Dear Dr. Mady:
I am a diabetic and I have had a lot of problems recently with my gums and teeth. My physician told me that I should see a dentist and should be going on a regular basis because of my diabetes. What has the dentist and my mouth got to do with diabetes and why is it important for me to get my mouth checked. Jeff in Essex
Dear Jeff,
I always say that it is important for everyone to visit the dentist on a regular basis, but for someone with diabetes, that cleaning and check-up are especially required. There is a strong link between diabetes and oral health and many people don’t even know this. Oral disease as it relates to diabetes should be given close attention, especially by someone like you.
Gum disease (periodontitis) is very common in individuals with diabetes. Periodontitis involves inflammation and destruction of the supporting structures of our teeth. These include the gums and bone surrounding our teeth. Plaque formation on teeth is the first step towards gum disease. If not removed by proper oral hygiene and professional cleanings, it will harden into tartar. Plaque and tartar make the gums vulnerable to infection which later can lead to tooth loss.
Blood Glucose levels are sometimes difficult to control for diabetics. Blood glucose control and good oral hygiene are the keys for a diabetic to avoid dental complications. Several reasons exist as to why diabetics are more susceptible to gum disease and oral infections. Diabetics have more sugar in the mouth which provides a more comfortable environment for bacteria.
Elevated and fluctuating blood glucose levels mean higher levels of bacteria and as a result, more possibility of complications. This also makes healing more difficult once infection has set in. It is analogous to infections on feet and extremities. Diabetics with uncontrolled or unstable blood sugar have problems with healing of wounds and infections, for example on their feet, and they will have the same trouble with infections in the mouth. These can become destructive and dangerous also.
Also, existing and chronic infections can make blood glucose control more difficult. Infection and inflammation, no matter where they are, will affect blood glucose. If you only visit your physician, the mouth will often get overlooked. This is why it is good that your doctor recommends you see a dentist.
There have even been cases where infections in the mouth affected insulin needs. Diabetics with oral infections often require more insulin. It has been found that after oral problems are under control, the need for increased insulin dropped. Diabetes can even attack the collagen which helps attach teeth to bones.
Patients with diabetes often experience decreased salivary flow and dry mouth syndrome, especially when they sleep. This lack of salivary flow causes bacteria to “stick” better on teeth and gums and promotes decay and gum disease. If you are experiencing this, ask your dentist to recommend an oral spray or something of the like to help moisten your mouth.
The best thing to do is to see your dentist and have a complete exam. Try and schedule the appointment between meals so that eating is not interrupted. Discuss the prescribing of an antibiotic if you require anything invasive and see what your dentist thinks. The bottom line is to take your medications, always monitor your blood glucose levels, see your physician and dentist regularly and practice good oral hygiene. The relationship between diabetes and oral health is much more important than you think!
Any questions for Dr. Mady can be e-mailed to drmady@drmady.com and also visit his blog at www.dentalden.com (dental education network)
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This column is reprinted with the permission of the author and The Windsor Star. “Ask the Dentist” is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to “Ask The Dentist”, c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5