It is a fairly well-known fact that diabetics have to manage and monitor their sugar intake. They also need to carefully consider the foods they consume, as hidden sugars may exacerbate their condition. However, one area in which diabetics may not know they may also need special care is dental hygiene and oral health. Let’s look at this specialised area of concern and treatment. Q: Why do people with diabetes need special dental care? A: One of the effects of diabetes is that it can leave diabetics more prone to gum disease. Gum disease is caused by oral bacteria. Having diabetes means you may have poor glycaemic control, which means your immunity to these bacteria is less than normal, or compromised. Furthermore, food does not have to be sugary or sweet to cause a cavity. Food particles left between your teeth will be broken down by bacteria to produce acids. This can lead to bad breath, tooth decay, cavities and other problems if you do not maintain proper oral and dental care. The most important advice to remember is to brush and floss your teeth twice daily, especially after a meal or a snack. Regular check-up visits to your dentist, involving x-ray assessments, is required to minimise any potential problems. Q: What are some of the oral diseases related to diabetes? A: Research has shown that there is a connection between diabetes and dental complications. This may surprise the millions of people living with diabetes, but studies have shown that there is a greater chance of gum disease in diabetics. One of the earliest signs to look out for is the mildest form of gum disease called gingivitis. Gingivitis means that the gums are inflamed, so that when you brush or floss, your gums may bleed. The more serious form of gum disease is called periodontitis. An important point to note with diabetics is that regular dental checks and cleaning is crucial to minimising the progress of periodontitis. Periodontitis can lead to increase in blood sugar levels (due to certain cytokine release) further perpetuating the diabetic condition. Insulin resistance in turn facilitates the progress of periodontitis. Gum disease, while being a complication of diabetes, can also have subsequent effects on a diabetic’s general health, for example, a person’s cardiovascular function. Gum disease has been associated with an increased risk of other diabetic complications involving blood vessels supplying blood to the brain, or problems with obstruction involving the arteries around the heart and the brain. 
Q: How do I manage this possible complication? A: If the symptom is detected early, gum disease – the mild form – can be remedied with professional dental cleaning, proper brushing, regular flossing and a change in your diet. You must always keep your dental healthcare professional informed of changes related to your diabetic condition, such as a change in medicine, or fluctuating blood sugar readings. Q: Is there a special dentist that treats diabetic patients? A: All dentists can treat diabetic patients. Most dentists will ask for a medical history prior to any procedure. In the off-chance that you are not asked, a diabetic should inform the dentist of their condition. A dentist may need to be informed prior to diagnosis and treatment that a person is diabetic, so that they can monitor possible complications such as an insulin reaction. Q: How is treatment different? A: Most people with diabetes can be treated by dentists the same way as those without diabetes. However, if you are on insulin for diabetes control, your dentist needs to be told. Here’s why: when a diabetic is at the dentist’s, he or she may be stressed out. Being stressed can affect your body’s uptake of insulin. This is because stress releases a hormone that can affect your body’s absorption of insulin. It can also affect your blood glucose (sugar) levels. Therefore, it is important to correctly time when you take your insulin medication and the time of your dental appointment. Many doctors recommend scheduling dentist visits in the morning as blood glucose levels tend to be under better control at this time. Generally, all non-emergency dental procedures must be reconsidered if a diabetic’s blood sugar level is not under control. Q: How can one tell if a diabetic is in need of dental treatment? A: The mouth of diabetics – when oral health is not maintained properly – can show red or bleeding gums or even receding gums that expose ‘long’ teeth. What diabetics may suffer from, which non-diabetics might not, is dry mouth due to lower production of saliva that can be caused by medication. Dry mouth is also a general complication of diabetes. This dry mouth condition can be counteracted simply by drinking more water, chewing sugarless gum, or snacking on crunchy foods to stimulate saliva production. Diabetics may also be more prone to a condition called oral thrush (candidiasis.) This is a yeast infection where yeast thrives on the sugar in your saliva. One sign of this is a white layer coating the diabetic’s tongue or the inside of the cheeks. Diabetics may also find, due to the higher level of sugar in their blood, that cuts or cold sores in or around the mouth may take longer to heal. This, again, is largely due to the poorer immune system response in diabetics with compromised immunity. 
Q: What is the usual advice from dentists to diabetic patients? A: The most important advice for diabetics when it comes to dental care is to control your blood sugar levels and maintain clean teeth and gums. Changing to a healthier diet and exercising more can help. Good blood sugar control can help your response to bacteria that can cause oral and dental complications. If you wear dentures, you should ideally clean them every day and leave them out of the mouth while asleep nightly. A complete avoidance of smoking is also highly recommended. All who are concerned with maintaining good oral healthcare should ideally brush their teeth twice a day with a soft brush and floss daily. And, of course, pay regular 6 monthly visits to your dentist. Q: What should a caregiver remember when helping to manage the health of a diabetic? A: One of the most important things to remember is that diabetes affects a person’s immune system. This means they are more prone to infection. This increased risk applies to oral care and dental care too. The relationship between diabetes and oral care and health is a two-way street. Diabetes has the ability to increase the risk of gum disease, which in turn has the ability to affect existing diabetic complications involving heart disease, blood vessel health and immunity. This is largely due to bacteria, bacterial infection and the decreased ability to fight these infections. This article is brought to you by IMU Healthcare. Related article: Diabetes Is No Sweet Subject Diabetes from a Chiropractic Perspective The Yin and Yang of Diabetes Treatment
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