Diabetes and Dental Disease

Diabetics who smoke face a significant risk for developing periodontal disease. Both insulin dependent and non-insulin dependent diabetics develop periodontal disease at the same rate, however, persons with long-term poor glycemic control and the presence of calculus (calcified plaque), have a higher incidence and more extensive periodontal disease. For that reason, people with diabetes must maintain good oral hygiene and have periodontal therapy as necessary. The good news is that this treatment is as effective on diabetics as with others.

What is periodontal disease? Simply, it is infection of the gum and bone that hold the teeth in pace. In advanced stages, it can lead to painful chewing and tooth loss.

What is the link between diabetes and periodontal disease? Surprise! There is a link between gum disease and glycemic control. In fact, people with good blood sugar control have no more periodontal disease than people who do not have diabetes. Children with IDDM also are at risk for gum problems. Tight control is the best protection. One factor in developing gum disease is the thickening of blood vessels which as we know is a complication of diabetes. Since blood vessels deliver oxygen and nourishment to body tissues and remove the waste from these tissues, when the blood is slowed so is this process. This can weaken the resistance of the gum and bone tissue to infection.

The second fact to understand is that many kinds of bacteria thrive on sugars, including glucose, the sugar linked to diabetes. When glycemic control is poor, germs can grow in the mouth and set the stage for gum disease.

How does periodontal disease develop? When we don't brush our teeth properly and floss, a sticky film of germs begins to build up on the teeth. The gums can become red and swollen and may begin to bleed when brushed or flossed. This is called gingivitis and is the first stage of periodontal disease. Gingivitis is easily reversed with brushing and flossing no less than twice a day (after every meal and/or snack is better). Not stopped, gingivitis will lead to more serious disease. This is the periodontal disease that we have been talking about. Plaque builds up and hardens under the gums and they in turn, pull away from the teeth, forming pockets of infection. This infection leads to the loss of bone that holds the tooth in its socket, then to tooth loss. There are often no warning signs of periodontis; pain, abscess, and loosening of the teeth do not occur until the disease is advanced. It can not be treated by regular brushing and flossing. You are, at this point, in the dental chair of a periodontist, a dentist who specializes in treating gum diseases.

Treatment depends on how much damage has been done. In the early stages, the dentist can deep clean the gums to remove hardened plaque and infected tissue under the gum. The dentist will smooth the damaged root surfaces of the teeth. This allows the gum to re-attach to the teeth. Antibiotics and mouthwash are often prescribed to control the infection.

Gum surgery is necessary when the disease has advanced to the point where the tissues that hold the tooth have been destroyed. The area is cleaned out under the gum and reshaped or replaced to support the tooth.

Serious periodontal disease can also cause changes in the shape of bone and gum tissue. The gum becomes uneven and dentures may not fit. This is a common complaint of diabetics.

Are there other dental problems for diabetics?

• Cavities: Young people with IDDM have no more tooth decay than do nondiabetic children. In fact, those who are careful about their diet and take care of their teeth and gums have fewer cavities.
• Thrush: This is an infection caused by a fungus that grows in the mouth. People with diabetes are at risk for developing this condition because the fungus thrives on glucose in the saliva. Smoking and wearing dentures can also lead to fungal infection. Medication is available to treat this condition, but good control, no smoking, and removing and cleaning dentures daily can help prevent it.
• Dry mouth: This is often a symptom of undetected diabetes. It can cause soreness, ulcers, infections, and tooth decay. The dryness means you don't have enough saliva which is a natural protective fluid. If not only washes away sticky foods that cause plaque, but helps control germ growth and other oral infections.

1. Learn how to brush and floss properly and then as the commercial says, "Just do it!"
2. You can check how well you are removing plaque by using "disclosing tablets" which stains where you have plaque on your teeth. This is a particularly good way to determine if children are brushing properly.
3. Have a dental checkup at least twice a year, more often if needed. Be sure to tell the dentist you have diabetes and your dental history. If you develop any of the symptoms described here, don't wait. Make an appointment. Have your doctor talk to the dentist about your over-all medical condition before you arrive.
4. Postpone non-emergency dental procedures if your blood glucose levels are not in control. This does not include abscesses and infections; as we have already stated, clearing these up can help control diabetes. In the meantime, strive to get your blood sugars under better control through diet, exercise, and medication as prescribed by your health care team.
5. If you have the complication of heat disease, be aware that the American Diabetes Association and the American Heart Association recommend that you take antibiotics before and just after each cleaning or dental work. Check with your diabetes doctor or your dentist for this prescription (my dentist hands anyone with heart disease a packet of the necessary medication at the end of each visit for the next time).
6. Control your diabetes. It sounds trite, but here is one more reason to do just that. All things considered wouldn't you rather be anywhere than in the periodontist's chair having gum surgery?