Diabetes and Your Mouth

Dental Health and Diabetes

This fact sheet is designed to answer questions relating to diabetes mellitus and the effects it has in the mouth.

Diabetes Mellitus: is a disease. It’s when your body cannot handle the amount of sugar that you’re eating. It results in excess glucose in your bloodstream.
UNCONTROLLED diabetes can lead to many health problems.

Insulin: a chemical produced in your body that triggers glucose absorption by the cells in your body.

There are 3 main types of diabetes:

Type I Diabetes: The body does not produce enough insulin. Insulin supplements such as injections are required (3).

Type II Diabetes: Your body produces a regular amount of insulin BUT: the cells in your body do not respond to the insulin. This can be managed through a healthier lifestyle. Exercising regularly and eating more healthy foods increases your bodys response to insulin.

Pregnancy Diabetes: (aka Gestational Diabetes) Pregnant women can acquire diabetes for the duration of their pregnancy (1). This can lead to an exaggerated response to plaque bacteria leading to an exaggerated form of gingivitis (gum disease) and possibly even periodontitis (gum a more serious form of gum disease). Studies have shown that gum disease can harm the developing child so extra care should be taken to ensure proper oral hygiene to prevent this form happening.

Two Way Relationship

An individual with uncontrolled diabetes can more easily get gum disease (2,3,7,8).

An individual with gum disease will have more trouble controlling their diabetes.

A disease such as diabetes affects the entire body including the mouth. Here is some information in a question and answer format that may shed some light on how diabetes effects the teeth, gums, and breath.

Q: Are Diabetics More At Risk For Getting Cavities Than Non-Diabetics?

A: Not necessarily. If the condition is monitored and controlled, the diabetic is at no greater risk for getting cavities than a non-diabetic.

If the condition is not controlled, for example, if the diet is unhealthy: consisting highly of sugary and fatty foods. And the individual is not exercising regularly:

The diabetics' chance of having uncontrolled diabetes will increase. These individuals have a delayed healing response and more exaggerated gum disease compared to individuals with diabetes that is well controlled.

à this exaggerated gum disease can more easily lead to getting cavities

It is understood that diabetics sometimes eat smaller meals, requiring more meals per day. This means frequent doses of sugar (in various forms) throughout the day. A diabetic needs to ensure he/she brushes their teeth after every meal and flosses daily.

Dry Mouth: Some diabetics have noted their mouths feel dry (6). If this is the case, then the risk of cavities is definitely increased. Normally, saliva washes over the teeth collecting some (not all) sugar and is then swallowed. Without enough saliva in the mouth, sugar is allowed to remain on the teeth. This allows the sugar an opportunity to cause decay. These individuals should drink water with and after their meals and snacks to help clear the oral cavity of food.


Q: What Can Gum Disease Mean For A Diabetic?

A: Diabetics are known to have a decreased dental healing response. Gingivitis is an infection within the gums caused by bacteria found in plaque. An uncontrolled diabetic can have an exaggerated response to plaque bacterial causing more profound gingivitis which may more easily lead to periodontitis (a more serious form of gum disease involving loss of the bone surrounding the teeth which will eventually lead to tooth loss if untreated)

A diabetic’s body doesn’t respond as quickly to fight this type of infection as a non-diabetic. If the infection persists it can become worse leading to the infection of underlying bone that anchors the teeth in place. It has been shown that diabetics who keep their condition under control have a better chance of combating infections that those who are poorly controlled.

In addition to controlling the condition of diabetes, the importance of maintaining good oral health is essential. Brushing and flossing help to reduce plaque and bacteria that cause infection and thereby decreasing the risk of gum disease.


Q: Will A Diabetic Lose Their Teeth Sooner Than A Non-Diabetic?

A: Many factors contribute to the loss of teeth in someone who has diabetes. A poor healing response (such as in an uncontrolled diabetic) combined with gum disease and the destruction of bone (periodontitis) anchoring the teeth in place may result in teeth that become loose and eventually fall out. Maintaining good oral hygiene habits (brushing and flossing regularly) and visiting a dental practice regularly will benefit the individual greatly.

Removing plaque will reduce or eliminate infection. Ensuring the diabetes is controlled (taking insulin, altering diet) is also a way of decreasing the risk of tooth loss.

It should be noted that a diabetic may have excellent oral hygiene and still suffer from gum disease and bone loss. If this is the case, additional measures can be taken. A dental hygienist can recommend a special prescription mouthwash which kills various bacteria in the mouth that contribute to gum disease. Your dentist can write the prescription. Diabetics should be encouraged to ask their hygienist any questions they have regarding their oral health status.


Q: Many Diabetics Have Unpleasant "Fruity-Sweet" Smelling Breath. Is There Anything They Can Do About It?

A: Unfortunately, no. The "fruity-sweet" breath is caused by the disease itself as a result of the body’s natural defense against decreased glucose use. There are some methods of masking the odor, but they are only temporary and do NOT eliminate the problem. Some things that may help are:

• chewing gum (make sure it’s sugarless!!)
• using a mint flavored mouthwash
• brushing frequently

Q: How do I take care of my diabetes?

A:

• If required, remember to take your insulin regularly as prescribed by your doctor
• Stay away from sugary and deep-fried foods
• Eat healthier foods that don’t turn into sugar as readily in your body such as: whole grain bread, bannock, fresh vegetables, fruits, and fresh meats.
• Have regular dental appointments
• Visit your doctor regularly

While there are many other concerns that people with diabetes may have, these are the basics pertaining to the oral health. If you have any questions that have not been answered, or would like more detail, please don’t hesitate to ask your dental hygienist!

References:

1. Chapper A, Munch A, Schermann C, Piacentini CC, Fasolo MTM. Obesity and Periodontal Disease in Diabetic Pregnant Women. Braz Oral Res. 2005; 19(2):83-7.
2. Jansson H, Lindholm E, Lindh C, Groop L, Bratthall G. Type 2 Diabetes and Risk For Periodontal Disease: A Role For Dental Health Awareness. J Clin Periodontol. 2006; 33: 408-414.
3. Mealey BL, Oates TW. Diabetes Mellitus and Periodontal Diseases. J Periodontol. 2006; 77 (8): 1289-1303.
4. American Academy of Periodontology – Research, Science, and Therapy Committee. Treatment of Plaque-induced Gingivitis, Chronic Periodontitis, and Other Clinical Conditions. American Academy of Pediatric Dentistry Reference Manual. 2006; 27 (7): 202-11.
5. Ramseier CA. Potential Impact of Subject-based Risk Factor Control on Periodontitis. J Clin Periodontol. 2005; 32 (6): 283-290.
6. Ogunbodede OE, Fatusi OA, Akintomide A, Kolawole K, Ajayi A. Oral Health Status in a Population of Nigerian Diabetics. J Contemp Dent Pract. 2005; 6(4):75-8
7. Salvi GE, Kandylaki M, Troendle A, Persson GR, Lang NP. Experimental Gingivitis in Type 1 Diabetics: A Controlled Clinical and Microbiological Study. J Clin Periodontol. 2005; 32: 310-316.
8. Anil S, Al-Ghamdi HS. The Impact of Periodontal infections on Systemic Diseases: An update for medical practitioners. Saudi Med J. 2006; 27 (6): 767-73.