Diabetes

Diabetes is a serious disease that causes altered levels of sugar in the blood.

Insulin is a hormone that is needed to convert sugar, starches and other food (blood sugars) into energy for the body. Diabetes can either be due to a deficiency in insulin production or the body’s inability to use insulin correctly. Some diabetics control their disease with insulin, most control it through diet and exercise. It is important for diabetics to regularly monitor their disease and to keep it under control. Uncontrolled diabetes can lead to infections and severe complications in general.

The most common dental problems associated with diabetes (especially uncontrolled diabetes) are:

  • Periodontal disease and/or recurrent periodontal abscesses
  • Reduced saliva flow and dry mouth
  • Burning sensation in the mouth or tongue
  • Increased sugars in the gingival fluid (between tooth and gum contributing to increased plaque and cavities)
  • Tooth decay
  • Fungal infection
  • Lichen planus and lichenoid reactions (inflammatory skin disease infection)
  • Delayed healing
  • Taste impairment.

Periodontal disease

Diabetes reduces the body’s resistance to infection in the mouth and causes gum bleeding, swollen gums, tenderness, pus, gums receding, gum abscesses (pus, swelling), bad breath, bad taste, loose or separating teeth. Tooth loss makes it difficult to chew and digest food and therefore impacts the ability to maintain proper nutrition and control of blood sugar levels.

In the case of periodontal disease, it’s a two-way street.

Diabetics are 3-4 times more likely to develop gum disease than non-diabetics (20 times more likely if they smoke). Periodontal diseases can be more severe in uncontrolled diabetics.

Untreated periodontal diseases can make it more difficult for uncontrolled diabetics to keep their diabetes under control. Periodontal infection disrupts glycemic control and can raise the blood sugar.

Diabetics are not only at risk for gum disease, gum disease also aggravates their diabetes. Periodontal treatment often results in a reduced need for insulin.

Salivary gland dysfunction (Xerostomia, Dry Mouth)

Dry mouth often occurs in people with diabetes. Dry mouth increases the risk of caries, gingivitis and fungal infection. Saliva helps to neutralize and remove the food, drink and bacteria on your teeth and soft tissues. A dry mouth can cause inflamed, painful soft tissues, tooth decay and periodontal disease.

Tooth decay

Teeth are covered with a sticky film of bacteria. When you eat or drink the bacteria use the sugar and release acids that attack the tooth and cause cavity. Uncontrolled diabetes can cause high glucose levels in saliva that may help bacteria cause repeated acid attacks.

An elevated sugar content in saliva improves the conditions for bacteria in the oral cavity. Thus, they can more easily form coatings, which means that the risk of getting caries increases.

Signs of caries can include be:

  • Whitish changes on the teeth
  • Crumbled, uneven tooth surface or a regular cavity in the tooth

Most cavities are not visible because they occur on tooth surfaces facing neighboring teeth or in relation to fillings. 

Oral Fungal Infections (Oral candidiasis, Thrush)

Bacteria, viruses and fungi are natural habitants of the mouth. Diabetics (high blood glucose levels and increased salivary glucose), smokers, denture wearers and dry mouth (lower salivary flow) have a higher risk of oral fungal infection. Thrush shows as white (sometimes red) patches that may be sore or with ulcers, located on soft tissues and tongue and causing a painful, burning sensation. This condition is treated by antifungal medication and good oral hygiene.

Lichen Planus, Lichenoid Reaction (Inflammatory Skin Disease)

The cause is unknown. Outbreaks are triggered by stress. It can vary from painless with a white lacy network to painful with ulcers. There is no permanent cure, but topical anesthetic or other medication may reduce and relieve the condition.

Infection and Delayed wound Healing

These are high risks for diabetics. If you are having oral surgery Dr. Hoffmeyer may prescribe antibiotics to minimize the risk of infection. Help yourself by keeping your blood glucose levels under control before, during and after surgery.

Taste Impairment

The taste for sweets may be diminished slightly. This may cause diabetics to eat more sweet food and therefore worsen general and dental health.

Dental Visit

You may need to schedule your dental appointment early in the morning, after you have eaten a normal breakfast, in order to stabilize and prevent a severe or sudden drop in your blood sugar levels. Be sure to let Dr. Hoffmeyer know of all your medications.

Oral Surgery

Diabetics can get infections with delayed healing. Talk to your physician in good time before the planned surgery. Ask if you need to adjust you meal schedule and the timing or dosage of insulin. Be sure your diabetes is under control by taking a test of your blood sugar. Dr. Hoffmeyer may prescribe antibiotics prior to surgery to minimize your risk of infection. Make sure you have received the prescription and bought the antibiotics prior to surgery.
 

Your first consult with Dr. Hoffmeyer – Please have your answers ready:

  •  Have you or has anyone in your family ever had diabetes
  •  Do you urinate more than six times a day?
  •  Are you thirsty much of the time?
  •  Do you feel numbness or tingling in nay part of your body?
  •  Does your mouth frequently become dry?
  •  Have you lost or gained more than 10 pounds / 5 kilos in the past year?
  •  Are you often fatigued?
  •  Women: Did you ever develop gestational diabetes while you were pregnant?
  •  When were you diagnosed with diabetes?
  •  What type of diabetes?
  •  What medications do you take? Write them down with name and what you take them for. 
  •  What over-the-counter products do you take?.
  •  Do you take insulin?
  •  Do you have a special diet?
  •  What is your baseline sugar level? How you measure it? How often do you measure it?
  •  When was your most recent HbA1c test taken and what was the result?
  •  What is the name, address, telephone of you diabetes care provider?

Keep in mind that diabetes that is controlled by a diet low in refined sugars and careful optimal oral hygiene will reduce your risk of both periodontal disease and cavities.

Periodontal disease can be monitored and controlled just like your diabetes. You should never let it be an uncontrolled factor that influences your diabetes.