|
Diabetic Dental Care
|
|
|
|
Diabetes has affected about 4.9 million Indians till date. If you have been diagnosed
with diabetes, you may know that the disease can cause problems with your eyes,
nerves, kidneys, heart and other parts of your body. Diabetes can lower your resistance
to infection and can slow the healing process.
|
|
How does diabetes affect oral health?
|
|
People with diabetes have narrower than normal blood vessels as they develop a thicker
lining as well as developing fatty deposits by a process called atherosclerosis.
As a result, the gums receive a decreased blood supply with less oxygen, fewer nutrients
and with less efficient removal of waste products.
|
|
People with diabetes are more prone to developing infections including gingivitis
and periodontitis. They have a defective immune system which makes them more susceptible
to disease. This means they develop more bleeding gums, pocketing, calculus (tartar)
and bone loss than people without the condition. Infections and wounds also take
longer to heal.
|
|
People with diabetes may suffer from decreased saliva flow, which in turn leads
to increased dental plaque buildup and calculus (tartar) deposits. This increases
the chances of developi ng periodontal disease.
|
|
Dose oral health affect diabetes?
|
|
Evidence suggests that periodontal disease may not only be a complication of diabetes
but it may also result in poor control of diabetes. A recent study analysing periodontal
disease and blood sugar levels showed that severe periodontitis was a risk for poor
blood sugar control.
|
|
What information do I need to give my dentist about my diabetes?
|
It’s important to keep your medical records up-to-date. Let your dentist know:
- if you have been diagnosed with diabetes;
- if the disease is under control;
- if there has been any other change in your medical history, and;
- the names of all prescription and over-the-counter drugs you are taking.
|
|
Top |
|
Diabetes and Gum Disease
|
|
Helping Patients with Diabetes Understand the 2-Way Relationship Between Diabetes
and Gum Disease
|
|
Most people think of gum disease, or periodontal disease, as in infection localized
to the oral cavity with tissue destruction confined to the mouth. However, mounting
research over the last 20 years provides evidence that pathways of inflammation
link oral infections, such as periodontal disease, to whole body damage. The strongest
evidence of a link relates to diabetes and periodontal disease. Periodontal disease
is often referred to as the sixth long-term complication of diabetes, but it often
goes unrecognized by physicians who treat diabetic patients. People with diabetes
are much more susceptible to periodontal disease and once periodontal disease is
established in a diabetic patient, metabolic control (glycemic control or blood
sugar levels) of diabetes is complicated from the constant reservoir of gram- negative
anaerobic bacteria that sit at the bottom of the gum pockets producing infection
and low grade inflammation throughout the body. That is why the relationship between
diabetes and periodontal disease is sometimes referred to as a two-way street, and
the reason why diagnosis and treatment of periodontal disease, just like optimal
glycemic control, are essential in the medical management of diabetes.
|
|
What does glycemic control have to do with periodontal disease?
|
|
Diabetic patients who have good control over blood sugar levels (good glycemic/metabolic
control) can prevent or delay the onset and slow the progression of the complications
associated with diabetes, particularly retinopathy, nephropathy, and neuropathy.
The same is true for delaying the onset or slowing the progression of periodontal
disease. However, for people with diabetes who have poor glycemic control (high
blood sugar levels), the risk of infection becomes much greater. For instance, it
is estimated that poorly controlled diabetic people are at a 2 to 4 times greater
risk for developing periodontal infection than non-diabetic people. That is why
it is important for diabetic patients to achieve and sustain the same level of glycemic
control as a healthy, non-diabetic individual. Good glycemic control, an HbA1c value
of less than 6% for most patients, significantly reduces the risk for the serious
complications of diabetes noted above. Another important aspect of this 2-way street
is the research that suggests chronic periodontal infection causes systemic inflammation
that enhances insulin resistance and hyperglycemia. Insulin resistance makes it
difficult for patients and their physicians to achieve and sustain optimal glycemic
control, and increases the risk for coronary heart disease.
|
 |
|
What happens if I have periodontal disease and it is not treated?
|
|
Most importantly, when a periodontal infection goes untreated in diabetic patients,
this puts them at greater risk for developing the long-term complications associated
with diabetes and cardiovascular disease. There is also research to suggest that
insulin-dependent diabetic individuals may be genetically predisposed to an exaggerated
inflammatory response to gram- negative bacterial infections like those found in
periodontal disease.
|
|
Currently there is no cure for diabetes or periodontal disease, but if you are a
motivated patient who complies with your dental and medical providers’recommendations,
these diseases can be controlled. Successful management of these diseases requires
frequent monitoring of and careful attention to your immune system’s response to
treatment, and monitoring of both glycemic control (blood sugar levels) and periodontal
status.
|
|
What kind of recommendations will my physician and dentist make to manage my diseases?
|
The following are recommendations often provided by healthcare providers to successfully
control diabetes and periodontal disease:
- Maintain excellent oral hygiene including thorough brushing with a toothpaste that
contains triclosan/copolymer at least twice a day, the use of dental floss daily,
and tongue brushing
- Undergo the treatment that your dentist or dental hygienist recommends for active
periodontal disease
- Take all medications prescribed by physicians and dentists as indicated
- Have regular periodontal maintenance visits that include periodontal evaluation
and re- treatment as needed
- Commit to smoking cessation if applicable
- Engage in adequate physical activity
- Reduce weight, if applicable
- Eat balanced meals with proper nutrition
|
|
This level of diabetes care is best facilitated by a team of healthcare providers
from both medicine and dentistry including physicians, nurses, diabetes educators,
dieticians, dentists, dental hygienists, and a number of other specialists..
|
|
Top |
|
Home Care
|
It is important to remember that people with diabetes need to be more motivated
and dedicated to care for their teeth and gums. Do not be discouraged when you don't
see immediate results. You only have one set of teeth for life so it is worth the
effort. Make them last!
