more severe in diabetic patients than in the general population. This is mainly due to the fact that diabetics have decreased wound healing and infection fighting ability.
Diabetics who smoke are at a much higher risk of disease. Their risk factor can be as much as 20x more likely than non-smokers to develop thrush and periodontal disease. Smoking does seem to reduce blood flow to the gums and this can also affect healing in the tissue area.
Because people who suffer from diabetes can be more prone to symptoms that may harm their oral health, it's very important to follow dental home care instructions and to note any changes in your oral health. Promptly schedule a dental consultation if you notice any changes.
Dental Hygiene for Diabetics
We always recommend visiting the dentist and hygienist at least twice a year but it is doubly important in patients with diabetes. They need to strive to keep their mouths as bacteria free as they can. In conjunction with proper brushing we also recommend that patients floss after every meal if possible. A daily mouthwash can be beneficial as well.
By Marielaina Perrone DDS
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