Diabetes and oral health – are they in any way connected? Diabetes is an illness wherein the body is unable to produce any or enough insulin, resulting in high levels of glucose in the blood. We know that the condition can lead to complications, but how about oral health problems?
The Relationship between Diabetes and Oral Health
Medical studies show that there is a connection between diabetes and oral health. The reason behind this is not fully understood, but it is believed that it has something to do with the body’s immune system, neutrophil (a type of white blood cell) activity, and cytokine (proteins involved in immune responses) biology.
People affected by diabetes have metabolic problems and weaker immune systems. As a consequence, the body’s ability to fight off infections is impaired. Individuals with diabetes have three times greater risk of developing oral health problems compared to non-diabetics (especially periodontitis).
Gingivitis is the inflammation of the gums. Poor oral hygiene can lead to the buildup of plaque on the teeth and along the gumline. Dental plaque is a sticky film of sugars and bacteria found within the mouth. Left unchecked, it could lead to a more serious condition – periodontitis.
Periodontitis is one of the complications of diabetes. It is the inflammation and subsequent destruction of the surrounding structures supporting the teeth (gums, periodontal ligaments, and bone), which eventually leads to tooth loss.
Periodontitis is much more widespread than you think; around 10 to 15 percent of the adult population are affected. There is a two-way relationship between periodontitis and diabetes. Periodontitis has a negative effect on glycemic (blood sugar) control, and diabetes increases the likelihood of having periodontitis.
Diabetes is also associated with an increased risk for thrush, a kind of fungal infection. Also, a diabetic person is more likely to experience a dry mouth. This condition can lead to cavities, dental infections, and mouth ulcers.
The Effects of Gum Disease on Diabetes
Studies suggest that periodontitis can lead to poor control of blood sugar levels. Also, it was discovered that other complications of diabetes such as cardiovascular disease, kidney problems, and retinopathy are more prevalent in people with periodontitis.
Medical research also show that individuals with periodontitis have an increased risk of developing diabetes. It was observed that they have a significant increase in HbA1c (glycated hemoglobin, used to measure the average blood sugar level over a time period of weeks or months).
Gum disease can make a person more vulnerable to mouth infections. In periodontitis, pockets form below the gum line, allowing bacteria to enter. If you have high levels of glucose in the blood, it will create an ideal environment for bacteria to flourish.
Those who have poorly-controlled diabetes are more susceptible to developing oral health problems. High blood sugar levels make it easier for bacteria to flourish in the mouth. This, together with poor oral hygiene, can aggravate gingivitis and periodontitis.
Smoking is a bad habit that can lead to many health problems such as heart disease, lung cancer, and oral cancers. Toxic chemicals found in tobacco such as nicotine will worsen existing oral health problems. Smoking can lead to higher blood glucose levels, so it is better to stop lighting up now; it’s not good for you.
People who drink too much alcohol have a greater risk of acquiring diabetes. If you consume too much alcohol, you might develop pancreatitis (chronic inflammation of the pancreas), which can affect its ability to produce insulin. Alcohol also dries up the mouth, making it more prone to oral health problems.
Taking certain medications such as barbiturates, corticosteroids, and diuretics can raise your blood sugar levels. If you have diabetes, it is important to inform your doctor about all the medicines that you are taking. This is because certain drugs can cause an adverse reaction.
Warning Signs of Gum Disease
Gum problems like gingivitis and the more severe condition periodontitis may be due to poor oral hygiene. But, diabetes can aggravate these conditions as proven by medical research. It is important therefore to tell the dentist about your medical history and have regular visits for cleaning and dental checkups.
The following are the warning signs that you have gum problems:
• Red, swollen, or tender gums
• Bleeding when brushing your teeth or flossing
• Chronic halitosis (bad breath), even after brushing
• Loosening of the teeth
• Receding gums, which makes the teeth look longer in appearance
How to Prevent Diabetes Complications and Oral Health Problems
• The most important thing that you should remember is to keep your blood sugar levels under control. Follow the doctor’s directions with regards to the proper administration of your medicines.
• Keep your cholesterol level and blood pressure under control. Either one can cause cardiovascular diseases; if you have diabetes, the condition is much worse. It might lead to a heart attack or stroke.
• Manage stress levels. Chronic stress can cause your blood glucose to shoot up. Relaxation techniques and breathing exercises can help the body cope with stressful situations. Having a positive attitude and strong family support system will also go a long way.
• Pay attention to your oral health. Regular toothbrushing and flossing are necessary to prevent the buildup of dental plaque. Visit your dentist at least twice a year for oral prophylaxis (teeth cleaning/scaling).
• If you need to go through a dental procedure such as a tooth extraction, consult with your doctor first. Testing of your blood glucose level may need to be performed. There is a high risk of infection if your diabetes is not well-managed.
Treatment for Gum Disease
The kind of treatment that is needed will depend on the severity of the gum disease. It is best to consult a periodontist (a dentist specializing in the diagnosis and treatment of gum problems and supporting structures of the teeth). The following are the procedures undertaken to treat gingivitis and periodontitis:
• Scaling and root planning – Scaling is the removal of dental calculus (hardened plaque) from the tooth surface and the gum line. Root planning is the smoothening/cleaning of the tooth root surfaces.
• Medications – Antiseptic mouthwashes (containing the antimicrobial chlorhexidine) and oral antibiotics may be prescribed to treat gum disease and prevent infection, especially after going through scaling or root planning.
• Surgery – In some cases, surgery might be necessary if other procedures were not successful in treating periodontitis. A periodontist may suggest flap surgery to reduce the size of gum pockets. The gums will heal after the surgery. Alternatively, a bone/tissue graft may be recommended to restore lost bone and gum tissue.
There is a 2-way relationship between gum disease and diabetes. People with diabetes have a higher risk of developing periodontitis due to high blood sugar levels and weaker immune system. Gum problems can increase the levels of glucose in the blood, and it can be a contributing factor to the progression of diabetes.
Poor control over blood sugar, smoking, consuming too much alcohol, and taking certain drugs can increase the risk of developing oral health problems and diabetes. If you have inflamed or receding gums, these may be signs of gingivitis or periodontitis. You should visit a dentist every six months to prevent oral complications of diabetes.