Diabetes and Dental Care

People with diabetes are more at risk of periodontal disease than those without, but periodontal disease can also exacerbate the chronic metabolic condition.

“It’s a two-way street,” says Martin Gillis, assistant professor of dentistry at Dalhousie University. “There’s a bidirectional relationship.”

Diabetes’ sixth complication

Periodontal disease is often considered the sixth complication of diabetes, in which the body makes insufficient amounts of insulin, a hormone required to control glucose levels in the blood, or doesn’t use insulin properly.

Those who don’t have their diabetes under control are especially at risk.

“Inflammation in the mouth can cause infection, and people with diabetes have a compromised ability to deal with infection,” Gillis says, who’s also a member of the International Diabetes Federation’s consultative section on diabetes education.

“This can affect insulin sensitivity. It can impair the ability to metabolize glucose and increase episodes of hyperglycemia [high].” As a result, people can be more prone to other complications of diabetes, such as kidney damage and blindness.

Furthermore, untreated periodontal problems can result in bacteria eventually entering the bloodstream, putting patients at increased risk for cardiovascular disease, which is the leading cause of death among diabetics.

The tissues that surround and support the teeth are known collectively as the periodontium. Gum disease begins when plaque, a white and sticky substance also known as “biofilm” that contains bacteria, forms on the teeth and gums. Gingivitis is the first stage of gum disease and can be reversed with proper dental hygiene.

But if plaque isn’t removed by regular, diligent brushing and flossing, it can harden into calculus, or tartar. From there, gingivitis can progress to more damaging phases of periodontal disease. See sidebar below for symptoms of periodontal disease.

Sometimes the tissue around the teeth is affected; in other cases gum disease can impact the supporting bone structure, and infection can spread to tissue in the neck and face.

Get back at gum disease

As many as 50 percent of people have gingivitis, while moderate to severe periodontitis affects another 5 to 15 percent of the population, according to the International Diabetes Federation.

Visit your dentist—often
Although financial barriers and fear are factors that can keep people away from the dentist’s office, Gillis urges routine visits.

“Regular, professional dental care is important, and it’s doubly important among people with diabetes,” Gillis says, noting that people should visit the dentist at least once a year. “That way, these problems can be recognized and picked up early.”

Bacteria and infection can be treated with a professional cleaning, including scaling, to remove tartar and plaque. Some dentists or hygienists may use a laser to remove plaque and tartar, which causes less bleeding, swelling, and discomfort.

Brush and floss twice daily
Self-care is crucial. Brushing at least twice daily and flossing at least once a day are necessary for good oral health. But a healthy lifestyle is just as important.

Eat well
Proper nutrition plays a key role in the prevention and management of periodontal disease and diabetes. Sugar is related to the formation of cavities. Tooth loss makes it harder to chew and, as a result, sometimes tougher to eat nutritious food.

Quit smoking
Smoking is one of the greatest risk factors for the development and progression of gum disease. Smokers are more likely than nonsmokers to have tartar (plaque that hardens on your teeth) and loss of bone and tissue that support the teeth.

Reduce stress
Even stress can contribute to gum disease, so making time for relaxation and regular exercise benefits oral health as much as overall well-being.

Natural approaches to dental health

Rinse
Consider an antimicrobial rinse, but be sure it’s water-based. Those with alcohol can cause dry mouth and make oral problems worse.

Supplement
Certain supplements support dental health. Omega-3 fatty acids and antioxidants such as vitamin C and coenzyme Q₁₀ help mitigate the inflammatory process in periodontal disease. Vitamin D has anti-inflammatory effects and may decrease the risk of gum disease.

Read labels
Tartar-control toothpastes help prevent tartar formation but can’t remove tartar once it has formed.
Sweeten naturally

Look for xylitol, a natural sweetener derived from the fibrous parts of plants. It prevents bacteria from sticking to the teeth and is said to have anticavity properties.

Avoid additives
Avoid dental care products containing sodium lauryl sulphate, which is used to create foam but also contributes to dry mouth and canker sores.

Probiotics
Although used widely to enhance digestive health, probiotics might also support oral health. More than 600 types of bacteria are found in the mouth, and although most are harmless, some are associated with oral disease. More research is needed, but probiotics appear to help balance oral microflora and could reduce the risk of periodontal disease as a result.

Go electric
The oscillating motion of an electric toothbrush thoroughly removes plaque and helps clean around obstacles such as braces, crowded teeth, and hard-to-reach areas. Most have a timer on them signalling when two minutes is up, the recommended amount of time people should be brushing.

Try oral irrigation
Devices that provide a pulsating stream of water to flush food and bacteria and stimulate gums help keep the whole mouth cleaner and healthier. Some are powered; some are cordless; some attach to shower heads or faucets.

Tea tree oil
Shown to have antibiotic properties, tea tree oil is used by some people to manage chronic gingivitis.

Cranberry
Cranberry may help prevent bacteria from sticking to teeth. Look for pure juice with no added sugar.

Symptoms of periodontal disease

• change of colour of the gums
• signs of infection between teeth
• foul breath
• changes in bite
• pain when chewing or swallowing
• loose teeth
• painful, swollen, or bleeding gums