Diabetes and Dental Health: A Guide to Dental Care for Diabetes

Receiving a diabetes diagnosis usually requires certain lifestyle changes to accommodate the condition. One very important aspect of diabetes care is keeping your mouth healthy to prevent gum disease, tooth decay, and other issues that can lead to tooth loss or recurring infections.

Aside from general dental hygiene practices, managing your diabetes and keeping blood sugar levels under control should help you avoid oral health problems in the long run. Here’s how.

Diabetes mellitus is a metabolic disease, which means it can change the body’s functions and, in turn, affect the health of the teeth and gums. This happens because high blood glucose decreases the amount of saliva and sometimes changes its glucose content. It can also be due to the general state of inflammation that affects people with diabetes.

Since the biggest issues stem from high blood sugar, when a person living with diabetes keeps their blood glucose levels under control and goes on regular dental visits, their risk of developing dental or oral disease due to diabetes becomes close to normal.

Gingivitis or gum disease is a condition where the gums become slightly swollen, reddish, tender to the touch, and bleed on contact with hard foods or toothbrushes. It’s usually caused by the accumulation of food debris on and between the teeth. This leads to bacterial buildup around the teeth that your dentist would call plaque.

Plaque harbours harmful bacteria that release inflammatory byproducts after digesting the accumulated food. It can affect certain areas of the mouth, mostly those that don’t get regularly brushed or flossed, or the entire mouth. Severe gum disease can progress into periodontal disease.

Periodontitis is the inflammation of the structures surrounding the teeth, which include the gums, tooth ligaments, and the underlying bone. It’s usually caused by not treating gum disease in time, leading to the spread of bacteria to the deeper layers of the periodontium.

When plaque isn’t regularly removed by using a brush, fluoride toothpaste, and dental floss, it can harden due to the accumulation of calcium. These deposits are called calculus, and they usually stick to the teeth, especially on irregular surfaces, causing more food debris to get trapped between them.

As the periodontal tissue gets buried under the calculus, the gum line starts receding, exposing more of the tooth and weakening its anchorage to the jaw bones. If left untreated, it can lead to loose teeth and severe tooth loss.

The American Dental Association (ADA) calls the link between diabetes and periodontal diseases a “two-way street” since studies have shown a correlation between periodontitis and developing type 2 diabetes.

Insufficient production of saliva can lead to a condition called xerostomia, where the tissues of the mouth become drier and more irritated than usual.

People with diabetes can experience dry mouth due to several factors, which include:

• Dehydration: a symptom of diabetes is being more prone to dehydration, leading to less saliva production.
• Neuropathy: the nerve supply to salivary glands might be affected by diabetes.
• High blood glucose level: hyperglycemia can cause dry mouth and increased thirst.
• Diabetes medications: some oral medications for diabetes, like metformin, can cause dry mouth and a metallic aftertaste as a side effect.

Aside from the unpleasant sensation and occasional bad taste or breath caused by having a dry mouth, it can also increase the risk for the following conditions:

One of the main functions of saliva is to wash away excess food debris from around the teeth after eating. This is especially important for sweet or acidic foods, which undermine the outer layer of the tooth, the enamel, and expose the weaker inner layer, the dentin.

Saliva also contains natural protective molecules, called immunoglobulins. They attack the bacteria found in the plaque, preventing it from causing tooth decay. When the mouth is parched due to diabetes, oral bacteria find it an inviting breeding ground. Coupled with the higher concentration of glucose in the saliva if the diabetes is uncontrolled, this combination leads to a higher risk of dental cavities.

The oral cavity is home to many strains of bacteria and fungi. The body is usually capable of keeping them in check, unless something throws the balance and allows one strain to overmultiply, causing a fungal infection.

A common fungus called Candida albicans tends to thrive in the mouths of people with diabetes. It can cause a condition called candidiasis, also known as oral thrush, where the soft tissues of the mouth are covered in inflamed white or red patches or sores that bleed easily when scraped. People who have complete or partial dentures, especially those who don’t take them out and clean them daily, or those who sleep in them, are most vulnerable to oral thrush.

