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Diabetes Mellitus and Oral Health

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Diabetes Mellitus and Oral Health

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This article emphasizes the impact of diabetes mellitus on oral health problems and its management.

Medically reviewed by

Dr. P. C. Pavithra Pattu

Published At December 27, 2018
Reviewed AtMarch 26, 2024

Introduction:

Diabetes mellitus is a metabolic disorder which affects the uptake and use of glucose by the human body. As a result, the glucose level in the blood rises beyond normal which has an overall impact on the general health and oral cavity. Diabetes that is poorly managed can weaken the white blood cells. White blood cells are the major defense mechanisms in the body and they act against any infection that enter the body. People with diabetes are at a greater risk of suffering from dry mouth, gum inflammation, poor healing of oral tissues, burning mouth or tongue, and so on.

What Are the Types of Diabetes?

  1. Insulin-dependent diabetes mellitus: It occurs due to deficiency of insulin hormone from the pancreatic cells. As a result, the glucose level in the blood rises which is not taken up by the liver cells.

  2. Non-insulin dependent diabetes mellitus: It occurs due to resistance to the action of insulin which can be due to various factors including obesity. As a result, glucose is not taken up by the cells to be utilized as fuel by the body.

What Are the Common Symptoms of Diabetes Mellitus?

  1. Polydipsia: Patient feels thirsty.
  2. Polyphagia: Patient feels hungry all the time.
  3. Polyuria: Frequent urination.

Oral Manifestations:

There are several oral manifestations of diabetes mellitus. These are:

  • Gingival inflammation or gingivitis.
  • Peridontitis.
  • Dryness of mouth or xerostomia from polyuria.
  • Loss of taste sensations or alteration in taste from neuropathy.
  • Poor oral hygiene from frequent calculus and plaque formation from rising glucose levels in saliva.
  • Salivary gland enlargement from hypertrophy.
  • Bone loss and tooth mobility from periodontitis and gingivitis.
  • Certain lesions like lichenoid reactions from the use of drugs to control diabetes.
  • Burning mouth.

What Are the Complications During Dental Surgery and Tooth Extraction?

  • Dry socket from susceptibility to infections and poor healing.
  • Delay in wound healing.
  • Septicemia or blood infection as these patients have lots of plaque and calculus which are safe haven for bacteria.
  • Hypoglycemic shock due to a sudden fall of blood glucose level and patient collapses. It is the most serious complication.
  • Hypotension due to a fall in blood pressure which occurs due to autonomous neuropathy among diabetic patients.

How Can a Diabetic Patient With Oral Problems Be Managed?

  • Maintain good oral hygiene by brushing twice daily.
  • Mandatory scaling every three to six months to avoid calculus formation.
  • Always try to do an atraumatic extraction.
  • Suturing the wound or extraction site.
  • Cleaning the extraction site with saline.
  • Avoid leaving bony spicule at the extraction site which can cause dry socket.
  • Always try morning extraction and ask the patient to come after eating food to avoid a hypoglycemic attack.
  • Give antibiotic prophylaxis if needed before extraction to avoid infection transmission.
  • Ask the patient to always come with an attendant.

When Should One Do Extraction?

First, ask the patient for fresh tests like fasting blood glucose level and postprandial level.

Ask the patient for CBC (complete blood count) and CTBT (clotting time and bleeding time) to avoid complications from bleeding.

Before a major surgery, ask the patient to take the consent of an endocrinologist as well.

If these tests are normal, then go for extraction and if these are not normal, send the patient to the endocrinologist for management till investigations return to normal.

Ideally, the dentist should ask the patient to bring fasting blood glucose report and monitor postprandial level before extraction. After extraction, the postprandial test should be repeated after two hours. It is always better to keep the patient on monitoring for two hours after surgery or extraction.

Ideally, it is better and safer to do an extraction after the patient has taken food because one can compromise with hyperglycemia but not with hypoglycemia.

Between fasting glucose level of 110 to 125 mg/dl, one can do the extraction and less than 140 mg/dl after measuring postprandial levels.

If the patient has well-controlled diabetes, oral hypoglycemic drugs can be stopped for 24 hours prior to extraction or minor surgery. But glucose levels need to be monitored pre and postoperatively for two hours until the patient eats again and medication is to be started again.

However, if the disease is poorly controlled, the patient may require insulin before surgery. For such cases, the consent of an endocrinologist must be taken.

  • Dry Mouth: Severe diabetes can reduce the salivary flow resulting in dry mouth.

  • Gum Infection and Periodontitis: Diabetes makes the blood vessels thicken resulting in reduced nutrients and waste substances from the tissues, including the mouth. When this occurs the body loses the ability to fight against infection.

  • Poor Healing: There will be slow healing at the treated site due to poor blood flow in case of diabetes.

  • Thrush: People with diabetes who take antibiotics regularly to fight infection can be affected by a fungal infection in the mouth called thrush.

