Diabetes and oral health: The importance of maintaining optimum oral health

Dental or oral infections in a patient with diabetes can frequently lead to loss of control over the diabetic condition. Oral complexities of diabetes include periodontal disease, tooth decay, salivary dysfunction, and pathologic changes.

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According to the Centers for Disease Control and Prevention (CDC), diabetes is the seventh leading cause of morbidity and mortality in the United States. (1) Dental or oral infections in a patient with diabetes can frequently lead to loss of control over the diabetic condition. Oral complexities of diabetes include periodontal disease, tooth decay, salivary dysfunction, and pathologic changes. This article will review diabetes and oral health.

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Uncontrolled bacteria production resulting in oral inflammation and infection can result in mobile teeth. Uncontrolled diabetes can result in enhanced inflammation, delayed healing of wounds, and changes to large and small blood vessels. (2) Failure to reverse these adverse effects by managing diabetes can lead to periodontal disease. This risk directly relates to fasting blood glucose levels. Patients with diabetes have a hyperactive inflammatory response and the bacterial challenge of a periodontal infection results in exaggerated inflammation and periodontal tissue destruction. Over time, this can lead to loose teeth, and eventually tooth loss. (2)

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Tooth dehydration is one of the causes of tooth decay. Like our hair, skin and other organs, our teeth can undergo dehydration. (3) Symptoms of tooth dehydration are dry mouth and tooth sensitivity. Those with diabetes who are experiencing hyperglycemia will likely also experience tooth dehydration because hyperglycemia leads to glucose excretion in the urine. Due to the loss of fluids saliva production will slow causing dry mouth, which will result in tooth dehydration. Another review was able to identify associations both between saliva and dental disease and between saliva and dehydration. (4) However, the exact meaning of these associations remains to be fully explained.

Dry mouth in those with and without diabetes will lead to tooth decay because saliva neutralizes and clean acids produced by bacteria, which creates a balanced pH and prevents the destruction of tooth enamel. If the production of bacteria accelerates faster than saliva due to dry mouth, colonization of bacteria will inevitably damage tooth structure. Repeated damage to the tooth structure results in tooth decay.

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Manifestations of several life-threatening diseases appear in the mouth, including diabetes. The American Diabetes Association (ADA) recommends screening tests for diabetes mellitus for all persons 45 and older. (5) Those with risks such as obesity and a family history belonging to ethnic or minority groups are also at risk for diabetes. Recent medical research demonstrated that on average, people who maintain healthy oral hygiene home care habits live 10 years longer than those who do not. Those with uninhibited diabetes may require hospitalization until the infection is under control. (6) Establishing regular dental visits for checkups and cleanings will significantly lower the risk of oral complications.

1. Johnson NB, Hayes LD, Brown K, Hoo EC, Ethier KA, Centers for Disease Control and Prevention (CDC). CDC National Health Report: Leading Causes of Morbidity and Mortality and Associated Behavioral Risk and Protective Factors—United States, 2005–2013. MMWR Surveill Summ. 63(Suppl 4);3-27.
2. Slim LH, Stegeman CA. Diabetes: A Multifaceted Syndrome Treatment Considerations in Dentistry. Dentalcare.com. http://www.dentalcare.com/media/en-US/education/ce93/ce93.pdf. Accessed September 7, 2015.
3. Chan W. Tooth Dehydration During Teeth Whitening in London. Dr. Wyman Chan website. http://www.drwymanchan.com/blog/tooth-dehydration-during-teeth-whitening/. Accessed August 27, 2015.
4. Smith AJ, Shaw L. Mild dehydration: a risk factor for dental disease? Eur J Clin Nutr. 2003;57(Suppl 2):S75–S80. doi:10.1038/sj.ejcn.1601905.
5. Patel P, Macerollo A. Diabetes Mellitus: Diagnosis and Screening. Am Fam Physician. 2010;81:863-870.
6. Stelbrink E. Diabetes and Oral Health. Endever. http://www.endevr.com/diabetes/Diabetes-and-Oral-Health. Published March 10, 2015. Accessed September 16, 2015.

Erin Stelbrink is a licensed dental hygienist with 5+ years of experience as an oral health care provider and leads research and program development for Wellbrink.com. She serves as a pioneer in developing programs that improve patient care while generating additional revenue for hygienists. For more information, email her at erin@wellbrink.com or visit www.wellbrink.com.

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