Many people know that diabetes adds to the risk of heart disease and heart attack, stroke, vision loss, infections, loss of sensation, gangrene and lower limb loss – amongst other things. Perhaps fewer people know about the implications for dental and oral health, which are as follows.
1) PERIODONTAL DISEASE (gum and jawbone disease)
This is the condition that, if unchecked, can cause loosening, drifting and loss of teeth, along with gum shrinkage, recession and sometimes painful infections. The gums are often swollen and bleed easily.
Periodontal disease is not caused by diabetes; its causes are bacterial plaque and calculus (calcified plaque) and the response of our immune system to bacterial components. Instead, diabetes that is not well controlled is a major risk factor, making periodontal disease itself not only more likely but the damage of disease more severe and often less responsive to treatment.
2) BACTERIAL TOOTH DECAY
A significant proportion of people with diabetes have reduced saliva flow. Reduced saliva flow is a major risk factor for bacterial tooth decay – the soft, invasive decay that chiefly affects areas where teeth touch, and root surfaces, where there is no hard tooth enamel covering. Gum recession from periodontal disease is itself a risk factor for bacterial tooth decay on root surfaces which would otherwise be sealed away from bacteria by gum, bone and connective tissue.
When glucose levels in the bloodstream are high, such as in inadequately controlled diabetes, there is a corresponding increase in glucose in the saliva. We know that glucose encourages bacterial plaque growth and is broken down by plaque organisms into lactic acid – the acid of bacterial cavities.
3) ORAL THRUSH
Thrush is an infection by Candida albicans, a fungus. Most people carry this organism harmlessly, but it is opportunistic, taking the chance to multiply in a harmful way when encouraged by certain conditions, one of which is diabetes.
As well as causing discharges in skin, nails, and female genitalia, the thrush fungus causes formation of a thick, grey scum on the tongue, which may bleed when scraped. Additionally, it may form scabby patches internally on the cheek and may cause a red, sore, thinning of the tissue of the roof of the mouth. Sometimes, with thinning and fragility of the tissue of the roof of the mouth, the tissue may over-grow, causing hygiene problems and difficulties with removable dentures. Until successfully treated, the infection can complicate, delay, or prevent oral surgical procedures such as dental implants to replace missing teeth.
4) IMPAIRED HEALING
Accidental or surgical wounds, including those resulting from oral surgery, often heal more slowly in diabetics and may be more likely to develop infection. This is understood to be due to reduced blood flow in small blood vessels and also because of deficient or altered function of the immune system. Our immune system plays a major role in tissue healing.
5) RESILIENCE TO DENTAL PROCEDURES
Some dental conditions and procedures may interfere with a patient’s usual eating schedule, and this can create difficulty in maintaining stable blood glucose levels. In addition, some procedures can be physiologically or emotionally stressful, and stress releases adrenal hormones which counteract the regulatory effect of insulin. Consequently, some dental procedures may be risky or even not offered to people with unstable diabetes. For procedures such as tooth extractions, dentists will often specify particular timing and liaise with the physicians of insulin-dependent diabetics.
With all of the oral health aspects of diabetes discussed here, their severity and prevalence is reduced when the diabetes is well controlled, with demonstrably stable blood glucose levels.
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