Diabetes mellitus is one of the most common diseases in the United States. The number of people diagnosed with diabetes is expected to climb toward 300 million by 2005.
Diabetes is a complex disease of carbohydrate (or sugar) metabolism involving the effectiveness of insulin. Insulin is an important hormone produced by the body that helps lower blood sugar levels. Because diabetes is a disease that involves the entire body, signs and symptoms of diabetes can occur in the oral cavity. As dental healthcare professionals, we have the opportunity and responsibility to promote health and be involved in prevention, diagnosis, and treatment of diabetes. Following are some dental consequences of diabetes.
This is the most common oral symptom. Higher than normal sugar levels in saliva may increase bacterial growth and interfere with periodontal healing. Additionally, diabetes causes blood vessel thickening, which slows down the flow of blood to body tissues, including the gums and dental bones. Blood flow is crucial in providing important nutrients and eliminating harmful wastes from body tissues. As a result of lowered blood flow, the gum and bone tissue supporting the teeth become less healthy and less resistant to infection from bacteria found in dental plaque.
Studies show that patients with poorly controlled diabetes have periodontal disease more often and more severely than those with good control of diabetes. Also, patients with poorly controlled diabetes have more incidence of tooth loss. Studies have also linked an increased risk for gum disease among diabetics who smoke. Smokers with diabetes, age 45 or older, are twenty times more likely to develop severe periodontal disease compared to individuals who do not smoke and do not have diabetes.
Non-surgical periodontal therapy is essential in helping control periodontal disease in diabetics, and when performed in a timely manner, can help prevent periodontal surgery.
Thrush (oral candidiasis) is another complication of diabetes. Thrush is an oral infection caused by fungus that grows in the mouth. The fungus that causes thrush thrives on increased levels of blood glucose found in the saliva of individuals with diabetes. Smoking, poor oral hygiene, and denture-wearers are at greater risk for developing this complication. This should be treated with medications with low sugar content.
Dry mouth (xerostomia) is another complication of diabetes. Dry mouth is the result of the decrease in production of saliva by salivary glands. As a result, dry mouth can lead to mouth soreness, tooth decay, increased risk of soft tissue infections, and ulcers. Treatment uncludes suger-free chewing gum as well as artificial saliva. Additionally, fluoride appliances are usually prescribed to help prevent tooth decay.
Burning Mouth Syndrome
This may resolve after glucose levels are under control. If not, tricyclic antidepressants, anticonvulsants, or low dose benzodiapenes may be prescribed by your physician.
When evident, herpes viruses should be treated quickly with oral acyclovir.
Due to dry mouth and an increase in bacteria, children with diabetes do not show incidence of increased tooth decay. In fact, studies indicate that tooth decay actually occurs less in children with diabetes due to the children's low sugar diets. Regardless, when a dry mouth is present, special consideration should be given to the acidity and pH of drinks consumed.
Diabetes causes an increase in the time for wounds to heal following surgeries or injuries. We observe precautions and work closely with your physician when dental invasive treatment is needed.
Researchers from the Harvard School of Dental Medicine and the University of Michigan School of Dentistry analyzed national data on more than 4,300 adults ages 45 to 90 with type 2 diabetes. They found that people with poorly controlled diabetes were nearly three times more likely than those with better-controlled diabetes to have severe periodontal dissease.
Gum disease may even be more important than obesity or age as a factor in the onset of diabetes in adults. Adult-onset diabetes, or Type 2 diabetes, accounts for more than 90 percent of the estimated diabetes cases in the United States and is almost always caused by lifestyle.
This study along with 2 others revealed results that blood sugar levels could be reduced and kept at a lower level most effectively with a single dose of oral antibiotic and repeated application of a topical antibiotic to the gums.
In another study, the University of Buffalo researchers showed that using antibiotics to treat gum disease decreases two markers of inflammation throughout the body - the inflammatory markers area associated with the development of arteriosclerosis and other chronic diseases.
Other clinical manifestations of poorly controlled or uncontrolled diabetes are:
- Polyphagia (increased hunger)
- Polydipsia (increased thirst)
- Polyurea (increased urination)
- Pruritis (itching)