Dental care and diabetes: Guide to a healthy mouth

You must take special care of your mouth when you have diabetes, especially your teeth and gums. Follow this advice to avoid serious complications.

When you have diabetes, elevated blood sugar levels can damage many parts of your body, including your mouth and teeth. Diabetes increases your risk of gum disease, cavities and tooth loss, dry mouth, and a variety of oral infections.

Conversely, poor oral health can make your diabetes more difficult to control. Infections may cause your blood sugar to rise and require more insulin to keep it under control.

In addition, diabetes can diminish your ability to taste sweets. Although this change may not be noticeable, it can influence your food choices in favor of additional sweeter tasting foods, thereby affecting your dental health, as well as your ability to control your diabetes.

Awareness of potential oral complications from diabetes will improve your chances of maintaining a healthy mouth and sound teeth.

Tooth and gum damage: Diabetes can take a toll

Day in and day out, high blood sugar caused by diabetes can contribute to progressive damage to your teeth and gums, which may cause tooth loss. Here's how it happens.

Day in and day out, high blood sugar caused by diabetes can contribute to progressive damage to your teeth and gums, which may cause tooth loss. Here's how it happens.

Plaque: Diabetes feeds this cavity-causing menace
An invisible film of bacteria, saliva and food particles (dental plaque) normally covers teeth. The bacteria feed on the sugars and starches in the foods and beverages you consume and produce acids that damage the hard enamel coating of your teeth.

Higher blood sugar that accompanies diabetes gives the bacteria a greater supply of sugars and starches, leading to production of even more acid. Damage from this acid increases the risk of tooth decay (cavities).

Gum disease: From irritation to tooth loss
Dental plaque can also cause other problems. If you don't remove it from your teeth with regular brushing and flossing, it hardens under your gumline into a substance called tartar, or calculus.

Tartar irritates the gums and causes gingivitis. This makes the gums tender, swollen and red, and they may bleed when you brush your teeth. Fortunately, your dentist or dental hygienist can prevent or treat gingivitis by removing tartar during a professional dental cleaning.

Untreated gingivitis leads to a more serious condition when bacteria infect your gums and the bones around your teeth (periodontitis). This can cause your gums to pull away from your teeth and your teeth to loosen and even fall out.

Gingivitis and periodontitis are the most common oral complications of diabetes. If you have type 2 diabetes, you're three times as likely to develop such gum disease as is someone who doesn't have diabetes. Diabetes lowers your body's resistance to many infections and slows the rate at which you heal.

In addition, some research suggests that people with gum infections may be at increased risk of cardiovascular disease. One theory is that bacteria from the mouth enter the bloodstream and cause inflammation throughout the body, including the arteries. This may be linked with the development of atherosclerotic plaques in the arteries, which increases the risk of heart attack and stroke.

To help prevent damage to your teeth and gums:

Diabetes and the rest of your mouth

Salivary glands	Oral thrush

Your teeth and gums aren't the only parts of your mouth at risk. The following problems also can occur — and while you might not be able to totally prevent them, you can minimize the trouble they cause you.

Dry mouth
Dry mouth (xerostomia) occurs when your salivary glands don't produce sufficient saliva to keep your mouth moist. Dryness contributes to cavities and gum disease, because saliva helps wash away the bacteria that contribute to these conditions.

Dry mouth also causes tissues in your mouth to become inflamed and sore. You may find that chewing, tasting and swallowing become difficult. If this reduces your interest in eating, it can make controlling your diabetes more challenging, since you may not eat properly and keep your blood sugar in control.

Your dentist may suggest an artificial saliva substitute to relieve the discomfort from dry mouth. Sucking on sugar-free candy or chewing sugar-free gum and frequently drinking water also may help ease dryness.

Fungal infection
Candida albicans is a fungus that normally lives inside your mouth without causing any problems. But when you have diabetes, deficient saliva in your mouth and extra sugar in the saliva that you do produce allows the fungus to cause an infection called candidiasis (thrush), which appears as sore white or red areas in your mouth.

To treat the infection, your dentist or doctor can prescribe an antifungal medication that you let dissolve in your mouth, or one that you take in pill form.

Smoking and wearing dentures all day and night increases the risk of thrush. Not smoking and limiting the time dentures are worn can reduce your risk of getting thrush.

Oral lichen planus
Oral lichen planus is a skin disorder that produces sores in the mouth. When severe, this disorder causes painful ulcers that erode the lining tissue (mucous membrane) in your mouth.

Although there is no permanent cure, your dentist may prescribe a topical anesthetic or other medication to reduce or relieve symptoms.

Burning mouth syndrome
If you have this condition, you may feel severe burning and pain in your mouth even though you don't see any problems in your mouth that could be causing it.

Dry mouth and candidiasis can cause burning mouth syndrome, so treating these conditions can alleviate the symptoms. Medications also may be prescribed to relieve the pain.

Oral surgery and diabetes: A delicate mix
If you need oral surgery, diabetes — particularly if poorly controlled — can complicate such surgery. Diabetes retards healing and increases risk of infection.

Your blood sugar levels also may be harder to control after oral surgery. The levels may fluctuate as a result of the stress of the surgery and inability to eat your normal diet due to discomfort.

Keeping your blood sugar levels under control before and after the surgery reduces the risk of such complications. Your dentist also may need to work closely with your doctor to minimize possible complications.

If you need oral surgery, follow the American Diabetes Association's recommendations:

   - Remind your dentist that you have diabetes. Also, discuss any problems you have     with infections or with controlling your blood sugar.

   -Eat before your dental visit. The best time for dental work is when your blood sugar     is in a normal range, which allows for better healing. If your blood sugar level is out     of control when you have a dental surgery scheduled, you may need to postpone     the procedure until it's in control.

   -Take your usual medications. Your dentist should consult with your doctor about     whether you need to adjust your diabetes medications or take an antibiotic to     prevent infection before dental surgery. Unless your dentist or doctor tells you to     change your medication schedule, continue taking your medications.

   -Plan for your eating needs after surgery. If you're having any dental work done that     may leave your mouth sore, plan to eat soft or liquid foods that will allow you to eat     without pain.

   -Wait until your blood sugar is under control. It's best to have surgery when your     blood sugar levels are within your goal range. If your dental needs are urgent and     your blood sugar is poorly controlled, talk to your dentist and doctor about receiving     dental treatments in a hospital or other setting where medical professionals can     keep closer tabs on your recovery after surgery.

If you have diabetes, you likely know the need to take certain precautions to keep your body working properly. To enjoy better oral health — which in turn can help keep your blood sugar in control — also treat your mouth and teeth with extra care and see your dentist regularly

Credited to Mayo Foundation for Medical Education and Research (MFMER):