Oral surgery to remove a loose or decayed tooth is one of the most common dental procedures. However, having diabetes can increase the associated risk due to the complications that come with delayed wound healing.

High blood sugar causes the white blood cells to become weaker and less responsive. Moreover, the blood vessels thicken and become narrower (angiopathy), slowing the circulation to the dental surgery wound.

If the blood clot formed in the place of the extracted tooth is dislodged, it can lead to a dry socket infection. 

Failing to treat this kind of infection can cause severe complications that include abscesses, jaw bone infection (osteomyelitis), and in rare cases, tissue death (gangrene).

Scientific evidence suggests that the combination of dry mouth, oral candidiasis, and angiopathy can cause Burning Mouth syndrome (BMS) in people with diabetes. It’s a condition that causes the person to feel a tingling, burning, or scalding sensation for a few days without relief.

Treatment of BMS includes eliminating the underlying cause of the burning sensation and offering preventative measures to prevent its recurrence.

Keeping your teeth and gums healthy can help you avoid invasive dental or periodontal treatment and prevent complications that can occur during or after your dental visit. 

It can also help you fight infections that have already taken hold, minimizing their long-term effects on your mouth. Here are a few important tips to maintain your oral hygiene and prevent dental problems:

Toothbrushing mechanically removes the leftover food debris after every meal. This reduces the buildup of plaque and lowers the potential for tooth decay. It can also help you get rid of any unpleasant odors if you suffer from bad breath.

Use a brush with soft bristles to avoid scratching the surface of your teeth or gums, and fluoride toothpaste to keep the enamel layer strong. Try to brush in a gentle circular motion.

Flossing allows you to reach the areas between your teeth that are inaccessible to a toothbrush. You should aim to floss at least once daily right before bed to maintain healthy teeth and gums.

If it’s been a while since you last flossed, you can expect some minor bleeding that should subside after a while. Use a small amount of toothpaste rubbed on your teeth before you insert the floss, and you can also use a medicated mouthwash after you’re done to prevent infections.

Regular dental visits are a sure way to stay updated about the condition of your mouth and whether you need to change anything in your oral hygiene routine. Your dentist can also notice signs of any oral diabetes problems.

Unless otherwise specified, you should visit your dentist at least once every 6 months.

Glycosylated hemoglobin (HbA1c) is a measure of your blood sugar over the previous 3 months. Check your levels regularly to avoid sustained periods of high blood sugar, which can put you at higher risk of dental problems, among others.

Smoking has been proven to cause multiple oral issues that can culminate in oral cancer. It can also worsen pre-existing oral conditions, like dry mouth or Burning Mouth syndrome.

If you need help with cessation, here’s a link to the Centers for Disease Control and Prevention “Quit Smoking” resources.

Dentists, hygienists, and nurses have some special accommodations for people with diabetes seeking dental treatment. These include:

• Booking the appointment earlier in the day while cortisol levels are still high to help with blood glucose regulation and wound healing.
• Checking the blood sugar level of the client before beginning the treatment
• Staying alert to the person’s condition throughout the appointment
• Avoiding long treatment sessions, especially for elective procedures
• Keeping an easy source of glucose handy at all times, like glucose tablets, gel, or non-diet soda, in cases of an insulin reaction or hypoglycemia.

As for the person seeking the dental treatment, they should:

• Take their prescribed diabetes medication on time as usual.
• Eat a filling, nutritious meal a couple of hours before the appointment.
• Disclose their blood sugar reading to the dentist if it’s too high or too low before they begin the treatment.
• Give the dentist a detailed medical history of all the conditions they have besides diabetes, including hypertension, heart disease, and any blood clotting disorders.
• Contact the dentist immediately if they notice any changes in their oral condition.

There are many oral manifestations of diabetes. They range from a slightly higher risk of gingivitis and more tooth decay than usual to complications of gum surgery that can lead to bone infection. The severity depends on how well diabetes is managed, as well as keeping your dentist in the loop about any changes you notice in or around your teeth and gums.

Staying on top of oral hygiene requirements helps you keep your mouth healthy and free of any bacterial or fungal infections. It also might prevent any potential worsening of diabetes symptoms, since the relationship between diabetes and oral health goes both ways.