This week's visit to the dentist inspired me to talk about diabetes and dental complications. I have had my share of dental issues and during the closure of the dentist offices I had two teeth that needed repair. Thinking more seriously about this ongoing problem, I read many articles on the subject and sure enough, Diabetes and Gum Disease might be considered the 6th complication of diabetes (another term used is Periodontitis). The first five complications we know are cardiovascular(heart/stroke) disease, kidney disease, eye damage/blindness, nerve damage and circulation/amputations. If the diabetes is out of control this can increase your risk of dental problems and likewise if you have long standing dental issues your diabetes can get out of control (perhaps not eating nutritiously, terrible taste in mouth, dry mouth). The symbiotic relationship comes into play because if we correct or improve one disease we can also influence the other problem.
The effects of diabetes on the oral cavity is a well studied subject. Complications can include periodontal disease, salivary gland dysfunction, halitosis, burning mouth sensation and taste dysfunction. Research implies that the poorer the diabetes control the greater the risk of oral complications.
Gum Disease Risk Factors:
1. Plaque- plaque that is not removed by brushing your teeth hardens over time into tartar and collects above your gum line. Over time your gums become red and swollen and bleed easily leading to gingivitis (see below). High glucose levels increase plaque.
2. Age- older age increases the risk
3. Smoking/tobacco use
4. Genetics
5. Stress
6. Medications
7. Clenching or grinding your teeth
8. Other chronic diseases such as heart disease or arthritis
9. Poor nutrition and obesity
Gingivitis: usually occurs first and presents as swollen tissues and increased redness but no loss of connective tissue or loss of bone structure in the mouth.
Periodontitis: this is a result of unmanaged gingivitis. In this case, gums may have pulled away from the teeth forming pockets which can get infected. This infection can last a long time and the body responds to this infection by breaking down the bone and tissue that hold the teeth in place. If this continues, teeth may become loose and either fall out or a dental extraction is required. Sometimes you experience bad breath and no matter what you do it won’t disappear.
Salivary gland dysfunction: is another oral symptom of DM (Diabetes Mellitus). Another way to describe this would be the lack of saliva in the mouth. This could be related to symptoms of diabetes such as increased thirst and urination. The clinical term for this dry mouth is Xerostomia. It can increase the risk of tooth decay and gum disease and may lead to taste disturbances. Symptoms may include a dry feeling in your mouth often or all the time, dry tongue, pain in the mouth, cracked lips, mouth sores or infection and problems chewing, eating, swallowing or even talking. Certain classes of medication can cause a dry mouth so please ask your pharmacist if any of your medications can contribute to this dry mouth problem, especially if it has an acute onset.
Oral burning: may be connected to taste disturbances. This may occur if you have established nerve damage. Symptoms may worsen throughout the day.
Can we control/manage any of the risk factors listed above? Yes, we can. Many of them are modifiable risk factors such as:
1. Increase brushing and flossing and have regular dental appointments to decrease the presence and build-up of plaque.
2. At first signs of redness, swelling, or gums that bleed, call your dentist. Go gently brushing your teeth since bleeding will open the skin and increase the risk of infection, especially if your blood glucose is high. Yeast and fungal infections in the mouth can occur and if you improve your glycemic control you help to decrease the possibility of infections.
3. Stop smoking since it can make things worse. It will increase your risk of gum disease and mouth infections. It also discolors your teeth and gives you bad breath. Seek help to quit. You don’t have to do it alone. There are many successful programs today and it is now recognized as a serious health problem and that it isn’t easy to stop.
4. Are you under a lot of pressure at work/home? Is it causing stress? Do you have someone to talk to or are you able to participate in a counselling session? Many employers have programs available to help their staff and it is free of charge. We have seen through this COVID-19 pandemic how many internet sites or groups that are offering free services. You might be surprised how many other people with and without diabetes are having the same concerns as yourself. Listen and learn as you progress through the program.
5. Grinding your teeth may be hard for you alone to judge, but your dentist will be able to tell, so ask him/her. They can offer ideas to help you solve this problem.
