Diabetes Forecast

The Healthy Living Magazine

Safeguarding Your Oral Health With Diabetes

What your mouth's saying about your diabetes

By Tracey Neithercott ,

If eyes are the window to the soul, then a smile offers a peek at the pancreas. Just as diabetes can affect your kidneys, feet, heart, and eyes, it plays a role in your oral health, too. Research in this area is young, but studies show that the disease affects the mouth by targeting the gums, increasing decay, and slowing healing.

Gum Disease

Probably the greatest impact diabetes has on the mouth is in upping the severity of periodontal disease. This serious gum infection can destroy the tissues and bones that keep the teeth in place and may result in tooth loss. Some signs include red, swollen, and/or bleeding gums, loose or sensitive teeth, and persistent bad breath. "There is very good evidence that diabetes is a risk factor for periodontal disease, both in extent and severity," says Ira Lamster, DDS, professor of dental medicine and dean emeritus of the College of Dental Medicine at Columbia University Medical Center.

Though gum disease is a direct result of bacteria, in the form of plaque buildup on teeth and especially below the gum line, there's no difference between the bacteria in your mouth and those in the mouth of someone without diabetes. Instead, Lamster says, gum disease is worse in people with diabetes because of a greater inflammatory response to the bacteria.

But the link between diabetes and gum disease isn't a one-way street. "If a person has moderately advanced to advanced periodontal disease and they have diabetes, their metabolic control will be worse," Lamster says. In fact, some research suggests early signs of gum disease may be an indicator of prediabetes and type 2 diabetes. A 2011 study in the Journal of Dental Research found that dentists could identify 73 percent of people with undiagnosed diabetes in part because of the presence of periodontal disease. That suggests routine cleanings could help screen for the disease.

The good news is that if you treat your gum disease, you may see improvements in your glucose control. Yet, according to the American Diabetes Association's 2012 Standards of Medical Care in Diabetes, the quality of studies on the topic is up for debate, so how much your A1C may improve is uncertain. Depending on the extent of the gum disease, a dentist may do a deep cleaning, prescribe medications, or perform surgery.

Tooth Decay

Dry mouth is a common problem for people with diabetes, and though it may be a result of aging or medications, Lamster says it could be a complication of the disease. The autonomic nervous system controls salivary gland function, so problems with creating saliva are a form of diabetic neuropathy. (Note that nerve damage doesn't cause any other problems in the mouth, not even tooth sensitivities or pain, which may be a result of gum disease, tooth decay, grinding teeth, tooth whitening, and so on.)

Lacking spit may not sound like a big deal, but the condition does more than make your throat dry and lips chapped. "Saliva is one of our body's defense systems," says Thomas Oates, DMD, PhD, assistant dean of clinical research and vice chair of the Department of Periodontics at the University of Texas Health Science Center at San Antonio Dental School. "It protects the gums from getting infected." Less saliva means less protection for the teeth against acid and plaque, which leads to tooth decay.

This is compounded if you eat often: "There's a lot of research that suggests frequency of eating can be a problem," Oates says, though he notes that there's no research directly linking diabetes to an increased risk of cavities. Eating glucose or candy to treat lows won't necessarily up your cavity count, but eating those foods often can. (If you're eating frequently to treat low blood glucose, however, talk to your doctor about ways to adjust your treatment and limit the number of lows.)

People with diabetes are more likely to have root decay, too. Receding gums, a problem that happens with age and gum disease, can expose a tooth's root and leave an opening for decay.

To stimulate the cleansing effects of saliva at times when you can't brush or rinse your mouth with water, try chewing sugar-free gum or candy. And take healthy-mouth steps to prevent decay. For starters, get rid of plaque by brushing twice a day with a fluoride toothpaste, floss daily, and get regular teeth cleanings (usually every six months), when a dental hygienist will scrape plaque from your teeth.

Slower Healing

It makes sense that if diabetes slows wound healing in foot ulcers, for instance, the same would be true for the mouth. But oral wounds typically don't face the same problems as elsewhere in the body because the mouth has lots of blood flow and possibly because saliva helps fight infection.

The same isn't true of healing from dental surgery. For the past six years, Oates has studied the effects of dental implants in people with diabetes and has found that they have delayed healing of the bone around the implant compared with people without diabetes.

Though the link between slow healing from dental surgery and diabetes is still being investigated, you can better your chances of a quick recovery by making sure your blood glucose is well controlled. In the end, you play a large role in preventing potential oral complications of diabetes, so take the time to keep your glucose in line and your mouth minty fresh.

Did You Know?

Acidic drinks such as soda, energy drinks, and water with lemon erode the surface of the tooth, called enamel, which can lead to decay. Instead of letting acid from drinks sit on your teeth, rinse your mouth with plain water.

Good to Know

Though uncontrolled diabetes can result in oral health problems, a single episode of high or low blood glucose won't harm your teeth.

How to Floss

  1. With floss between two teeth, curve the floss into a C shape so it's snug against one tooth.
  2. Rub floss up and down against the tooth and into the space between the tooth and gum.
  3. Repeat with the other tooth before moving on to the next gap between teeth.

Brushing Tip

Experts recommend brushing for at least two minutes, concentrating on each individual tooth, including the surrounding gum.

Q & A

Do I have to brush each time I treat a low with glucose?

Nope, but it's smart to rinse your mouth with water and/or chew sugar-free gum or candy. Doing so will stimulate the saliva that protects teeth.

Did You Know?

Acidic drinks such as soda, energy drinks, and water with lemon erode the surface of the tooth, called enamel, which can lead to decay. Instead of letting acid from drinks sit on your teeth, rinse your mouth with plain water.


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