Diabetes and Dental
Health
National Diabetes Education Program
NEWS FLASH
Poorly Controlled Diabetes Can Lead
To Tooth Loss
Americans with poorly controlled
diabetes are at higher risk for severe periodontal disease, which can
lead to tooth loss.
Researchers from the Harvard School of Dental Medicine
and the University of Michigan School of Dentistry analyzed national
data on more than 4,300 adults ages 45 to 90 with type 2 diabetes. They
found that people with poorly controlled diabetes were nearly three
times more likely than those with better-controlled diabetes to have
severe periodontal disease.
Periodontal disease is an infection of the gums,
ligaments and bone surrounding the teeth. It can lead to bleeding gums,
receding gums and loose teeth. Teeth eventually may fall out or need to
be removed.
People with diabetes also can be at increased risk for
other oral problems — including gingivitis (the first stage of
periodontal disease), dry mouth, fungal infections and slow wound
healing — if they do not take steps to control their blood-sugar levels.
The study was published in the June issue of
Community Dentistry and Oral Epidemiology. By Nancy VolkersInteliHealth
News Service. June 2002
Gum disease may even be more important than obesity or
age as a factor in the onset of diabetes in adults, Adult-onset
diabetes, or Type 2 diabetes, accounts for 90 percent of the estimated
diabetes cases in the United States and is almost always caused by
lifestyle.
This study along with 2 others revealed results that blood sugar levels
could be reduced and kept at a lower level most effectively with a
single dose of oral antibiotic and repeated application of a topical
antibiotic to the gums.
"The study shows that in this group of severe diabetics we were able to
increase glucose control with repeated treatment of their periodontal
infection". This study underscores the importance of prevention and
early treatment of gum disease in people who are at risk of developing
diabetes. In a third study, the University of Buffalo researchers showed
that using antibiotics to treat gum disease decreases two markers of
inflammation throughout the body. The inflammatory markers area
associated with the development of arteriosclerosis and other chronic
diseases.
Sara Grossi, clinical assistant professor of oral
biology at the University of Buffalo in New York. March 2002
Most Adult Diabetics In United States Have
Hypertension
Nearly three-quarters of adult diabetics in the United States have
hypertension. Regardless of age, sex, race or ethnic origin, all may
benefit from efforts to prevent it.
Dry Mouth More Common in People with Diabetes
This study established a link between diabetes,
neuropathy and dry mouth. Diabetics according to this study report:
- More symptoms of
dry mouth and impaired salivary flow.
- Diabetics who
smoke and snack frequently had more symptoms of dry mouth.
- Those taking
mediations that tend to dry mouth had lower salivary flow.
- Those who were
not well controlled reported more dry mouth symptoms.
These observations could be due to a decreased
responsiveness of the nerves that stimulate the production of saliva.
Saliva washes the sugar out of the mouth after eating and when this
ability is decreased it can lead to:
- dry mouth
- tooth loss
- gingivitis
- periodontists
- abscesses
originating in a tooth
- soft tissue
lesions in the mouth and tongue.
Dental Product Report, Dr Trevor Orchard, NIH, pg
30, Dec 2001
November is National Diabetic Month
Diabetes Epidemic Surges
When you have diabetes, your chances of getting gum
disease increase.
There are more bacteria in your mouth right now than
there are people on Earth.
If those germs settle into your gums, you've got gum
disease. "Not me?" you say. Here are the facts:
- More than half
of all adults have at least the early stages of gum disease.
- About 90 percent
of adults have gum disease during their lives.
- If you have
diabetes, you are at higher risk for gum problems. People with
diabetes tend to have more gum disease and infections. Poor blood
sugar control makes gum problems more likely.
- Gum disease can
start at any age. Children and teenagers who have diabetes are at
greater risk than those who don't have diabetes. Just when you
thought the news was all bad, remember, there is a lot you can do to
fight gum disease:
- Learn how
gum problems start.
- Brush your
teeth twice a day.
- Floss you
teeth every day.
- Look for
early signs of gum disease.
- Visit your
dentist at least twice a year.
