We all know diabetes is a chronic metabolic disorder that affects millions of people worldwide. What we might not know is that it greatly influences oral well-being and can cause gum disease, gaps between teeth and even loss of teeth.
Rajini G, a 63-year-old homemaker from Coimbatore, Tamil Nadu, has been experiencing dental issues due to uncontrolled diabetes. She was diagnosed with type 2 diabetes in 2014, a condition that runs in her family. She has been taking medication and controlling her diet to manage her blood sugar levels. However, for the past five years, her diabetes has remained uncontrolled, and this has led to dental issues.
Rajini says, “I noticed my gums shrinking and exposing the roots of the teeth. I was also seeing gaps in between my teeth.” Her front teeth have drifted from their position and started loosening. In addition, she says that she gets frequent mouth ulcers.
Her dentist removed the weak teeth and replaced them with partial dentures. “People with diabetes are at a higher risk of developing gum disease and other oral health conditions such as dry mouth and bad breath,” informs Dr Deepa Natarajan, a periodontist from Chennai, Tamil Nadu. She adds that it is important for people with diabetes to take extra care of their oral health.
Bi-directional relationship
Diabetes mellitus can occur due to dysfunctions in insulin secretion, insulin action, or a combination of both factors. Periodontitis is a long-term condition that causes inflammation and infection of gums and affects the supporting bone of teeth.
A 2015 study published in the Journal of Clinical Medicine shows that diabetes and periodontitis may occur simultaneously and require an early diagnosis. It further states that the bacteria that cause gum infections can enter the bloodstream and trigger systemic conditions like diabetes. Meanwhile, uncontrolled diabetes can worsen the periodontal condition.
Oral manifestations
Experts say that people with diabetes experience frequent urination and increased dehydration. A 2017 study mentions that these symptoms are associated with decreased salivary flow leading to dry mouth.
“People with diabetes have multiple abscesses (collection of pus) in the gums. In addition, they experience alveolar bone (supporting bone of tooth) loss, receding gums (shrinkage of gums), and loosening of teeth,” says Dr Natarajan. To avoid such conditions, they should undergo regular oral examinations with their dentist.
Dr Remya John, aesthetic dentist, Coimbatore, Tamil Nadu, says, “People with diabetes are more likely to experience tooth decay, burning mouth, altered taste, and the tongue has deep depressions or white coating.”
Reduced immunity
A 2019 study published in Journal of Dental Research shows that microorganisms in the oral cavity may be affected by diabetes and other autoimmune conditions. This alters the beneficial bacteria and increases the harmful bacteria. It eventually increases the inflammation of gums, thereby increasing the severity of gum diseases.
“In diabetic people, the impaired immune system, reduced salivary flow, and increased blood glucose level make them prone to fungal infections and ulcers in the mouth,” says Dr Natarajan.
Importance of oral hygiene
Dr John advises the following preventive measures:
- Drink enough water to overcome dehydration and dry mouth
- Brush with toothpaste containing fluoride twice a day, to manage tooth decay and maintain oral health
- Avoid using tobacco products and alcohol as it may cause dry mouth and bad breath
- Keep diabetes in check to maintain oral health
Importance of scaling
A study published in 2020 in the Journal of Brazilian Oral Research, shows that regular scaling along with brushing and flossing improves gum health. Scaling is a procedure in which the dentist uses special tools to remove the deposits from the teeth. In addition, it reduces the gum inflammation.
“Scaling cannot be performed when an individual has random blood sugar levels of more than 250 to 300 mg/dL. This is because they may experience delayed healing and an increased incidence of infection after the process,” observes Dr Natarajan. The dentist performs scaling once the blood glucose level is in control (less than 200 mg/dL).
Using mouthwash after scaling also helps to reduce gum inflammation and bad breath. However, it should not be used for more than 15 days without the dentist’s prescription.
Other management measures
Dr. Natarajan says, “Splinting is a procedure that connects multiple teeth together with a wire or fiber, when there is loosening of front teeth. This procedure helps keep the weakened tooth in position.”
Dr. Natarajan adds, “Doctors perform tissue grafting when there is severe receding of gums. This procedure involves taking a small piece of tissue from the palate and placing it over the area where the gums have shrunk.”
Moreover, scaling and root planing (a procedure of making the roots smooth after removing the deposits from them) help in reducing inflammation and control the blood sugar levels in individuals with type 2 diabetes.
All it takes is a little awareness and a bit of regular care to make sure diabetes does not hamper oral health. If you have diabetes, or your loved one does, make sure to visit the dentist more frequently and regularly. The more people with diabetes are aware of potential complications, the easier it will be for them to prioritise their oral health and hygiene.