  • Burning of the Tongue: This is caused due to the occurrence of thrush.

How to Prevent Oral Health Issues in a Diabetic Person?

  • During each visit to the dentist, inform them regarding your diabetes level. Try to maintain it as close to the normal level.

  • Before going for a periodontal treatment get an opinion from the doctor. Before any oral surgical treatment, ask the dentist or the general physician regarding any prior antibiotics that need to be taken.

  • Inform the dentist regarding all the medication along with dosages before starting any treatment.

  • If the blood sugar level is high, try to postpone any non-emergency oral treatments.

  • In the case of diabetes, the healing process may be difficult. The instructions given by the dentist should be followed for proper healing.

What Are the Misconceptions of Diabetic People Regarding Oral Health?

Some common misconceptions are

  • People with diabetes are more prone to dental cavities.

  • People with diabetes tend to lose teeth more often than those without diabetes.

  • Diabetic people are more prone to post-surgical complications and infections as these are very common in people with diabetes.

Conclusion:

It is important for any diabetic patient to follow the preventive measures and maintain a good oral health. If one have sufficient technical and manpower support, then they can go for extraction. But, if one has problems of poor infrastructure, it is always wise to send the patient to an established government or private hospital. If the patient has poor diabetic control, one must never hesitate in referring the patient to an endocrinologist

Frequently Asked Questions

1.

What Is the Influence of Diabetes on Oral Health?

Every other individual is affected by diabetes. Diabetes causes increased sugar levels which cause poor wound healing. In addition, it increases the risk of tooth decay and tooth mobility. Hence diabetic patients need to visit their dentist once in six months to undergo scaling and identify dental problems at an earlier stage.

2.

Does Diabetes Have Any Impact on Teeth?

Diabetes increases the level of sugar in saliva. This helps the oral bacteria to multiply and cause tooth decay rapidly. In addition, it increases the risk of tooth loss and helps to adhere food particles to the tooth surface due to the sticky saliva.

3.

What Is the Relationship Between Diabetes and Periodontitis?

Periodontitis is the sixth major symptom in patients with diabetes. Periodontitis refers to the inflammation and infection of the tissues supporting the tooth and covering the bone. Severe periodontitis results in tooth mobility, eventually resulting in tooth loss.

4.

Is Tooth Loss Associated With Diabetes?

Diabetes increases the risk of tooth loss in patients with poor oral hygiene. Hence diabetic patients have to pay extra attention to their teeth and visit dentists regularly for a thorough cleaning and dental check-up. In addition, using dental floss and mouthwash can prevent the risk of caries susceptibility.

5.

Does Diabetes Cause Dryness of the Mouth?

Dryness of mouth, also called xerostomia, is associated with diabetic patients. Individuals with high glucose levels are more prone to mouth dryness. Artificial saliva and consumption of citrus fruits are advised in patients with dry mouths to induce salivary secretion.

6.

What Are the Associated Risk Factors of Diabetes?

The following are the risk factors of diabetes:
- Family history of diabetes.
- Prediabetes.
- Obesity.
- Lack of physical activity.
- Gestational diabetes.

7.

Does Mouth Ulcer Occur in Diabetes?

Diabetes causes mouth dryness which results in ulcer formation. It also increases the risk of mouth soreness and causes fungal infections like candidiasis. Mouth ulcers can be painful and cause difficulty in chewing food.

8.

Are Sore Gums Seen in Diabetic Patients?

Diabetes is prone to cause gum-related infections like periodontitis. It weakens the peripheral support of the tooth resulting in tooth mobility. Gum infections are a common indicator of diabetic patients.

9.

Is White Tongue Caused by Diabetes?

The white tongue in diabetes is caused by a fungal infection called candidiasis. This infection usually occurs in the tongue and hard palate. It is non-scrapable and can be treated with antifungal drugs.

10.

Are Lips Affected by Diabetes?

Diabetic patients have dry and cracked lips, which may bleed in severely damaged cases. Applying lip balms and petroleum jelly can help to keep the lips moist and prevent dryness. Also, drinking adequate water helps to hydrate the body.

11.

Is Mouthwash a Potent Cause of Diabetes?

Medicated mouthwashes must be used as the dentist recommends for a stipulated period. Prolonged use of mouthwash can stain the teeth. However, mouthwash is not a potent cause of diabetes. It is an additional oral hygiene measure to protect teeth and gums from microorganisms.

12.

What Is the Effect of Excess Sugar on the Tongue?

The tongue comprises multiple tiny taste buds that help to recognize different tastes as food is swallowed. In diabetic patients, these taste buds are damaged due to excess sugar consumption. It results in oral candidiasis, a fungal infection that can be effectively treated with medications.
Source Article IclonSourcesSource Article Arrow
Dr. Soheel Hussain Zargar
Dr. Soheel Hussain Zargar

Dentistry

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oral hygiene maintenanceoral prophylaxis
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