A Big Plaque Attack
When you have gum disease, germs work to destroy your
gums (gingiva) and the bone around your teeth. It starts with plaque.
Plaque is a sticky film of food, saliva, and germs. Plaque loves to
settle in at the gum line. There germs get busy making your gums red,
tender, and likely to bleed.
The goal of your daily tooth brushing and flossing is
to clean away plaque. When plaque stays put, it hardens into tartar.
Tartar builds up under the gum line. More plaque forms over the tartar.
Only your dentist can get tartar off your teeth.
If plaque and tartar are not cleaned away, even gentle
brushing can cause your gums to bleed. This is called gingivitis. It is
the first stage of gum disease. You can fight gingivitis with:
- daily good
brushing and flossing habits
- getting your
teeth cleaned at least twice a year at your dentist's office
If you ignore gingivitis, the gum disease gets worse.
The more severe form of gum disease is called
periodontitis. When you reach this stage, your gums begin to pull away
from your teeth. Pockets form between your teeth and gums. These fill
with germs and pus and deepen. When this happens, you may need gum
surgery to save your teeth. If nothing is done, the infection goes on to
destroy the bone around your teeth. The teeth may start to move or get
loose. Your teeth may fall out or need to be pulled.
Warning Signs
As if this is not enough, diabetes can make things
worse. Plaque is the main bad guy of gum disease. But diabetes can also
be a culprit. Diabetes may weaken your mouth's germ-fighting powers.
High blood sugar levels can help the gum disease get worse. At the same
time, gum disease can make diabetes harder to control.
Often gum disease is painless. You may not even know
you have it until you have some serious damage. Regular dentist visits
are your best weapon.
When you schedule your visit to the dentist, plan
to:
- Tell your
dentist you have diabetes. Also, share any problems with infections
or trouble keeping your blood sugar levels under control.
- Eat before you
go to see your dentist. The best time for dental work is when your
blood sugar level is in a normal range and your diabetes medicine
action is low. If you take insulin, a morning visit after a normal
breakfast is best.
- Take your usual
medicines before your dentist visit, unless your dentist or doctor
tells you to change your dose for dental surgery. Your dentist
should consult with your doctor to decide about adjustments in your
diabetes medicines or to decide if an antibiotic is needed before
surgery to prevent infection.
- Stick to your
normal meal plan after dental work. If you can't chew well, plan how
to get the calories you need. You may need to use your sick-day meal
plan that uses more soft or liquid foods.
- Wait to have
dental surgery until your blood sugar is in better shape, if your
diabetes is in poor control. If your dental needs are urgent (pain
or swelling), talk to your dentist and doctor about having dental
treatment in a hospital or special setting where you can be checked
on during and after surgery.
Diabetes also makes you prone to other mouth
problems.
Oral infections. An oral infection is a cluster of
germs causing problems in one area of your mouth. Here are some warning
signs:
- Swelling or pus
around your teeth or gums or any place in your mouth. Swelling can
be large or as small as a pimple.
- Pain in the
mouth or sinus area that doesn't go away.
- White or red
patches on your gums, tongue, cheeks, or the roof of your mouth.
- Pain when
chewing.
- Teeth that hurt
when you eat something cold, hot, or sweet or when you chew.
- Dark spots or
holes on your teeth.
Infections can make your blood sugar hard to control.
By planning ahead and discussing a plan of action with your dentist, you
will be prepared to handle needed adjustments.
Fungal infections. Having diabetes means you are more
prone to fungal infections such as thrush. If you tend to have high
blood sugar levels or take antibiotics often, you are even more likely
to have this problem. Thrush makes white (or sometimes red) patches in
areas of your mouth. These can get sore or turn into ulcers. If you
think you have a fungal infection, talk to your dentist.
Poor healing. If your diabetes is poorly controlled,
you heal more slowly and you increase your chance of infection after
dental surgery. To give yourself the best shot at healing well, keep
your blood sugar under control before, during, and after surgery.
Dry mouth. Some people with diabetes complain of dry
mouth. This may be caused by medicines you take. You may notice a dry
mouth if your blood sugar levels are high. A dry mouth can increase your
risk of cavities, because there's less saliva to wash away germs and
take care of the acids they create.
