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Diabetes and Dental Health

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Diabetes and Dental Health

As you are probably aware, diabetes is best managed with a team approach. Your team includes your diabetes medical providers (physicians, nurse practitioners, and physician assistants), diabetes care and education specialists, dietitians, exercise experts, nurses, pharmacists, mental health professionals and, most importantly, you! But did you know that your team should also include dental specialists? It is important to establish an ongoing relationship with a dental hygienist and dentist for your oral health care. Your dental hygienist will conduct a professional cleaning and provide instruction on routine home care and cleaning to maintain or reestablish oral health, while your dentist will perform an oral examination and diagnose conditions such as cavities, gum disease, and yeast and/or fungal infections. As part of your care, you should also receive an oral cancer screening during a dental visit.

In fact, taking care of your mouth and teeth is a big part of your diabetes health. It is very important to make every effort to ensure you keep up your daily oral hygiene practices and schedule regular visits with your dentist and dental hygienist for cleanings and oral health checkups.

Your dental toolkit 

A healthy mouth begins with proper maintenance. Always keep a toothbrush and toothpaste on hand. Brush your teeth at least twice a day, in the morning and evening, ideally after meals and snacks. Soft-bristled tooth brushes are best to clean the teeth and along the gum line. Hard or firm bristles can irritate your gums and cause them to recede (or pull away from the teeth) over time. Make sure your toothbrush is in good condition, with bristles that are not bent or frayed. Be certain to replace your toothbrush about every three months. Your toothbrush should be a comfortable size for your mouth. A toothbrush that is too big can make it hard to reach all tooth surfaces and limit your range of movement — the ability to move the toothbrush around — while brushing.

Whether to use a manual or an electric toothbrush is up to you. However, your dentist or dental hygienist might suggest an electric toothbrush if they see you are having trouble cleaning thoroughly with a manual brush. If you start to use an electric brush, you will likely be asked to bring it to one of your office visits so they can show you how to use it based on the design.

To use a manual brush, you should hold the toothbrush at an angle and brush your teeth with short circular strokes, being sure to cover all surfaces of the teeth, including the gum line. When using an electric brush, most of the movement is done for you, but you’ll still want to work with your dentist and hygienist to make sure you’re getting the best possible results. Remember, the goal of brushing is to remove food debris and the “sticky” plaque that can be easily missed along the gum line. Brushing all of your teeth should take about two minutes.

Flossing and cleaning between your teeth is especially important and is recommended as a daily practice. Your dentist or hygienist will help determine what type of floss or flossing device is best to clean these hard-to-reach areas. Flossing is a learned skill, and the selection of the best interdental cleaner should be recommended by the dentist or hygienist, with one-on-one instruction provided for how to use it. While dental floss is the best choice for many people, other tools, such as preloaded floss on a dental pick, interdental brushes, or Stimudents, might work better for you. These tools help break up and remove plaque and trapped food that the toothbrush can’t reach. Based on their recommendation, your dentist or hygienist can help you learn how to floss or show you how to use one of the other interdental cleaning tools to make it easier if you have arthritis or difficulty with moving your hands. You should practice good dental care on a daily basis and schedule a visit with your dentist and hygienist at least twice a year for a cleaning and oral health checkup.

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Diabetes and dental disease

People with diabetes are at higher risk for dental complications. These include gum disease, tooth loss, and dry mouth that could cause thrush or other infections. The American Dental Association says that one out of five cases of tooth loss is connected to diabetes, and that 22% of people with diabetes have gum disease. If you have diabetes and are a smoker, the risk for gum disease is 20 times higher.

Hyperglycemia and your mouth

Hyperglycemia (high blood glucose) can make dental problems much worse. When blood glucose levels are consistently high, the glucose in your saliva also increases, which provides “food” to the harmful bacteria in your mouth, helping it grow. In addition, consuming foods high in sugars and starches can make your saliva thick and add to the growth of bacteria, which increases the amount of plaque. Plaque is a soft, sticky film that can be found most commonly at the gum line. If plaque is not removed by proper brushing and flossing, it can turn into tartar, which is hard and can’t be removed with routine brushing and flossing. Tartar can only be removed by your dentist or dental hygienist. Plaque and tartar buildup that is not removed can lead to swollen, inflamed gums that become tender, red and bleed easily. This condition is called gingivitis, and 50% to 90% of people worldwide have it, but it is reversible.  

However, a condition called periodontitis is not reversible, and it can develop if your gingivitis is not treated. Periodontitis is a chronic gum disease that causes the gums to pull away from the teeth and form spaces or “pockets” around the teeth. These pockets collect food debris and bacteria and limit your ability to clean your teeth at home. Without proper cleaning, these pockets can become infected. As these infections spread between teeth and under the gum line, they can begin to damage the bone and gum tissues that support the teeth. This can lead to loose teeth, difficulty chewing, and eventual tooth loss. Periodontal disease is a risk associated with diabetes. Some studies have shown that screening for diabetes in dental offices has resulted in up to 30% of individuals being diagnosed with prediabetes or diabetes when referred back to their primary care provider.

