Dental Care and Diabetes

Diabetes is a disease that can affect the whole body, including your mouth. People with diabetes face a higher than normal risk of oral health problems due to poorly controlled blood sugars. The less well controlled the blood sugar, the more likely oral health problems will arise. This is because uncontrolled diabetes impairs white blood cells, which are the body's main defense against bacterial infections that can occur in the mouth.

What dental problems are people with diabetes at higher risk for?

People with diabetes face a higher risk of:

Uncontrolled diabetes can decrease saliva flow, resulting in dry mouth. Dry mouth can further lead to soreness, ulcers, infections, and tooth decay.

Gum inflammation (gingivitis and periodontitis). Besides impairing white blood cells, another complication of diabetes is that it causes blood vessels to thicken, which slows the flow of nutrients to and waste products from body tissues, including the mouth. When this combination of events happens, the body's ability to fight infections is reduced. Since periodontal disease is a bacterial infection, diabetics with uncontrolled disease may experience more frequent and more severe gum disease.

People with uncontrolled diabetes do not heal quickly after oral surgery or other dental procedures because blood flow to the treatment site can be impaired.

People with diabetes who frequently take antibiotics to fight various infections are especially prone to developing a fungal infection of the mouth and tongue. The fungus thrives on the high glucose levels in the saliva of people with uncontrolled diabetes.

This condition is caused by the presence of thrush.

People with diabetes who smoke are at even a higher risk – up to 20 times more likely than nonsmokers -- for the development of thrush and periodontal disease. Smoking also seems to impair blood flow to the gums — which may affect wound healing in this tissue area.

Points to Consider

Since people with diabetes are more prone to conditions that may harm their oral health, it's essential to follow good oral hygiene practices and to pay special attention to any changes in your oral health and to seek a prompt dental consultation if such changes occur. Here are some points to consider.

Keep your blood sugar as close to normal as possible.

At each dental visit, tell your dentist about the status of your diabetes. For instance, he or she may want to know your glycosylated hemoglobin (HgA1C) level to determine how well controlled your diabetes is (good control is indicated by a level under 7%). If you've had a hypoglycemic episode in the past (low blood sugar, also called an insulin reaction), you are at increased risk to have another one. Tell your dentist when your last episode was, how frequently such episodes occur, and when you took your last dose of insulin (if you take insulin).

See your diabetes doctor before scheduling treatment for periodontal disease. Ask your doctor to talk to your dentist or periodontist about your overall medical condition before any dental treatment is performed. If oral surgery is planned, your doctor or dentist will tell you if you need to take any presurgical antibiotics or need to change your meal schedule or the timing and dosage of your insulin (if you take insulin).

Make sure to give your dentist your diabetes doctor's name and phone number to include on your personal file. This information will then be readily accessible by your dentist should any questions or concerns arise. Bring your dentist a list of all the names and dosages of all medications you are taking. Your dentist will need to know this information to prescribe medications least likely to interfere with the medications you are already taking if medications are needed. If a major infection is being treated, your insulin dose (for those taking insulin) may need to be adjusted. Check with your doctor.

Postpone nonemergency dental procedures if your blood sugar is not in good control. However, acute infections, such as abscesses, should be treated right away.

Keep in mind that healing may take longer in people with diabetes. Follow your dentist's post-treatment instructions closely.

People with diabetes with orthodontic appliances (such as braces) should contact their orthodontist immediately if a wire or bracket results in a cut to their tongue or mouth.

Diabetes Dental Tips

Diabetes can cause serious problems in your mouth

If you have diabetes, make sure you take care of your mouth. People with diabetes are at risk for mouth infections, especially periodontal (gum) disease. Periodontal disease can damage the gum and bone that hold your teeth in place and may lead to painful chewing problems. Some people with serious gum disease lose their teeth. Periodontal disease may also make it hard to control your blood glucose (blood sugar).

Other problems diabetes can cause are dry mouth and a fungal infection called thrush. Dry mouth happens when you do not have enough saliva—the fluid that keeps your mouth wet. Diabetes may also cause the glucose level in your saliva to increase. Together, these problems may lead to thrush, which causes painful white patches in your mouth.

You can keep your teeth and gums healthy. By controlling your blood glucose, brushing and flossing everyday, and visiting a dentist regularly, you can help prevent periodontal disease. If your diabetes is not under control, you are more likely to develop problems in your mouth.

If you have diabetes, follow these steps:

Control your blood glucose.

Brush and floss every day.

Visit your dentist regularly. Be sure to tell your dentist that you have diabetes.

Tell your dentist if your dentures (false teeth) do not fit right, or if your gums are sore.

Quit smoking. Smoking makes gum disease worse. Your physician or dentist can help you quit.

Call your dentist when you notice a problem.

Take time to check your mouth regularly for any problems. Sometimes people notice that their gums bleed when they brush and floss. Others notice dryness, soreness, white patches, or a bad taste in the mouth. All of these are reasons to visit your dentist.

Remember, good blood glucose control can help prevent mouth problems.