Discussing Diabetes with your Dentist: Why it is Important
Jun 04, 2014 04:52PM
By Dr. Claire Stagg
It is commonly known that Diabetes is a disease that, if out of control, can harm the eyes, nerves, kidneys, heart and your white blood cells, a main defense against infection. Did you know diabetes can also cause problems in your mouth?
Managing your blood glucose levels is key to controlling and preventing mouth problems. Patients with poor blood glucose control get periodontal disease, a bacterial infection, more often and more severely than people whose diabetes is well controlled. If you have severe periodontal disease, you need to get treatment. Successful treatment also can help improve diabetic control. Any type of infection may cause blood sugar levels to rise. If the infection is treated successfully, your blood sugar may go down, and you may need less medicine to control your diabetes.
In addition to monitoring your blood glucose levels, the best defense against oral complications of diabetes is proper personal dental home-care. The daily regimen should include daily irrigation, flossing and brushing after each meal as well as regular dental check-ups.
People with diabetes are at risk for mouth infections, especially periodontal (gum) disease. Periodontal disease can damage the gum and bone that hold your teeth in place and may lead to painful chewing problems. Some people with serious gum disease lose their teeth. Periodontal disease may also make it hard to control your blood glucose (blood sugar). So it is best to visit your dentist often. The dentist will probe (measure the health of your gum tissues) regularly to determine how often you should have your dental maintenance visits. However, see your dentist right away if you have trouble chewing, bad breath, a bad taste in your mouth, bleeding or sore gums, red or swollen gums, or sore or loose teeth.
Another problem diabetes can cause is dry mouth. Dry mouth happens when you do not have enough saliva—the fluid that keeps your mouth wet. Saliva normally washes away sugars and bits of food that are fuel for decay-causing bacteria. As a result, a dry mouth will be more prone to cavities. There will also be a tendency for sores, ulcers, infections, and tooth decay. Smoking makes these problems worse.
Diabetes may also cause the glucose level in your saliva to increase. Together, these problems may lead to a fungal (yeast) infection called thrush or oral candidiasis, which causes painful white patches in your mouth. This condition is treated with antifungal medicine. Thrush can cause a burning sensation and/or a bad metallic taste in the mouth.
If you have uncontrolled diabetes, you may have problems healing quickly after oral surgery or other dental treatment. There are several reasons for the slow healing, including poor blood flow to the site. No matter how well your diabetes is controlled, it's important to keep your dentist informed about your condition. Your dentist should be a part of your health care team and should know about any changes in your condition, allergies, current medications including over-the-counter vitamins and supplements. Tell your dentist about any changes in the type and/or amount of insulin that you take. Also, be sure to tell your dentist about any reaction you have had to any medicine.
Your dentist may want to know the results of some of your blood tests (for example, hemoglobin A1C and fasting blood glucose). This information helps your dentist to better understand your diabetes control. In general, diabetics with a hemoglobin A1C level of less than 7% are considered to be well controlled. Levels above 8% indicate poor control.
People with poorly controlled diabetes have higher risks of infection and poor wound healing. Because diabetes can affect your blood counts, always give your dentist a copy of your most recent blood tests.
People with poorly controlled or uncontrolled diabetes may need to take antibiotics before and after dental treatment that might put them at risk of a bacterial infection. This is even more important for diabetics who also have heart or kidney problems.
If you've had low blood sugar (hypoglycemic) episodes in the past, tell your dentist how often they have occurred and how severe they have been. Low blood sugar can occur when your insulin level peaks. If you take insulin, make sure your dentist knows when you last took insulin and ate food.
Some medicines your dentist might use can interfere with some pills you may take for diabetes. This makes it even more important that your dentist know the medicines you are taking and their doses.
There is a lesser known fact brought to light by rapidly accumulating data from studies performed documenting the co-occurrence of obstructive sleep apnea (OSA) with glucose intolerance, insulin resistance, and type 2 diabetes mellitus. OSA is a significant risk factor for cardiovascular disease and mortality. Also, intermittent hypoxia and reduced sleep duration due to sleep fragmentation, as occur in OSA, have a noted adverse effect on glucose metabolism.
It is important therefore for the dentist to monitor their diabetic patients’ risk of OSA and conversely, to evaluate the presence of type 2 diabetes in their apneic patients.