Keeping your teeth and mouth healthy requires a team
effort.
You're the most important person on this team to do
the day-to-day mouth care. Remember, good dental health can create a
healthy mouth and a smile that will last a lifetime.
Source: For more information on diabetes, visit American
Diabetes Association Book Store or follow the hyperlinks to these
related books : Complete Guide to Diabetes and The Uncomplicated Guide
to Diabetes ComplicationsAugust
The oral complications of diabetes involve the
teeth, periodontal tissues, oral soft tissues, salivary glands or
temporomandibular joints (TMJ).
Dental Caries can occur more often due to generalized
lack of self-care or secondary to sustained hypoglycemia with low
salivary flow and high salivary glucose levels.
Gum disease is know as the sixth clinical complication of DM which
includes loss of gingival attachment, abnormal pockets around teeth, and
gingivitis. Severity of periodontal disease appears to be related to
age, duration of the DM and glycemic control. Gum disease in patients
with DM is approximately 2.6 time normal. In both type 1 and type 2
DM, poor oral hygiene and poor control of DM appear to contribute to
periodontal disease.
Oral Soft Tissue Lesions in type 1 DM have increased incidence of
candidal and noncandidal lesions with candida albicans, glossitis,
denture stomatis and angular cheilitis.
Xerostomia is due to changes in the composition of the saliva,
salivary flow rates and an increase in salivary glucose levels in adults
with Diabetes. Poorly controlled patients have more impairment of
salivary flow than better controlled patients. Some diabetic
medications cause dry mouth like ACE inhibitors. Reduced salivary flow
associated with DM may be a clinical manifestation of neuropathy.
Oral Neuropathies is burning tongue syndrome or burning mouth syndrome
and can occur frequently in type 2 DM.
Once the diagnosis of DM is made, your goal is toward long term control
of blood glucose, which can reduce or delay these complications.
Managing Patients with Diabetes, Part 2, Dr. Jerome
Rothstein, Dentistry Today, July 2001 pgs 62-65.
May
Relationship of Insulin-dependent Diabetes and Oral
Soft Tissue Lesions
In a study that evaluated soft tissue lesions of Type
1 diabetes (early onset insulin-dependent diabetes) with non-diabetic
patients, it was found that 45% of the 405 patients with type 1 diabetes
had at least one lesion. Seven lesions were identified as appearing more
frequently in this group. Three of these lesions were non-candidal:
fissured tongue, irritation fibroma and traumatic ulcer. 15 % of this
group had Candidiasis. Thus the rate of soft tissue candidal lesions are
greater with Type 1 diabetes.
Dentistry Today April 2001 pg 44
Study finds periodontal disease, diabetes
connection
Bethesda, Md. — Study results from the Marquette
University School of Dentistry suggest chronic periodontal disease may
increase the risk of developing Type 2 diabetes.
The new research, presented at the
Periodontal-Systemic Connection Symposium currently underway here, ties
the incidence of diabetes in patients with periodontal disease to the
release of bacteria into the bloodstream that triggers a reaction from
the immune system
Immune system cells can release proteins called
cytokines that can disrupt production of insulin, the hormone that is
key to diabetes, the researchers said.
"In the pancreas, the cells responsible for insulin
production can be damaged or destroyed by high levels of cytokines,"
said Dr. Anthony Iacopino from the Marquette University School of
Dentistry. "Once this happens, it may induce Type 2 diabetes, even in
otherwise healthy individuals with no other risk factors for diabetes."
The research also points to high cholesterol, or
lipid, levels as a risk factor for people who are already diabetic
developing periodontal disease. "Low fat diets, lipid lowering drugs and
exercise are vitally important for diabetics who want to improve their
quality of life, as well as their oral health," Dr. Iacopino noted. ADA
Online News April 2001
For more information:
Periodontal Disease is Associated with the Development
of Glucose Intolerance J Dent Res 83(6): 485-490, 2004 The Severity of
Periodontal Disease is Associated with the Development of Glucose
Intolerance in Non-diabetics: The Hisayama Study
December 22, 2007.
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