Bleeding and inflamed gums can be a window into what is happening to the rest of the body. Bacteria from infected gums can move into the bloodstream with normal activities like eating, flossing, or brushing your teeth. Once these bacteria enter the bloodstream, they can start a chain reaction in the body’s defense system, which can trigger problems in the mouth and throughout the rest of the body. This increase in the defense system can have harmful effects and lead to more inflammation, which could cause blood glucose levels to climb even higher by making your body more resistant to insulin. In addition, the higher blood glucose can delay healing of wounds and infections, which can increase your risk for gum swelling and bleeding gums, increased pockets and bone damage, and certain infections. 

Hyperglycemia can also increase your risk for dry mouth and an oral fungal infection called thrush (also known as candidiasis). Hyperglycemia can cause dry mouth by decreasing the production of saliva, which is one of the body’s natural weapons to protect your oral health. Saliva washes away food debris and it also dilutes the harmful acids from food and bacteria.  Without enough saliva, bacteria and acids can build up and lead to tooth problems and gum disease. Thrush is caused when a fungus that normally occurs in the mouth begins to grow uncontrollably. Sore white or red patches can be found on the roof of the mouth, gums, tongue and cheeks, causing pain and discomfort, especially with eating and drinking. Medication can be prescribed by your dentist or diabetes care provider to treat thrush. Your toothbrush (as well as anything that touched your mouth during the outbreak) should be replaced. 

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Dental definitions

Gingivitis

Red, swollen, and bleeding gums caused by inflammation from plaque.

Periodontitis

Gum disease caused by infection in the gums, which can lead to irreversible damage to the teeth, bone, and tissues.

Plaque

Sticky film containing bacteria found along the gums.

Tartar

Hardened plaque that has not been removed.

Thrush

A naturally occurring fungus that grows uncontrollably, causing white patches in the mouth that may progress to open sores. Also known as candidiasis.

Xerostomia

Lack of saliva in the mouth, or “dry mouth,” which can lead to pain, cracked lips, and mouth sores.

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Tips to stay on track

You can do many things to limit your risk of dental problems. If you have diabetes and are concerned about your oral health, consider these tips to keep you on the right track:

  • Stay connected with your diabetes care provider and diabetes care and education specialist for optimal blood glucose control.
  • Keep your gums as healthy as possible at home by using good dental care practices.
  • Check your mouth often for any signs of red, swollen, or bleeding gums.
  • Be sure to visit your dentist at least twice a year and ask the hygienist to discuss the measures they take to check your gums for pockets and any signs of damage.
  • Plan for your visit! Contact the dental office ahead of your appointment to discuss your medications and how long the visit will take, so you can plan around meals.
  • Take your diabetes medicine and eat your meals on your regular schedule. If your medicine can cause hypoglycemia (low blood glucose), or if the visit will interfere with your meal time, plan to bring a snack or source of treatment to the office with you.
  • Have your blood glucose monitor on hand to check your levels before the dental visit and while you are there, if necessary.
  • Talk to your diabetes care provider and your dentist about the best way to prepare for your appointment. 
  • Finally, if you smoke, work with your diabetes care provider to make a plan to quit. Smoking increases your risk for gum disease, oral and throat cancers, and fungal infections in the mouth like thrush. Smoking also raises your risk for many other diabetes-related complications

Good news

Research shows that thorough, routine dental cleaning at home and regular dental checkups can ensure optimal oral health by reducing inflammation of the teeth and gums and actually improving blood glucose levels in people with type 2 diabetes. Treatment of severe gum disease in people with type 2 diabetes has been shown to lower A1C levels (a long-term measure of glucose control), with the benefit being about the same as you might experience if your diabetes care provider added another diabetes medication. Now that is something to smile about!

Want to learn more about keeping your mouth healthy with diabetes? Read “Diabetes and Dental Care,” “Four Ways to Improve Your Oral Health,” and “Practice Good Oral Health for Diabetes.”

Korinne Callihan, MSN, RN

Korinne Callihan, MSN, RN on social media

Callihan is the manager of the University of Kentucky patient and family education department. She is also a doctor of nursing practice student at the College of Nursing.

Dawn Dawson, RDH, CCRC

Dawn Dawson, RDH, CCRC on social media

Dawson is a registered dental hygienist and certified clinical research coordinator in the Delta Dental of Kentucky Clinical Research Center in the University of Kentucky College of Dentistry.

Laura Hieronymus, DNP, MSEd, RN, MLDE, BC-ADM, CDCES, FADCES

Laura Hieronymus, DNP, MSEd, RN, MLDE, BC-ADM, CDCES, FADCES

Laura Hieronymus, DNP, MSEd, RN, MLDE, BC-ADM, CDCES, FADCES on social media

A doctor of nursing practice, master licensed diabetes educator, and Practical Diabetology editor. Hieronymus is the associate director of education and quality services at the UK HealthCare Barnstable Brown Diabetes Center, University of Kentucky, Lexington, Kentucky.

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