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Diabetes and Oral Health

Periodontal disease is the most common oral disease affecting individuals with diabetes. Encouraging diabetic patients to seek regular treatment with a dentist can help in improving their HBA1c levels and reduce oral complications.

What are the oral signs of untreated or uncontrolled diabetes?

The main oral complication of patients with persistent poor glycemic control is periodontal disease. Because of the impaired immunity and healing related to diabetes, the progression of periodontal disease may be more rapid and with increased severity. Patients may complain of bleeding or swollen gums, loose teeth, halitosis, and/or changes in the way their bite feels.

There is a tendency for salivary flow to decrease with increased HBA1c levels and therefore patients may suffer from xerostomia. Xerostomia can cause secondary pathology, such as oral candidiasis, dental caries, disturbances in taste and changes in the oral mucosa.

While the relationship is not clear, many individuals with diabetes also have burning mouth syndrome. Patients may describe a tingling, burning, or scalding sensation that usually affects the tongue, but can also include lips, gums, throat or the whole mouth.

What is periodontal disease?

Periodontal disease is an infection that affects the gingiva and the bone that supports the teeth. The bacteria in the mouth that form plaque and calculus causes inflammation in the gingiva. During the gingivitis stage, the gums will be irritated and may bleed easily. At this point no irreversible tissue damage has occurred.

If gingivitis is left untreated, the disease can progress to periodontitis where the bacteria by products can cause attachment loss and resorption of bone surrounding the teeth occurs. Once bone is lost it does not reform. In severe cases, the loss of support can result in tooth mobility and acute infections of individual teeth.

What is the relationship between diabetes and periodontal disease?

Research suggests that the relationship between diabetes and periodontal disease goes both ways. While diabetes is a major risk factor of periodontal disease, evidence supports that periodontitis could have a negative effect on glycemic control.

Diabetes has been shown to impair wound healing and increase inflammation. As a result, the periodontal response to bacteria and their inflammatory products is affected, causing inflammation and increased bone loss around the teeth. There is growing evidence that treatment of periodontal disease can impact HBA1c levels. Encouraging regular dental visits and good oral hygiene is essential to controlling diabetes.

How can periodontal disease be prevented?

All patients should be encouraged to see a dentist every six months for their regular preventative cleanings to address gingivitis before it progresses to an irreversible state. Dentists, doctors and other health professionals should conduct periodontal screening every time a diabetic patient attends a check-up.

How is periodontal disease treated?

A dentist can provide a thorough oral examination consisting of radiographic images, periodontal probing, and visual examination to determine the severity of the disease. Based on the severity, periodontal surgery, scaling and root planning, or more frequent cleanings may be recommended. Similar to diabetes, there is no cure for periodontal disease and regular monitoring and maintenance is necessary throughout life.

Resources

https://www.ada.org/en/member-center/oral-health-topics/diabetes

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5694181/

https://jada.ada.org/article/S0002-8177(14)65193-X/pdf

http://www.ada.org/~/media/ADA/Member%20Center/FIles/Perio_diabetes.ashx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3467897/

https://www.cdc.gov/diabetes/ndep/pdfs/toolkits/working-together/150-healthy-teeth-matter.pdf