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The Effects of Diabetes on Your TeethDiabetes and dental care -
Learn how to use knowledge, skills, and tools to build confidence and emotional strength to manage diabetes. Find ways to get support in person or online from family, friends, their community, and their health care team.
Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ. Periodontitis in US adults: National Health and Nutrition Examination Survey — J Am Dent Assoc. Periodontitis and glycemic control in diabetes: NHANES to J Periodontol.
Pre-diabetes and well-controlled diabetes are not associated with periodontal disease: the SHIP Trend Study. J Clin Periodontol. Association between periodontitis and mortality in stages chronic kidney disease: NHANES III and linked mortality study.
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Cancel Continue. Insulin is a peptide hormone that plays an important role in blood glucose regulation. It is secreted rapidly into the blood in response to changes in blood sugar. In diabetic patients, insulin-dependent cells are unable to use available blood glucose as an energy source.
To compensate, the body turns to its stored triglycerides as an alternative fuel source and ketoacidosis may result. As hyperglycemia proceeds, the body will attempt to get rid of excess blood glucose by excreting it in the urine. This explains why polyuria is a classic sign of DM. Increased fluid loss from excessive urination results in dehydration; therefore, polydipsia is another classic sign.
DM is also associated with an increased incidence of microvascular and macrovascular complications. Some possible long-term sequelae include neuropathy, nephropathy and chronic kidney disease and retinopathy with possible loss of vision.
Obesity, hypertension, dyslipidemia and atherosclerosis are common in diabetic patients and increase their risk of cardiac events. The fasting plasma glucose FPG test measures blood glucose level following a period of zero caloric intake for at least 8 h.
An FPG level of about 5. This test, which is reported as a percentage, is used by clinicians to assess control and management of DM. In a healthy, non-diabetic patient, an HbA1C level of 5. Information provided. Sources: Diabetes Canada Clinical Practice Guidelines Expert Committee et al.
At the core of every DM management or treatment plan is an attempt to restore blood glucose levels to as close to normal as possible. Notably, if blood glucose levels can be adequately managed and controlled, progression to complications can be delayed or even prevented.
Thorough patient education, compliance with medication, adherence to lifestyle changes i. Numerous randomized controlled trials have demonstrated beneficial metabolic effects of nutritional recommendations for diabetic patients.
In an attempt to override insulin resistance, physicians may incorporate exogenous insulin into the treatment plans of some T2DM patients as well. Effective duration, h. The major classes of oral hypoglycemic medications include biguanides, sulfonylureas, meglitinides, thiazolidinedione, dipeptidyl peptidase 4 inhibitors, sodium-glucose cotransporter inhibitors and α-glucosidase inhibitors.
Representative agents. The effects of DM on the oral cavity have been studied extensively. Complications, such as periodontal disease, salivary gland dysfunction, halitosis, burning mouth sensation and taste dysfunction, have been associated with DM in scientific literature.
Table 4 23 highlights the influence of glycemic control on the oral manifestations of T2DM. Numerous studies have identified a link between DM and periodontal disease.
Although the mechanisms are not entirely understood, increased periodontal tissue destruction in diabetic patients is thought to result from reduced polymorphonuclear leukocyte function that is secondary to the formation of advanced glycation end products and changes in collagen metabolism.
Although effective management of DM can lower susceptibility to periodontitis, evidence suggests that periodontal therapy can improve glycemic control as well. Salivary gland dysfunction is another widely reported oral manifestation of DM.
Several authors have reported that diabetic patients are susceptible to fungal and bacterial infections. This can be attributed to impaired host defense mechanisms associated with poor glycemic control. Further, oral soft tissue regeneration and osseous healing processes are compromised in a diabetic patient.
This is thought to result from delayed vascularization, reduced blood flow, decreased growth factor production, weakened innate immunity and psychological stress. Especially during invasive procedures, dentists should take extra precautions to avoid the need for profound wound-healing processes.
Before initiating treatment of a diabetic patient, dentists must appreciate important dental management considerations see Box 1. In doing so, dentists can help to minimize the risk of an intraoperative diabetic emergency and reduce the likelihood of an oral complication of the disease.
Box 1: Dental management considerations for the diabetic patient. Effective management of a diabetic patient begins with the dentist taking a thorough medical history and carrying out a review of systems.
