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Diabetes and Oral Health

Introduction

Too much glucose (also called sugar) in your blood from diabetes can cause infection and other problems in your mouth. Your mouth includes your teeth, your gums, your jaw, tissues such as your tongue, the roof and floor of your mouth, and the inside of your cheeks.

Glucose is present in your saliva-he liquid in your mouth that makes it wet. When diabetes is not controlled, high glucose levels in your saliva help harmful germs, called plaque, grow. Plaque also comes from eating foods that contain sugars or starches. Some types of plaque cause tooth decay or cavities. Other types of plaque cause gum disease.

Gum disease can happen more often, be more severe, and take longer to heal if you have diabetes. In turn, having gum disease can make your blood glucose hard to control. Some studies show that treating your gum disease makes it easier to control your blood glucose

Categories of diabetes: Type I, which results from an absolute insulin deficiency; Type II, which is the result of insulin resistance and an insulin secretory defect (Ship, 2003).

Systemic Aspects of Diabetes

The onset of symptoms is rapid in type I diabetes, and includes the classic triad of polyphagia (increased appetite), polydipsia (increased thirst) and polyuria (increased urination), as well as weight loss, irritability, drowsiness and fatigue. Symptoms of type II diabetes develop more slowly, and frequently without the classic triad; rather, these patients may be obese and may have pruritis, peripheral neuropathy and blurred vision.

Oral Signs And Symptoms Of Diabetes

Dental Caries: Patients with diabetes are susceptible to oral sensory, periodontal and salivary disorders, which could increase their risk of developing new and recurrent dental caries. Several studies have reported a greater history of dental caries in people with diabetes (Moore, Weyant, & Mongeluzzo, 1999). Factors for caries development include Streptococcus mutans levels, previous caries experience, poor metabolic control of diabetes (Twetman, Johansson, Birkhead, & Nederfors, 2002), underscoring the need for dental professionals to follow up all patients with diabetes on a regular basis for new and recurrent dental decay.

Salivary Dysfunction: Dry mouth, or xerostomia, has been reported in people with diabetes mellitus (Guggenheimer, Moore, & Rossie, 2000a). Salivary flow may be affected by a variety of conditions, including by the degree of neuropathy and subjective feelings of mouth dryness that may accompany thirst.

Oral mucosal diseases: Diabetes is associated with a greater likelihood of developing certain mucosal disorders (Guggenheimer, Moore, & Rossie, 2000b). There are reports of greater prevalences of lichen planus (Petrou-Amerikanou, Markopoulos, Belazi, & Karamitsos, Papayanatou, 1998) and recurrent aphthous stomatitis (Lorini, Scaramuzza, & Vitali, 1996) as well as oral fungal infections.

Oral infections (candidiasis): Another manifestation of diabetes and an oral sign of systemic immunosuppression is the presence of opportunistic infections, such as oral candidiasis. Fungal infections of oral mucosal surfaces and removable prostheses are more commonly found in adults with diabetes. Candida pseudohyphae, a cardinal sign of oral Candida infection, have been associated significantly with cigarette smoking, use of dentures and poor glycaemic control in adults with diabetes (Guggenheimer, Moore, & Rossie, 2000b).

Taste disturbances: Taste is a critical component of oral health that is affected adversely in patients with diabetes (Settle, 1991).One study reported that more than one-third of adults with diabetes had diminished taste perception. This sensory dysfunction can inhibit the ability to maintain a proper diet and can lead to poor glycemic regulation (Ship, 2003).

Gingivitis and Periodontitis: Diabetes has been associated with incidence and progression of diabetes-related complications, including gingivitis, periodontitis and alveolar bone loss (Taylor, 1999). Poorly controlled diabetes, particularly in connection with tobacco use, is a risk factor for periodontal disease (Moore, Weyant, & Mongeluzzo, 1999). Periodontal infections also contribute to problems with glycaemic control (Taylor, Burt, Becker, Genco, & Schlossman, 1998). Treating chronic periodontal infections is essential for managing diabetes (Grossi, 2001)

Prevention Of Oral Complications By Patients

  • Follow your doctor’s advice about diet and medications to keep your blood glucose levels as close to normal as possible.
  • Thoroughly clean your teeth and gums with an appropriate toothbrush and fluoride- containing toothpaste.
  • Visit your dentist regularly- for advice about proper home care, early intervention and preventive maintenance visits to keep your teeth and gums healthy. Your dentist would
    want to know about your blood glucose levels and medications that you are taking.
  • Avoid having a dry mouth-drink plenty of water and chew sugar-free gum to stimulate saliva production.
  • If you smoke, quit smoking (Diabetes 2010)

Conclusion

Effective control of oral disease can be attained systemically through better glycemic control and locally through improved oral hygiene (Hallmon & Mealey, 1992). Therefore, diabetics must be educated about the importance of controlling blood sugar, removing oral plaque daily through meticulous oral hygiene, managing dry-mouth, ceasing tobacco use, managing diet, and obtaining regular professional dental cleaning and care (Rees, 2000).

