Oral Health and Diabetes

I am privileged to be making a special presentation next week to the diabetes support group at Moses Cone Medical Center here in Greensboro, and it occurred to me that since one-third of all the adults in the United States with diabetes go undiagnosed, this might be a topic that would interest all our readers.

There are many reasons why good oral health is particularly critical for patients with diabetes.  Research has shown that patients with periodontitis have a significantly higher prevalence of diabetes than those without. Some studies show that diabetics with severe periodontitis experience more diabetes-related complications and worse metabolic control than patients without periodontitis. These study results reinforce the profound mouth-body connection that becomes more evident as time goes by.

Dentist play a key role in improving oral health for all patients, but particularly in those with diabetes.

Since most people see their dentists more frequently than their physicians, we may be the first point of care for patients with diabetes and be the first to diagnose the disease by observing the changes in their oral health.  We can detect gingivitis, periodontitis, abscess formations, fruity or acetone breath, asymptomatic parotid gland enlargement, xerostomia and cervical caries during routine oral exam. Each of these has implications for a patient’s physical health.

There are several factors that can complicate oral care for patients with diabetes. Periodontal disease and diabetes are a shared inflammatory response and periodontal disease can make diabetes worse as infection anywhere in the body makes glucose control more difficult. People with diabetes have higher blood sugar. This decreases their output of saliva which leads to erosion, root caries, plaque buildup and periodontitis. Additionally, they experience prolonged healing time that can exacerbate infections and cause problems after oral surgery. Periodontal disease is also a significant cause of tooth loss.

Our preventive advice for patients with diabetes is extensive. We recommend that they brush their teeth with antimicrobial toothpaste with fluoride, and rinse with antimicrobial mouthwash at least two times a day. Good insulin control is important, as is following a nutritious diet and maintaining a healthy weight. Morning appointments are better for these patients because their blood glucose levels are more stable at this time of day.

In conclusion, if you or a family member have diabetes, please be sure to include your dentist in your diabetes management team. We play an important role in helping you stay healthy!