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Caring for your teeth, gums, and mouth is a vital part of your health toolbox if you have diabetes
Most people with diabetes know how paramount it is to be vigilant about what they eat and drink and keep glucose levels within a healthy range. Most know about the importance of regular eye examinations (high sugar levels can lead to visual problems such as retinopathy) and being conscious of feet health (peripheral neuropathy can cause loss of sensation), among others.
However, the dental and mouth complications that can arise from diabetes, and the importance of maintaining oral health, are less known.
On October 3, 2022, the American Diabetes Association launched a collaborative Oral Health campaign with Pacific Dental Services, one of the country's leading dental support organizations, to increase awareness of the link between gum disease and diabetes.
"A holistic approach to health prevention and maintenance should incorporate care for our mouths as well as for the rest of our bodies."
In addition, the campaign seeks to promote consumer educational materials, including articles, daily health tips, and social media posts, on the American Diabetes Association's website.
"A holistic approach to health prevention and maintenance should incorporate care for our mouths as well as for the rest of our bodies," says Susan Renda, a nurse practitioner, certified diabetes care and education specialist, and faculty member at John Hopkins University School of Nursing in Baltimore, Maryland.
"If patients do not keep their glycemic levels under control, we begin to see increasing problems as they age or when they have been living with diabetes for a longer time," she explains.
There are numerous reasons why diabetes contributes to the possibility of poor oral health. There is a bi-directional link between oral health and diabetes. Periodontitis (a chronic inflammatory disease characterized by the destruction of the supporting structures of the teeth) can negatively influence metabolic control.
Conversely, early effective treatment of teeth or gum problems can help to improve glucose levels. If left untreated, gingivitis (inflamed gums) can lead to full-blown gums recession, loosening teeth, and the more severe type of periodontal disease.
"When glucose levels are elevated, the white blood cells that help fight infection have more difficulty reaching the sites on the periodontal tissues where bacteria congregate," says Renda. The overgrowth of bacteria triggers a reaction driven by substances produced by various inflammatory and structural cells called cytokines, which play a vital role in gum disease.
Along with tissues in the mouth becoming less elastic as we age, the teeth themselves become less sensitive. As a result, patients may not be aware that they are developing dental caries (cavities).
When glucose levels are elevated, the white blood cells that help fight infection have more difficulty reaching the sites on the periodontal tissues where bacteria congregate.
Moreover, some medications used to treat diabetes can cause dry mouth (xerostomia) due to decreased saliva production, which reduces the ability to wash away food particles.
Bacteria or oral fungi can lead to infections and the formation of abscesses. For example, Candida albicans infections, taste disorders, and pre-malignant oral lesions are more prevalent in people with diabetes mellitus.
In addition, a burning mouth and tongue can indicate the presence of oral thrush caused by the Candida fungus.
People with poor dentition (meaning excessive tooth loss or other problems) may have trouble biting into or chewing crunchy (read: healthy) foods like vegetables and fruits and may turn to high-carbohydrate, easy-to-eat foods like pasta, rice or potatoes. This is because the digestive system converts carbohydrates into sugar, entering the bloodstream and raising glucose levels.
Renda says one of the essential things for preventing periodontal disease is maintaining consistently good glycemic control. Using diabetes-related medications as directed can help prevent elevated glucose levels.
"Bacteria and funguses love when your blood sugar levels are high, which leads to large amounts of glucose showing up in your saliva. To them, it signifies, 'there's a cake and cookie party in your mouth, and we're invited!'" says Renda. She also emphasizes the importance of drinking plenty of fluids to stay hydrated.
Correspondingly, inform your dental professional that you have diabetes. Ask about special measures to ensure good oral health, including particular mouthwashes or toothpaste formulated to avoid a dry mouth.
Non-emergency dental surgery should be performed, if possible, when glucose levels are within the target range. High blood sugar increases the risk of infections after surgery and slows wound healing. If a significant dental infection is treated, insulin doses for those taking insulin might need to be adjusted. `
Self-care measures facilitate optimal oral health for everyone, whether they have diabetes, pre-diabetes, or normal glucose levels.
When it comes to dental implants, these are considered safe and reliable in patients with adequately controlled diabetes, according to the American Dental Association.
Yet, dentists should consider the patient's HgA1C status as part of risk assessment before deciding on an implant.
In patients with poorly controlled diabetes, implant placement may have an unpredictable response, with the possibility of inflammation around the implant site. Lastly, for denture wearers, it is essential to make sure they fit correctly since food particles could get trapped under them or they could cause gum irritation.
Jerry A. Brown, the first and currently only dentist who is also a Certified Diabetes Care and Education Specialist, has lived with diabetes for more than 45 years. His words of wisdom? "Be diligent about your daily oral health care regimen, and don't underestimate the importance of visiting your dental health care professional, at minimum, every six months."
"Treat gum disease when gingivitis is first discovered. More often than not, gingivitis is reversible with a dental cleaning, good oral hygiene, and thorough homecare."
Ultimately, self-care measures such as brushing your teeth twice a day, flossing daily, and limiting sweets can facilitate optimal oral health for everyone, whether they have diabetes, pre-diabetes, or normal glucose levels.
Also, getting enough sleep and physical activity, keeping stress levels at bay, eating a nutritious diet, avoiding smoking, taking prescribed medications, getting immunizations as recommended, and managing other chronic medical problems are all necessary measures that contribute to overall health and wellness, including oral health.
And that is something to smile about!
