Diabetes Forecast

Mind Your Mouth: Oral Care With Diabetes

By Tracey Neithercott ,

Here’s something to smile about: Even though diabetes raises your risk for tooth and gum problems, most can be avoided with good oral care. But when was the last time you really thought about how to tend to teeth? (We’ll admit, our last lesson happened sometime around third grade.) Read on for basic tips on how to keep your mouth clean and healthy.

Brushing 101
Brushing teeth seems so simple: Add paste, insert brush, flick wrist. That’s the general idea, but there’s more to brushing than a simple back-and-forth. Brush your teeth at least twice a day, following the proper technique:

1. The goal of brushing is to dislodge plaque, which builds up at the gum line. “Remember, you’re not only brushing your teeth, but you’re brushing your gums, too,” says Leslie Seldin, DDS, a New York City dentist and spokesperson for the American Dental Association.

2. Your brush should meet the outer and inner surfaces of your teeth at a 45-degree angle. For the back side of the front teeth, hold your brush vertically and move it up and down. For the chewing surface of your teeth, hold the brush horizontally.

3. Move your brush in short strokes (about the length of a tooth), vibrating it back and forth across the tooth surface, gum line, and gums. “If you do big, circular strokes and big motions, you’re not going to be focused on the place [at the gum line] that matters,” Seldin says.

4. Brushing all your teeth and gum line should take about two minutes. (We promise, it’s not that long!)

If you’re low, reach for glucose tablets or gel. Chewy candies (think Starbursts) stick to the teeth and are more likely to cause plaque and decay.

Harder Isn’t Better
Stiff bristles and firm pressure won’t remove more plaque. In fact, brushing too hard can do more harm than good. Over time, hard bristles and too much pressure while brushing can damage the gums and the tooth’s protective enamel and can even cause the tooth to wear away. “If you go gently, you’re going to be just as effective as if you’re scrubbing hard,” says Seldin, who recommends that most people use a soft-bristle brush.

Brush Size Matters
Just as everyone’s mouth is a different size, so are toothbrush heads. The best one for you will fit comfortably in your mouth and allow you to easily reach all of your teeth. If you have a small mouth, a large toothbrush can make it hard to reach all tooth and gum surfaces.

Manual vs. Electric
The answer to the great toothbrush debate is really a matter of personal preference. That said, people with dexterity problems such as arthritis tend to brush more effectively with electric toothbrushes, which do part of the job simply by vibrating.

Flossing 101
When you floss, you’re trying to do two things: dislodge trapped foods and break up between-the-teeth plaque. A quick in-and-out job won’t cut it. Here’s how it’s done:

1. Gently slide floss between two teeth. (Go too hard and you could irritate or harm the gums.)

2. Slide the floss up and down the sides of the teeth in what Seldin refers to as a “shoe shine” manner.

3. Hug the floss to the base of the tooth, gently dipping below the gum line.

4. Use a back-and-forth motion as you remove the floss from between your teeth.

5. Pick a clean section of the floss and repeat for the rest of your teeth.

Bleeding gums? Pressing too hard with the floss may be to blame, but if gentle flossing still leads to blood, you may have gum disease or inflammation. If that’s the case, don’t stop flossing; because it removes bacteria at the gum line, flossing can improve gum disease. Yet, it’s important to talk to your dentist about any persistent oral bleeding, whether from flossing, brushing, or something else.

Tongue Tips
Your tongue accumulates bacteria in the same way your teeth do, so round out your oral-care routine by brushing your tongue. As with your teeth, there’s no need to scrub. A gentle brushing will remove bacteria. And it’s perfectly fine to use your toothbrush on your tongue, says Seldin. That said, plenty of tongue scrapers are available at most drugstores, and they work just as well as bristles in beating bacteria.

Did You Know?
Women who are pregnant or menstruating may notice a spike in gum sensitivity. The extra hormones might cause gums to bleed or, in the case of continually elevated hormones in pregnancy, raise a woman’s risk for gum disease.

The Right Rinse
You don’t have to use mouthwash—swishing with water after brushing is effective—but if you prefer the fresh taste or extra benefits, it’s smart to know what you’re getting. According to Seldin, there are two types of mouth rinses: Breath fresheners help your mouth feel, taste, and smell better, but that’s about it. Treatment rinses aim to fight decay with ingredients such as fluoride. Which is best for you? “This is not a decision you should be making alone,” says Seldin. Instead, discuss your home tooth care with your dentist.

Grinding Gone Bad
Talk about a hard habit to break: Many people aren’t even aware they grind or clench their teeth because it often happens during sleep. But it’s harmful all the same. “It’s damaging to the tooth,” says Seldin. “It can be damaging to the muscles of the jaw.” The result is worn-down, “flattened” teeth, major jaw aches, or both.

Though the exact cause of tooth grinding isn’t known, Seldin says most of the time it’s a direct result of stress. If you grind your teeth, look for ways to relieve stress—such as asking for help, getting regular exercise, taking a before-bed bath, or sipping tea. When the habit can’t be broken, dentists will create custom mouth guards to protect against grinding and clenching.

How to Beat Dry Mouth
There are a number of reasons people with diabetes are more likely to have dry mouth, says Foti Panagakos, DMD, PhD, a researcher with Colgate and expert in oral health for people with diabetes. Elevated blood glucose, which dehydrates the body, may be to blame. Other likely culprits: kidney complications and medications, many of which list dry mouth as a side effect (though it’s usually not an issue for blood glucose–lowering drugs).

In these cases, the mouth still has the ability to make saliva, so it’s a matter of stimulating production. Chewing sugar-free gum or sucking on sugar-free candy will do the trick. So will some over-the-counter gels that, when spread on the teeth, can alleviate some of the discomfort associated with dry mouth. If that doesn’t work, talk to your dentist. He or she might prescribe special dry mouth–fighting products. And if dry mouth is a problem for you, avoid alcohol-based rinses, which can be painful.

Diabetes Care Helps Your Teeth
According to Panagakos, here’s why blood glucose management is important to your oral health.

  • Because high blood sugar levels impair your ability to heal from oral infections, you’re more likely to develop gum disease than someone without diabetes.

  • Uncontrolled diabetes makes treating gum disease more difficult.

  • Gum disease progresses more than twice as fast in people with diabetes as in those without.

  • High blood glucose can cause dry mouth, a condition that’s usually uncomfortable and sometimes painful (“How to Beat Dry Mouth,” above).

  • Bacteria in the pockets between your teeth and gums—the most dangerous kind because they are hard to clean out—thrive on sugar. If you have elevated blood glucose, says Panagakos, “you’re actually feeding the bacteria.” They, in turn, produce acid, which erodes the tooth enamel and causes decay.


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