Are there mouth problems related to diabetes?
Maintaining excellent dental health is decisive, quite apart from what happens in the mouth. The reverse is also possible: your general state of health can worsen oral health problems. Stress, for example, has been linked to a range of them. Does the same apply to diabetes? Can diabetes cause problems with the mouth? Is there a two-way connection between oral health problems and the severity of diabetes?
Unfortunately the answer is yes in both cases
Diabetes can lead to problems with the mouth and with oral hygiene. And oral health problems are another risk factor that can make managing diabetes harder. Given the connection between diabetes and heart disease and stroke, it is clear that this is a vicious circle in which both conditions, if not kept under control, can further harm and even kill people. In this article we examine the interaction between the two, discuss possible oral health problems and give pointers on what to do next.
There is not one but several variables that can cause oral health problems in people with diabetes. It would be simpler to look at the relationship the other way round and consider the conditions necessary for mouth problems to spread. Plaque, a sticky film that forms on the teeth, is the result of the interaction between high levels of sugar and starch and the bacteria naturally present in the mouth. Since the acids in this plaque attack the surface of the tooth, decay and gum disease can result. Diabetes leads to a rise in blood sugar, which makes more sugar and starch available to the bacteria. The damage increases as more plaque is formed.
Dry mouth
A dry mouth is frequently, at least in part, the cause of oral health problems. People with diabetes often have a relative lack of saliva, which raises the risk of a range of dental and oral diseases, since dryness goes along with reduced saliva production. An oral condition such as periodontitis, a significant gum disease that occurs three times more often in people with diabetes, very probably raises blood sugar and makes diabetes harder to control. This unfavourable connection also works in the other direction. There are numerous peer-reviewed scientific studies documenting the connection between oral health problems and diabetes and the reverse relationship.
Once the connection is established, it is important to understand which dental health problems diabetes can cause. As described above, the build-up of plaque can lead to problems ranging from mild gum disease, or gingivitis, which is troublesome but manageable, to severe gum disease, or periodontitis. If plaque remains on the surface of the tooth, over time it irritates the gum so that it swells and bleeds easily. That condition is called gingivitis, and another typical effect is bad breath. Even if gingivitis can be painful, it is not a condition that causes long-term damage by itself and is relatively easy to cure: it is enough for a hygienist to remove the tartar. Gingivitis can, however, develop into periodontitis, a more serious form of gum disease. This condition leads to the breakdown of bone and tissue around the teeth, which raises the risk that they will loosen and eventually fall out.
A serious condition
A serious condition called periodontitis is associated with heart disease and can worsen diabetes. Since it requires special treatment, using a strong mouthwash does not help either. For someone with bleeding gums it can be quite difficult to distinguish gingivitis from periodontitis, since the symptoms are identical although the damage is very different. It is important to have the symptoms examined thoroughly. People with diabetes in particular should follow that advice, since their risk of developing periodontitis is 300 per cent higher.
Infection
Diabetes can also cause thrush, a fungal infection that can lead to ulcers — painful white and red patches in the mouth. It can also lead to a dry mouth, which raises the risk of gum disease, since the mouth lacks the saliva that normally helps fight bacteria. In summary, patients with diabetes very frequently suffer from gum disease.
Reducing the risk
Good dental care is the first piece of advice for people with diabetes, as for everyone else. Teeth should be brushed twice a day with an electric brush, and floss or an interdental brush should be used too. Your diet also affects your oral health: meals high in sugar or acid are clearly harmful.
Do not smoke
Smoking should also be avoided, since it greatly raises the risk of gum disease and oral cancer. A more specific piece of advice would be always to mention your diabetes when visiting your dentist and hygienist. It is crucial that the health of your gums is examined and tracked over time so that any problems are recognised early, since the risk of gum disease and the associated effects on diabetes are raised.
Next steps
Simple improvements to oral hygiene and a change of diet are the next steps for anyone with diabetes concerned about their dental health — and for smokers, try to stop or at least cut down. Arrange a check-up with a dentist, ideally one with a team of hygienists and a periodontist, so that a referral can easily be made if gum problems are discovered.
