Diabetic Patients

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Oral Complications Of Diabetes

The relationship between diabetes and periodontal disease dates back more than 100 years, before the discovery of insulin.

The oral complications of uncontrolled diabetes mellitus are devastating. These may include gingivitis and periodontal disease; xerostomia and salivary gland dysfunction; increased susceptibility to bacterial, viral and fungal (oral candidiasis) infections; caries; periapical abscesses; loss of teeth; impaired ability to wear dental prostheses (related in part to salivary dysfunction); taste impairment; lichen planus; and burning mouth syndrome.

Oral manifestations of uncontrolled diabetes can include xerostomia, burning sensation in the mouth (which may possibly be related to neuropathy), impaired/delayed wound healing, increased incidence and severity of infections, secondary infection with candidiasis; parotid salivary gland enlargement; gingivitis and/or periodontitis.

In diabetic patients with poor glycemic control, bacterial antigens tend to trigger more tissue inflammation than they would in nondiabetic patients, and that inflammation is responsible for most of the periodontal destruction around the tooth. 

Frequent follow-up for cleaning, re-examination, and thorough retreatment for any disease recurrence is likewise recommended.

7 Things To Know About
Diabetes and Dental Treatment

Both type 1 and type 2 diabetes can greatly impact different aspects of your health. Your dental health is no exception, which is why in managing diabetes, check-ups at the dentist should not be skipped or overlooked.

Whether you’re seeking treatment for an underlying dental problem or looking to get a routine exam, you should know how diabetes factors into your oral health. Let’s delve into the five key connections between this medical condition and your smile:

Dental Care Is A Crucial
Part Of Diabetic Care

For individuals with diabetes, dental care is more than just about maintaining a bright smile; it’s an essential part of managing the condition. High blood sugar levels can lead to an increased risk of oral health problems. Regular dental check-ups and maintaining good oral hygiene are pivotal in preventing complications that could exacerbate diabetes.

Higher Risks Of Oral
Health Infections

Diabetics are at a higher risk for oral infections, such as gum disease and fungal infections like thrush. These infections are more common and can be more severe due to elevated blood sugar levels, which create a more conducive environment for bacteria and fungi to thrive. Early detection and treatment are key to preventing these infections from becoming serious issues.

Glucose Levels Can Affect Results Of Dental Treatment

Blood glucose levels can significantly impact the success of dental treatments. Uncontrolled diabetes can impair healing and increase the risk of infections after dental procedures. It’s important to manage blood sugar levels diligently, especially before undergoing any dental work, to ensure the best outcomes.

Treatments For Diabetes Can Impact Infection Recovery

Does Metformin affect your teeth? Certain medications taken to control blood sugar levels and other factors of this disease can also suppress immune system functionality. These immunosuppressant drugs can make it more difficult for the body to fight off infections like gingivitis and oral thrush.

Taste Alteration

Diabetes can change the way foods taste. This might seem like a small issue, but it can have a big impact on what and how you eat, and in turn, on your oral health. For example, if sweet foods don’t taste as good, you might eat less of them, which can be good for managing diabetes. But, if things taste bland, you might add more salt or sugar to make them taste better, which isn’t great for your teeth or this autoimmune disease.

Lower Pain Tolerance

While everyone has a different perspective and experience with pain, diabetes can make certain procedures like a root canal feel more painful than what’s usually expected. It’s crucial to speak with your doctor about pain management and expectations before a dental procedure.

Salivary Gland Dysfunction

Diabetes can alter salivary gland function, leading to several oral health challenges:

Reduced Saliva Production: Both types of diabetes can decrease saliva production, leading to a condition known as xerostomia or dry mouth. Saliva is essential for neutralizing acids produced by bacteria, limiting bacterial growth, and washing away food particles. A reduction in saliva can increase the risk of dental decay and infections.

Altered Saliva Composition: Diabetes can also change the composition of saliva. This alteration can affect its ability to protect teeth and gums, potentially accelerating dental issues like cavities or gum disease.

Treating Patients with Diabetes in Dentistry

Patients with poor glycemic control are more prone to oral manifestations of diabetes, including periodontal disease, salivary gland dysfunction, halitosis, burning mouth sensation, delayed wound healing and increased susceptibility to infections. Diabetic patients are also at risk of experiencing an intraoperative diabetic emergency in the dental office. Therefore, dentists must appreciate and implement important dental management considerations while providing care to diabetic patients. In this article, we discuss the diagnosis, oral findings, dental care and emergency management of diabetic patients.

