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Family Health Magazine
DIABETES

Diabetes and Oral Health
Your condition can contribute to gum disease

Are you aware that diabetes can play a role in the overall health of your mouth? Since diabetes can contribute to gum disease, people with diabetes have a higher than average risk of developing it. The good news is you can prevent gum problems by taking excellent care of your teeth at home and visiting the dentist regularly.

The first step in the battle against gum disease is the control of blood sugar levels. Poorly controlled blood sugar levels can cause increased glucose in saliva. Bacteria use this sugar to grow. When blood sugar levels are controlled, excess sugar is not available for bacterial growth that contributes to the progression of gum disease. As long as blood sugar is controlled, people with diabetes are at no greater risk than anyone else to develop gum disease.

Stages of Gum Disease

Gum disease, also known as periodontal disease, goes through different stages of development. The first stage is gingivitis which happens when a person is not practising adequate care of their mouth at home. Without regular brushing and flossing, pieces of food and bacteria build up on the teeth, forming plaque. Excess blood sugar adds to the problem. Red and swollen gums develop which bleed easily when brushed or during eating. At this stage, gingivitis is reversible through adequate care. If left uncontrolled, it will progress to periodontitis.

Periodontitis involves the destruction of the supporting structures including the gums and bone around teeth. Plaque and calculus (hardened plaque) build up under the gum line between the gums and the roots of the teeth. Gums begin to pull away from the roots. This 'unzipping' of the gum tissue from the root coincides with bone loss and produces areas called pockets. A pocket is the area from the top of the gums to the bottom of the unzipped tissue and bone level.

As pockets deepen, an abscess can form as teeth loosen or are even lost. Seventy per cent of all teeth lost in our population after the age of 45 are due to periodontal disease. Not only does this infection cause the loss of teeth, it can make it more difficult to control blood sugar levels. If there is poor control of blood sugar, a person is more susceptible to periodontal disease. It becomes a vicious circle of disease progression.

Treatment of Gum Disease

Treatment of gum disease should always start with improved oral care at home. Brush with a soft toothbrush at least twice a day. Alternative brushes or aids may be suggested by your dental team to help remove irritants. Always use a soft toothbrush since stiffer bristles can wear away gum tissues. This can lead to the gums receding or dropping in height to avoid the irritation of the brush. Flossing between teeth should also be done daily using a piece of floss about a foot and a half long. Using a sawing motion, curve the floss around each tooth front and back. Gently scrape each area from below the gum line to the top of the tooth three to four times.

Visit your dentist for a check-up, and have your teeth cleaned regularly. If the disease has progressed, your dentist or periodontist (gum specialist) may suggest a deep cleaning with or without freezing. Removing the irritants from along the root surface may zip the tissues back up to approach the top of the gums.

If deep cleaning is not successful, surgery may be required to stop the progression of the disease - common when pockets are too deep or hard to reach. During surgery, the gums are pulled away from the roots of the teeth. The dentist or specialist can then see and remove all the plaque, calculus and irritants. The tissue is then stitched back in place. With the recent advances in dentistry, even lost bone can now sometimes be regenerated by replacement methods.

Before any dental treatment, discuss the type and present level of control of your diabetes and blood sugar levels with your dentist. Morning appointments are generally the best. Take your insulin or oral medication and eat a regular breakfast. Keep your appointments as short and stress-free as possible.

If you feel any symptoms associated with a low blood glucose level, inform the dental team immediately. If surgery is required, antibiotics may be needed. As well, you may need to change your diet if chewing is affected. If your blood sugar is not under control, hold off on any dental treatment unless it is an emergency.
Periodontal therapy is always ongoing. Even if surgery is successful, there is no guarantee that the disease will not return or progress. This is why regular dental visits and very careful home care are important.

Look for telltale signs of the health of your teeth and gums. The following indicate that you could have one of the stages of gum disease:

• swollen, red gums that bleed easily
• persistent bad breath
• pus coming from your gums
• a recurring bad taste
• loose teeth.

If you have any of the above concerns, contact your dentist. Sometimes being seen every six months is not enough, and more frequent visits are required.

Controlling your blood sugar is the most important step you can take to prevent tooth and gum problems. If you have poorly controlled diabetes, you are more likely to develop gum infections than people who do not have diabetes. Diabetes does not cause gum disease, but can contribute to its progression. Much of what you eat requires good teeth and gums for chewing.

Have a dental check-up every six months and be sure to ask your dentist to demonstrate procedures and aids available that will help you to maintain great oral health. By developing an acceptable home routine and controlling blood sugar levels, you can easily maintain your teeth for a lifetime!