- Monitor your blood glucose and see your doctor regularly for good diabetic control.
- Use a proven antibacterial fluoride toothpaste l to toughen teeth and prevent gum
disease.
- Use a small-headed, soft bristled toothbrush and brush your teeth and gums thoroughly
at least twice a day. Change your toothbrush regularly.
- Floss every day to remove the plaque from between teeth where your toothbrush can't
reach.
|
|
To maintain good oral hygiene, it is essential to remove dental plaque from your
teeth every day by brushing and flossing.
|
|
It is important to use a toothbrush that has a small head and soft bristles so that
plaque can be removed from all areas of the mouth without causing damage to teeth
and gums..
|
|
We also recommend the use of an antibacterial mouthrinse or gel to help keep teeth
plaque-free.
|
|
Visit your Dental Professional regularly
|
|
Regular dental visits can prevent minor problems from becoming major ones.we will
be able to detect any early signs of gum disease and remove calculus (tartar) build-up.
If you have any problem areas with your brushing or flossing ask us to assist you.
These problems can be discussed and in some cases additional cleaning aids such
as chlorhexidine mouth rinses or gels, interproximal brushes or special purpose
periodontal floss may be recommended. It is important not to wait until you have
any signs of periodontal disease before visiting you dental professional.)
|
|
Top |
|
FAQ
|
|
What oral health problems can be associated with diabetes?
|
The most common oral health problems associated with diabetes are:
- tooth decay;
- periodontal (gum) disease;
- salivary gland dysfunction;
- fungal infections;
- lichen planus and lichenoid reactions (inflammatory skin disease);
- infection and delayed healing;
- taste impairment.
|
|
What should I know about diet and tooth decay?
|
|
Your teeth are covered with plaque, a sticky film of bacteria. After you have a
meal, snack or beverage that contains sugars or starches, the bacteria release acids
derived from dietary sugars that attack tooth enamel. Repeated attacks can cause
the enamel to break down and may eventually result in cavities.
|
|
When diabetes is not controlled properly, high glucose levels in saliva may help
bacteria thrive. Brushing twice a day with fluoride toothpaste and cleaning once
a day between your teeth with floss or an interdental cleaner helps remove decay-causing
plaque.
|
|
Plaque that is not removed can eventually harden (calcify) into calculus, or tartar.
When tartar collects above the gumline, it becomes more difficult to thoroughly
brush and clean between teeth. This can create conditions that lead to chronic inflammation
and infection in the mouth.
|
|
What else can I do to help prevent oral health problems?
|
|
Preventive oral health care, including professional cleanings at the dental office,
is important if you are to control the progression of periodontal disease and other
oral health problems. Regular dental checkups and periodontal screenings are important
for evaluating overall dental health and for treating dental problems in their initial
stages. We may recommend more frequent evaluations and preventive procedures, such
as teeth cleaning, to maintain good oral health.
|
|
What should I do if my mouth frequently feels dry?
|
|
Saliva helps wash away food particles and keeps the mouth moist. Without adequate
saliva, bacteria continue to colonize. Xerostomia, or dry mouth, is a common complaint
among diabetic dental patients and patients undergoing radiation of the head and
neck for cancer therapy. Constant dryness irritates the soft tissues in the mouth,
often making them inflamed and painful. This condition greatly increases the risk
of tooth decay and periodontal diseases.
|
|
We may recommend a saliva substitute that can be used for relief from dry mouth
discomfort. We may also recommend rinsing with a fluoride mouthrinse or having a
topical application of fluoride at home and in the dental office to help prevent
rampant tooth decay. These products are sold over-the-counter at pharmacies.
|
|
Using sugarless gum, sugarless mints, taking frequent sips of water or using melting
ice chips may help alleviate a dry mouth. Restricting intake of caffeine and alcohol
also can help.
|
|
What other some other oral conditions that can be associated with diabetes?
|
|
Oral candidiasis, a fungal infection in the mouth, appears to occur more frequently
among persons with diabetes including those who wear dentures. Your dentist may
prescribe antifungal medications to treat this condition. Good oral hygiene is critical.
|
|
Lichen planus is a skin disorder that produces lesions in the mouth. A more severe
type of Lichen planus involves painful ulcers that erode surface tissue. Although
there is no permanent cure, your dentist may prescribe a topical anesthetic or other
medication to reduce and relieve the condition.
|
|
Some diabetics have reported that their taste for sweets is diminished, although
the taste impairment is usually not severe. Altered taste sensations, barely perceptible
to most diabetic patients, may influence their food choices in favor of sweet tasting
foods with highly refined carbohydrate content. This may worsen the diabetic patient’s
dental health and overall health.
|
|
What if I need oral surgery?
|
|
Infection is a risk for the diabetic patient and can make it more difficult to control
blood glucose levels. If you are having extensive oral surgery, your dentist may
prescribe antibiotics to minimize the risk of infection. To help the healing process,
keep your blood glucose levels under control before, during and after surgery.
|