Most cases of Diabetes Mellitus can be classified as type 1 (T1DM) or type 2 (T2DM). Prediabetes refers to a condition in which blood glucose levels are elevated, but not high enough to warrant a diagnosis of T2DM. People with prediabetes have an increased risk of developing Diabetes Mellitus in the future.

Oral Complications and Manifestations

The effects of DM on the oral cavity have been studied extensively. Complications, such as periodontal disease, salivary gland dysfunction, halitosis, burning mouth sensation and taste dysfunction, have been associated with DM in scientific literature. People with DM are also more prone to fungal and bacterial infections, oral soft tissue lesions, compromised oral wound healing processes, dental caries and tooth loss. Notably, the degree of a patient’s glycemic control appears to be an significant factor in predicting the severity and likelihood of oral complications.

Therefore, it is important that dentists take an active role in educating patients about DM control and the potential impact of lack of control on their oral well-being. 

Numerous studies have identified a link between DM and periodontal disease. Although the mechanisms are not entirely understood, increased periodontal tissue destruction in diabetic patients is thought to result from reduced polymorphonuclear leukocyte function that is secondary to the formation of advanced glycation end products and changes in collagen metabolism. Research has shown a bidirectional relationship between DM and periodontitis. Although effective management of DM can lower susceptibility to periodontitis, evidence suggests that periodontal therapy can improve glycemic control as well.

Salivary gland dysfunction is another widely reported oral manifestation of DM. Although the mechanism of hyposalivation is unknown, some have hypothesized that it is related to polydipsia and polyuria. Xerostomia in a diabetic patient may lead to halitosis, taste disturbances, exacerbated periodontal disturbance, dental caries and tooth loss. Therefore, it is important for dentists to anticipate and manage xerostomia in a diabetic patient.

Several authors have reported that diabetic patients are susceptible to fungal and bacterial infections. Also, people with diabetes are prone to more severe bacterial infections and their recurrence. This can be attributed to impaired host defense mechanisms associated with poor glycemic control. Further, oral soft tissue regeneration and osseous healing processes are compromised in a diabetic patient. This is thought to result from delayed vascularization, reduced blood flow, decreased growth factor production, weakened innate immunity and psychological stress. Therefore, dentists must anticipate, prevent and promptly treat infections in their diabetic patients. Especially during invasive procedures, dentists should take extra precautions to avoid the need for profound wound-healing processes.

Dentists play a critical role in the management of oral health for patients with diabetes. Key considerations include:

Comprehensive Assessment

Before any dental work, it’s important to understand a patient’s diabetes. This includes checking their blood sugar control and looking for any kidney problems, or other health issues. Knowing all this helps the dentist plan safe dental care.

Preventive Measures

Regular dental care, like cleanings and check-ups, is crucial. These help stop even more complex health problems in people with diabetes, who are more likely to experience kidney diseases, infections, and issues with other systems connected to the mouth and pancreas.

Collaborative Care

Dentists often work together with the patient’s doctors. This teamwork makes sure dental care fits well with the patient’s overall diabetes management.

Tailored Treatment Plans

Customizing dental treatments based on the individual’s diabetes diagnosis and current health status. If a patient struggles with dry mouth, periodontal disease, tooth loss, or issues in addition to diabetes, a dentist should work with their primary care physician to ensure they receive the best and safest dental care possible. The intersection of diabetes and dentistry is a complex one, demanding a comprehensive and informed approach to care. For people with diabetes, maintaining good oral health is a critical aspect of managing their condition. Dental professionals are integral in ensuring that treatments are safe, effective, and tailored to the unique needs of diabetic patients.

Discover Comprehensive Care In Family Dentistry

Don’t let diabetes stand in the way of achieving optimal oral health. Schedule a routine check-up at Merrick Dental Coral Gables, where we understand the unique dental needs of our patients with diabetes.

Regular dental check-ups are an integral part of diabetic care. Our family-friendly team is committed to providing comprehensive, compassionate care to ensure the best oral health outcomes for you and your loved ones.

Visit our website or call us today to book your appointment. Take a proactive step towards a healthier smile and a healthier you.

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