Studies also show that improved oral health may facilitate better glycemic control in people with poorly controlled diabetes (Jones et al. 2007).

Support Group

Persatuan Diabetes Malaysia
(Tel:03-79574062)
Secretariat :
No.2, Lorong11/4E,
46200 Petaling Jaya
Selangor Darul Ehsan

References

  1. http://diabetes.niddk.nih.gov/dm/pubs/complications_teeth/index.aspx
  2. Diabetes and Oral Health (2010). Caring for your teeth and gums. Retrieved April 18, 2011,
  3. from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Diabetes_and_oral_health
  4. Grossi S., (2001). Treatment of periodontal disease and control of diabetes : an assessment of the  evidence and need for future research . Annals of  Periodontology;6(1):138-45.
  5. Guggenheimer, J., Moore P.A., &  Rossie, K. (2000a) Insulin-dependent diabetes mellitus and oral soft tissue pathologies part 1 : prevalence and characteristics of non-candidal lesions. Oral Surgery Oral Medicine Oral Pathology Oral Radiology Endodontology; 89 : 563-9.
  6. Guggenheimer, J., Moore, P.A., & Rossie K(2000b) Insulin-dependent diabetes mellitus and oral soft tissue pathologies part II : prevalence and characteristics of Candida and candidal lesions. Oral Surgery Oral Medicine Oral Pathology Oral Radiology Endodontology; 89 : 570-6.
  7. Hallmon, W.W., Mealey, B.L. (1992) Implications of diabetes mellitus and periodontal disease. Diabetes Educator Jul–Aug;18(4):310–5.
  8. Jones, J.A., Miller, D.R., Wehler, C.J., Rich, S.E., Krall-Kaye, E.A., McCoy, L.C. (2007). Does periodontal care improve glycemic control? The Department of Veterans Affairs Dental Diabetes Study. Journal of Clin Periodontology Jan;34(1):46–52.
  9. Little J.W., Falace D.A., Miller C.S., Rhodus N.L., (2002) Diabetes In: Little JW, ed. Dental management of the medically compromised patient. 6th ed. St. Louis: Mosby:248-70.
  10. Lorini, R. Scaramuzza, A., &  Vitali, L., (1996) Clinical aspects of coeliac disease in children with insuli-dependent diabetes mellitus . Journal of  Paediatric Endocrinology; 9 (supplement 1): 101-11.
  11. Moore, P.A., Weyant, R.J., Mongelluzzo, M.B., (1999). Type 1 diabetes mellitus and oral health: assessment of periodontal disease. Journal of Periodontology; 70:409-17.
  12. Petrou-Amerikanou, C, Markopoulos, A.K., Belazi, M., Karamitsos, D., Papanayotou, P. (1998). Prevalence of oral lichen planus in diabetes mellitus according to the type of diabetes. Oral Disease 1998; 4(1) ;37-40.
  13. Rees, T.D. (2000). Periodontal management of the patient with diabetes mellitus. Periodontology  Jun;23:63–72.
  14. Settle, R.G. (1991). The chemical senses in diabetes mellitus. New York : Raven Press:829-43.
  15. Ship, J.A.,(2003). Diabetes and Oral Health: An Overview. Journal of American Dental Association  Vol. 134, October:4S-10S
  16. Taylor G.W., Burt B.A., Becker M.P., Genco R.J., & Shlossman M (1998). Glycemic control and alveolar bone loss progression in type 2 diabetes. Annals of Periodontology; 3(1):30-9.
  17. Taylor, G.W.,(1999) Periodontal treatment and its effects on glycemic control: a review of the evidence.; Oral Surgery Oral Medicine Oral Pathology Oral Radiology Endodontology: 87: 311-6.
  18. Twetman, S., Johansson, I., Birkhead, D., Nederfors,T. (2002) Caries incidence in young type 1 diabetes mellitus patients in relation to metabolic control and caries-associated risk factors. Caries Research; 36(1):31-5.
Last Reviewed : 25 April 2014
Writer : Dr. Uma a/p Subramaniam
Accreditor : Dr. Chan Yoong Kian
Reviewer : Dr. Sharol Lail b. Sujak