Introduction

 

The International Diabetes Federation has estimated that at present there are about 285 million people affected by Diabetes and it is likely to increase to 435 million within 20 years. The number of diabetics increases by 7 million every year. According to IDF diabetes is the fourth leading cause of global death.

The International Journal of Diabetes in Developing Countries has said that India is the diabetic capital of the world and has the highest number of diabetic patients; this causes major health problem in this country. It says that there is alarming rise in diabetes and this has surpassed epidemic form to reach a pandemic one.

What is diabetes mellitus?

 

Diabetes mellitus is a condition in which there is insufficient production of insulin by the pancreas in your body or alternately the cells in the body do not respond to the insulin produced; both these factors result in non-absorption of blood sugar by the body cells.

This condition can be identified by symptoms such as frequent urination, excessive thirst, hunger and lethargy. Depending on the type of diabetes you might have to take either oral medications or insulin injections in addition to changing your diet.

How are diabetes and oral healthcare related?

 

The condition of diabetes affects the total body functions which includes your mouth. The blood sugar level in a diabetic will be high in the mouth that can cause oral health problems. The diabetes when uncontrolled impairs the white cells in your blood which is necessary for fighting bacterial infections that can occur in your mouth. In addition to impairing white blood cells, diabetes causes thickening of blood vessels in the mouth. This further reduces the ability of the body to fight infections.

What are the dental problems that can affect diabetics?

 

Diabetics are likely to suffer from the following dental problems if they do not control their sugar level.

  • Dry mouth – lack of control of sugar level will reduce the saliva flow thereby resulting in dry mouth. Dry mouth leads to infections, soreness, ulcers, and tooth decay.
  • Candidiasis or oral thrush – in order to fight various infections the diabetics often take antibiotics and this weakens their immune system thereby exposing themselves to secondary infections in their mouths and tongue and this is known as candidiasis or Oral Thrush. The fungus Candida albicans responsible for thrush outgrow at high glucose levels in the saliva that prevails normally in uncontrolled diabetics.
  • Delayed healing of oral tissues – the diabetics take longer time to heal if they undergo oral surgery or any other dental procedures; this is mainly because of the reduced blood flow to the area of treatments.
  • Cavities – many types of bacteria resides in your mouth. These bacteria interact with the starches and sugars in your diet and produce a sticky film called plaque and this film sticks your teeth. The acids in plaque attack the hard enamel in the outer surface of your teeth which might result in tooth decay / dental caries / cavities. The diabetics will have a high blood sugar level and this means that there will be excess supply of sugar which will accelerate tooth wear out.
  • Burning mouth and/or tongue – oral thrush results in Burning Mouth Syndrome.
  • Gingivitis – this occurs when you do not remove the plaque from your teeth by proper oral hygiene; the plaque will get hardened under your gum line thereby forming tartar or calculus. The plaque and tartar will cause irritation to your gingiva which is the part of your gum around the base of your teeth. As days progress you will find that your gums become swollen and bleed easily causing Gingivitis.
  • Periodontitis – If gingivitis is not treated on time the resultant infection destroys the soft tissue and bone supporting your teeth; this is called Periodontitis. The effect of periodontitis is that it pulls away your gums from your teeth that might make your teeth get loosened and fall. Periodontitis affects diabetics more because diabetes reduces your resistance to infection thereby causing slow healing.

What are the consequences of smoking by diabetics on dental health?

 

Diabetics who smoke are at a greater risk (20 times) for developing thrush and periodontal disease than non-smokers. In addition to this since smoking reduces the blood flow to your gums it increases the healing time of any wound in gum tissues area.

What precautions a diabetic should take to avoid dental problems?

 

The following precautions should be taken by diabetics to reduce the extent of dental problems.

  • First and foremost you must control your sugar level and keep it as near to normal as possible
  • In case your blood sugar level is not nearer to normal you should avoid dental care procedures that are not emergent. However, if the infections are serious it should be attended to straightaway.
  • Get your blood sugar level tested before you see a periodontist or dentist.
  • Get your glycosylated hemoglobin (HgA1C) level tested to find out how well your diabetes is under control. A level below 7% indicates that the control is satisfactory.
  • Low blood sugar or insulin reaction also increases the risk.
  • Before performing oral surgery the dentist will prescribe antibiotics to be taken. It is also possible that he asks you to change your meal timings and the insulin dosage.
  • Healing of wound takes longer in a diabetic and you must follow the doctor’s instructions without fail.
  • Give your dentist the list of medicines you are taking at present so that there is no interference that takes place between the medicines being prescribed by the dentist as well as the medicines you are taking at present.

What are the oral hygiene routines that a diabetic should follow??

 
  • Teeth and gums need to be checked and cleaned at least twice a year; however this depends on the advice given by your dentist or Periodontist.
  • Use dental floss once a day to prevent buildup of plaque.
  • Brush your teeth after every meal.
  • Clean your dentures thoroughly everyday.
  • Stop smoking.

Are diabetics at greater risk for getting dental cavities?

 

Diabetics have high glucose content in their saliva which helps in the thriving of bacteria thereby resulting in gum disease as well as cavities. The diabetic patient takes frequent meals during the day which again results in the growth of bacteria and cavities development.

On the other hand the diabetics are more knowledgeable about this condition and also diet that they have to eat to control their diabetes. This will reduce the sugar content in their saliva.

The probability of getting tooth decay and gum diseases for a person with controlled diabetes is more or less the same as a person without diabetes. Hence it is important that a diabetic follows good oral hygiene and control his glucose level to avoid gum diseases and cavities.

Are diabetics prone to gum disease and loss of teeth as compared to non-diabetics?

 

Uncontrolled diabetes results in gingivitis as well as periodontal diseases and this infection could spread to the underlying bone anchoring the teeth. Further these infections take a longer time to cure in diabetics.

However it is possible to prevent or reduce the occurrence of tooth loss by practicing good dental care and oral hygiene habits viz. brushing after every meal with a toothpaste containing fluoride, daily flossing and also keeping the blood glucose levels under control.