Diabetes can lead to multiple complications in the mouth. These complications can increase in severity when a patient has poor control of their blood glucose levels. Patients with complications of diabetes, particularly diabetic neuropathy, can be more likely to develop oral complications. This is because they have lowered resistance to infection and may not heal as easily.
The most commonly recognised oral complication related to diabetes is periodontitis (advanced gum disease)
Signs of advanced gum disease
These can include bleeding from gums, bad breath, sensitive teeth, loose teeth, recession of the gums (or longer looking teeth) and gaps developing between the teeth which may lead to food becoming stuck.
Other oral complications can include:
Dental caries (tooth decay)
A decrease in saliva production causing a dry mouth (xerostomia)
Oral thrush (fungal infection)
Delayed or poor healing of wounds in the mouth, such as mouth ulcers
Altered taste
Xerostomia:
When your blood glucose levels are high, you may have a dry mouth and more glucose in your saliva. This can lead to the build-up of plaque on your teeth—a sticky film consisting mostly of bacteria. The bacteria produce acids which can damage the surface of the tooth, leading to tooth decay and gum disease.
Fungal Infections:
Oral thrush (candidiasis) is a fungal infection. It is caused by an overgrowth of the yeast,
Candida albicans, occurs naturally in the mouth.
People with diabetes who frequently take antibiotics to fight various infections are especially prone to developing a fungal infection of the mouth and tongue. The fungus thrives on the high glucose levels in the saliva of people with uncontrolled diabetes. Wearing dentures (especially when they are worn constantly) can also lead to fungal infections.
Oral thrush causes white or red patches on the skin of the mouth, which can result in discomfort and ulcers. Good mouth hygiene and optimal blood glucose levels are critical to successfully treating oral thrush. Your dentist can treat this condition by prescribing antifungal medications.
Caring for your teeth and gums
If you are a person living with diabetes, and wish to prevent tooth and gum problems, it is advisable to:
Follow your doctor’s advice about diet and medication to keep your blood glucose levels as close to optimal levels as possible.
See your doctor before scheduling treatment for periodontal disease. Ask your doctor to talk to your dentist or periodontist about your overall health condition If oral surgery is planned, your doctor or dentist will tell you if you need to take any pre-surgical antibiotics, if you need to change your meal schedule or the timing and dosage of your insulin (if you take insulin).
Make sure to give your dentist your doctor’s name and phone number. This information will then be easily available to your dentist should any questions or concerns arise.
Thoroughly clean your teeth and gums twice a day with toothpaste that contains fluoride.
Use dental floss or interdental cleaners every day to clean between your teeth.
Visit your dentist regularly for advice about proper home care, early intervention and regular preventive maintenance visits to keep your teeth and gums healthy. Your dentist will want to know what your blood glucose levels are and what medications you are taking.
Bring your dentist a list of all the names and dosages of all medicines you are taking. Your dentist will need to know this information to prescribe medicines least likely to interfere with the medicines you are already taking. If a major infection is being treated, your insulin dose (for those taking insulin) might need to be adjusted.
Postpone non-emergency dental procedures if your blood sugar is not in good control. However, acute infections (infections that develop quickly), such as abscesses, should be treated right away.
Keep in mind that healing might take longer in people with diabetes. Follow your dentist’s post-treatment instructions closely.
Call your orthodontist immediately if a wire or bracket (such as those in braces) cuts your tongue or mouth.
Avoid having a dry mouth – drink plenty of water and chew sugar-free gum to stimulate saliva production.
Don’t smoke – speak to your doctor or call Quitline Tel. 13 7848 (13 QUIT) for guidance and support. People with diabetes who smoke are at an even higher risk — up to 20 times more likely than non-smokers to develop thrush and periodontal disease. Smoking also seems to impair blood flow to the gums, which might affect wound healing in this tissue area.
If you wear dentures, remove them and clean them daily.
Diabetes is a common disease among Australians, affecting almost 1.5 million people (around 7.6 per cent of the population).