6. Avoid medications that are causing the dry mouth. No doubt there are alternative medications for you to use. At this time of year if you have seasonal allergies, products called antihistamines (https://karenmaccurdy.wixsite.com/diabetes/post/itchy-eyes-stuffy-nose-seasonal-allergies-and-diabetes) might aggravate this symptom so be sure to choose one of the newer agents since this is less of a problem. Your pharmacist can help make this choice with you at any time
7. Try and eat a healthy and nutritious diet. As individuals with diabetes we may think we are doing good but no doubt we can all cut out a few food favorites that will help improve our glycemic control and lessen the risk of gum disease.
8. For dry mouth there are artificial saliva products designed to mimic natural saliva both chemically and physically. These agents do not stimulate the salivary glands to increase your own saliva production and are only to be considered a replacement, not a cure. These products can be used quite liberally but should be used after meals and at bedtime. Once again, your pharmacist can help with this decision.
Factors that we can’t change are age and genetics, but we can still take steps to help keep our mouth healthy such as:
· Improve glycemic control.
· Brush at least once or twice a day.
· Change your toothbrush every 3 months or sooner since a new toothbrush removes more plaque. This is something I have not been doing so I better change my habit.
· Be sure you are brushing correctly. Ask your dentist or hygienist or watch a video on line at:https://www.youtube.com/watch?v=leVF5RYj42Y
· Use dental floss to clean between the teeth at least once a day or watch this video to get you started: https://www.youtube.com/watch?v=noExCv6n2oc
· Seek professional help if your gums are consistently bleeding, red, swollen or you are having difficulty in tasting or swallowing food. Don’t delay in taking action if at all possible.
I realize dental care is expensive and coverage is often limited on various procedures. Check with a university that offers a dentistry program and ask if they accept patients to help reduce your cost, community colleges or other specialized learning institutions that may offer programs such as dental assistant/hygiene that you could at least get your teeth cleaned and have someone knowledgeable check your mouth for cavities and gum disease.
I looked at many websites to prepare for this discussion and I would suggest the same if you want to expand your knowledge on this topic. Check out the following at your convenience:
Hints on preparing for, during and after your dentist visit:
o Be sure you have eaten and taken your medication as usual. Check before your visit how long the procedure may take so you can plan ahead and avoid any unexpected reactions.
o Bring a source of glucose with you and be sure your dentist knows the warning signs of hypoglycemia. I always bring a juice box.
o Try to book appointments at the time when you are less likely to experience a hypoglycemia reaction. Most dentists would be very obliging.
o If your mouth is sore after the procedure, do you know what you can and cannot eat/drink? Ask your dentist this before starting the procedure.
o It is wise to increase the number of times you check your blood glucose for at least 24-48 hours. The stress of the procedure may cause a rise in glucose values or if you couldn’t eat for an extended period of time you might have to lower your insulin dose or miss one dose of an oral medication. Your dentist and pharmacist can help you make that decision.
o Have food available that is soft and easy to chew and swallow such as jello with or without sugar depending on your blood glucose value.
o Have a driver take you and pick you up. No matter what, make sure you are alert and check your blood glucose before driving.
Diabetes and Dental complications is a reality. Many of us may not have realized the Symbiotic Relationship between these two health states. Be sure your dentist knows you have diabetes and what responsibility each of you have to ensure you will have your teeth as long as is possible. Smile and show off those wonderful teeth and be proud of your hard work.
Thank you for taking the time to read today’s blog. I hope you have learned something as I know I did in preparing the blog. I will be changing my toothbrush this weekend for sure.
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References:
https://spectrum.diabetesjournals.org/content/24/4/199 accessed on May 5th,2020
https://www.perio.org/consumer/gum-disease-and-diabetes.htm accessed on June 3rd,2020
The Relationship Between Diabetes and Periodontal Disease by Debora C Matthews: Journal of Canadian Dental Association,March 2020,Vol 68, No.3
J Can Dent Assoc 2020;86:k8
Diabetes Spectrum Diabetes and Periodontal Disease: An Update for Health Care Providers by G.Rutger Persson, Volume 24, No 4,2011
I loved this picture and I got permission to use it from the Canadian Dental Association so please check it out:
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