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BPHC: How diabetes can affect your oral health

Boston Public Health Commission

In the United States, 25.8 million children and adults have diabetes. That is about one in every 12 people. And according to the American Diabetes Association, 1.9 million people were newly diagnosed in 2010. To help educate everyone about this serious disease, November is Diabetes Awareness Month.

It is no secret that diabetes increases the  risk of developing heart disease, stroke, high blood pressure, blindness, kidney disease and neuropathy (nervous system disease), but many people do not know that diabetes also increases the risk of having tooth decay (caries), periodontal (gum) disease and oral infections that can actually make diabetes even harder to control.

Diet and tooth decay
Every time you eat foods and drinks that contain sugars and starches like bread, pasta and rice, food particles are left on your teeth forming a sticky, colorless, thin film called plaque. The bacteria found in plaque feeds on these food particles and releases an acid that destroys the outer layers of the tooth (enamel) resulting in tooth decay.

When diabetes is not well controlled, the high levels of glucose (a form of sugar) in the mouth become a constant food source for bacteria to continue to produce acids. This excess acid production exposes teeth to more frequent and longer periods of acid attacks which increases the risk for tooth decay.

Almost all foods have some type of natural or added sugar, but you can help control the amount of sugar you consume by following a few simple steps. Read food labels and choose a variety of foods with naturally occurring sugars, for example fresh fruits, vegetables and whole grains. Select beverages that are low in added sugars. Limit foods with added sugars like soft drinks, candy, cookies and pastries.  Develop healthy habits such as drinking plenty of water and cutting down on snaking between meals to reduce acid build up.

Periodontal disease
In addition to tooth decay, bacteria in the mouth can cause gum inflammation, and if left untreated, it can progress to severe gum disease called periodontal disease. It is estimated that 80 percent of the U.S. adult population has some form of periodontal disease but many are unaware of this until the condition has progressed!

If detected early, gingivitis (the initial form of gum disease) can be reversed by brushing teeth at least twice a day, flossing regularly, getting regular dental cleanings and by avoiding smoking, which contributes to inflammation.

Symptoms of periodontal disease might include tender, bleeding gums; painful chewing; a bad taste in your mouth or bad breath that won’t go away; loose teeth; a bite that feels different; dentures that do not fit well; sensitive teeth; and receding gums. If left untreated, periodontal disease can lead to tooth loss.

People with diabetes are at a greater risk of developing more frequent and severe periodontal disease than non-diabetic people. In fact, research shows that the relationship of periodontal disease and diabetes goes both ways. This means that people with diabetes may have even more difficulty controlling their blood glucose levels if they have periodontal disease.

Oral infections
Due to high blood glucose levels, people with diabetes may be prone to developing oral candidiasis or thrush — a fungal infection characterized by white or red sore patches found on the tongue, palate or gum that can cause a painful burning sensation and difficulty swallowing. Talk to your dentist if you think you might have an oral fungal infection, which can generally be treated by antifungal medications.

Recommendations for a healthy mouth
It is important for everyone to take good care of their teeth and mouth, but it’s especially important if you have diabetes. Follow these recommendations from the American Diabetes Association to prevent oral health complications related to diabetes:

• Maintain appropriate blood glucose levels.

• Have a dental checkup at least every six months or as often as indicated by your dental provider, or if a problem occurs.

• Tell your dentist and hygienist if you have diabetes or any other medical condition as well as any prescription or over the counter medications you take.

• Brush your teeth for two minutes twice a day with a soft-bristled toothbrush and fluoride toothpaste with an antigingival/antibacterial ingredient that is accepted by the American Dental Association (has the ADA seal) to help prevent gum disease and tooth decay.  

• Floss your teeth at least once a day to remove food and bacteria caught between your teeth where it is difficult for a toothbrush to reach.

Contact your dentist or hygienist if you experience any of these signs of gum disease:
• Gums that bleed or are red, puffy or swollen, or sore

• Gums that have pulled away from your teeth

• Changes in the way your teeth fit together when you bite

• Pus that appears between your teeth and gums

• Constant bad breath or a bad taste in your mouth

The Boston Public Health Commission encourages everyone to maintain healthy blood sugar levels, have a well-balanced diet, practice proper oral health care and visit your dental provider on a regular basis keep your teeth and mouth healthy!