Also, the dentist should review the current DM management plan, including doses and times of administration of all medications, as well as any lifestyle modifications, such as exercise or nutritional changes. Of note, a variety of medications that are taken for reasons other than DM may interact with and potentiate the effect of oral hypoglycemic agents.
Cortisol is an endogenous hormone that increases blood glucose levels. Because cortisol levels are typically higher in the morning and during times of stress e.
For patients receiving exogenous insulin therapy, appointment scheduling should avoid the time of peak insulin activity when the risk of hypoglycemia is highest. If these patients require surgery or invasive procedures, the dentist should consult their physician regarding possible adjustment of insulin doses.
At the beginning of each appointment, the dentist should make sure that the diabetic patient has eaten and taken their medications as usual. If not, the patient may be at risk of a hypoglycemic episode.
In some cases, the dentist may need to measure and record blood glucose level before initiating treatment. If blood glucose is low, the patient should consume a source of oral carbohydrates before treatment is initiated. If blood glucose is high, treatment should be postponed, and the dentist should refer the patient to their physician to re-asses glycemic control.
Electronic blood glucose monitors are relatively inexpensive and quite accurate. The most common intraoperative complication of DM is a hypoglycemic episode. Initial signs and symptoms of hypoglycemia include hunger, fatigue, sweating, nausea, shaking, irritability and tachycardia.
If the patient is unconscious or cannot swallow, the dentist should seek medical assistance. Emergency management. Because of the prolonged onset of symptoms, diabetic ketoacidosis and hyperosmolar hyperglycemic state are unlikely to present as acute emergencies in the dental office.
Following treatment, the dentist must remember that diabetic patients are prone to infections and delayed wound healing. This is especially true for a diabetic patient whose condition is uncontrolled. Therefore, depending on the dental procedure, some consideration should be given to providing antibiotic coverage.
Notably, salicylates are known to potentiate the effect of oral hypoglycemic agents by increasing insulin secretion and sensitivity. Recent estimates suggest that million people are living with DM worldwide.
Given the numerous possible oral manifestations of DM and the risk of an intraoperative diabetic emergency, it is important for dentists to recognize and appreciate the impact of the disorder on dental care. Gum disease is a very common disease.
But when you have diabetes, your risk is higher. Controlling gum disease can help you control your blood sugar levels. People with type 1 diabetes are also more at risk. Tooth decay You are also at greater risk of developing another very common disease, tooth decay, also known as caries.
Types of common dental problems Mouth problems linked to your diabetes can mean: infection in the soft tissue and bone that support the teeth periodontitis and more gum recession tooth decay gum inflammation gingivitis dry mouth xerostomia that increases your risk of tooth decay fungal infections oral thrush irritated and sore mouth, meaning you might have difficulty wearing dentures tooth loss abscesses The early signs of mouth problems are things like bleeding gums, loosening teeth and bad breath.
Check your blood sugars — regularly check them and try to keep them in your target range. Brush twice a day — If you have gum recession, use interspace brushes rather than floss to clean between your teeth.
Ask for your Basic Peridontal Examination scores and what they mean to help you to monitor your own gum health. Choose the right food and drink — follow a healthy, balanced diet which is low in sugar.
And once you have gum disease, smoking makes it harder for your gums to heal. Get help with giving up smoking. Keep your dentures clean. Do not wear them when you are asleep.
Thank you Dentak visiting nature. You anr using a browser version with limited Diabetes and dental care Diabeyes CSS. Cwre obtain the best experience, we Website performance improvement you use a more up to date browser or turn off compatibility mode in Internet Explorer. In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. Dental professionals can have a profound impact on patients with diabetes by communicating the need for excellent oral hygiene, says Dawn Woodward. Diabetes affects many parts of your body, dentap your Antioxidant-Rich Vegetables. People with diabetes are wnd likely denta, have gum CaeDiwbetes, and other problems with their teeth Body fat percentage scale gums. Taking good Dextrose Endurance Support of your teeth and gums, including getting regular cleanings and needed treatments, will help you prevent these problems or stop them from getting worse. Keeping your mouth healthy will also make it easier for you to manage your diabetes and prevent diabetes-related health problems, such as heart disease and kidney disease. Diabetes can affect your mouth by changing your saliva —the fluid that keeps your mouth wet.
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