by Lisa M. Miller, RN, BSN
Did you know your oral health and your general health affect one another? In 2003, the U.S. Surgeon General released a study citing how the condition of the mouth is a direct reflection of the body’s condition. Approximately 75% of Americans are afflicted with gum disease. Amazingly, 90% of Americans who have a systematic disease like diabetes, kidney disease, or heart disease also have oral manifestations.
Oral problems associated with diabetes include tooth decay, periodontal (gum) disease, salivary gland dysfunction, fungal infections, lichen planus, and lichenoid reactions (inflammatory skin disease), infection and delayed healing, and taste impairment.
Because of the relationship between oral health and diabetes, you should notify your dentist if you have diabetes, if your diabetes is under control, if there has been any change in your medical history, as well as the names of all prescription and over-the-counter medications you are taking.
Diabetes relates to dental problems because high glucose levels in saliva help bacteria (germs) to thrive. In addition, if plaque is not removed, it can harden into calculus or tartar. When tartar is above the gum line, it becomes more difficult to thoroughly brush and clean between teeth, thus leading to chronic inflammation and infection in the mouth. Studies also suggest gum disease may be harder to manage and eliminate in diabetes patients.
Periodontal disease is an infection of the gum and bones that hold the teeth in place. Diabetes reduces the body’s resistance to infection, leaving the gums a susceptible target. Persons with inadequate blood sugar control are twice as likely to develop gum disease as diabetics with adequate control. Poor glucose control can also lead to more severe disease, causing more lost teeth.
See your dentist immediately if you have gums that bleed easily, red, swollen or tender gums, or gums that have pulled away from the teeth. Other problems that require immediate evaluation by a dentist are: pus between the teeth or when the gums are pressed, persistent bad breath or bad taste in the mouth, permanent teeth that are loose or separating, any change in the way your teeth fit together when you bite, or any change in the fit of partial dentures.
Fungal infections can be another sequel to diabetes. Oral candidiasis is a fungal infection in the mouth—and appears more frequently in people with diabetes. Oral candidiasis also increases if you smoke, have high blood glucose levels, or are taking antibiotics frequently. Thrush is an oral fungal infection that causes white patches in the mouth that may be sore and cause ulcers. (Editor’s Note: This fungus is also dangerous to the toenails.)
Dry mouth can cause diabetics to suffer as well, and is seen more often in poorly-controlled diabetics. Dry mouth can cause soreness, ulcers, infections, and cavities. Good blood glucose control may prevent or relieve dry mouth caused by diabetes.
So what can you do to prevent poor oral health? The key for diabetics is to brush twice a day with fluoride toothpaste or after each meal and snack. Use a soft toothbrush, turn the bristles against the gum line, and brush gently using small, circular motions. Brush the front, back, and top of each tooth. Clean once a day between teeth with floss or an interdental cleaner and have regular dental check-ups and periodontal screenings, at least every six months. It is best to choose oral care products that display the American Dental Association’s Seal of Acceptance.
Your dentist may suggest using an antimicrobial mouth rinse or toothpaste to control gingivitis. As with other complications of diabetes, it is essential to control your blood glucose levels and have a goal HbA1C of <7.0. Take all your medications as directed and follow your diabetic diet. Do not smoke. If you wear dentures, remove and clean them daily. Tell your dentist if your dentures do not fit right, or if your gums are sore. Watch closely for signs of oral disease, and see your dentist immediately if they occur. Last but not least, SMILE!