About diabetes

Diabetes affects how your body turns food into energy. It is one of the most common chronic health conditions, affecting more than 30 million people in the USA alone. Nearly 25% of people with diabetes don't realize they have it.

What's more, 88 million Americans are pre-diabetic, a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of Type 2 diabetes. Shockingly, 84% of pre-diabetics don't realize they have it. This is concerning because those with pre-diabetes are at increased risk for diabetes, heart disease, and stroke.¹

There are three types of diabetes:

• Type 1 diabetes is an autoimmune disease in which the pancreas creates little or no insulin. 5% to 10% of all diabetes cases are Type 1.
• Type 2 diabetes accounts for 85% to 90% of diabetes cases. With Type 2 diabetes, the tissues in your body have a decreased response to insulin, production of insulin is poorly regulated, or both.²
• Gestational diabetes is an intolerance to glucose that may occur in the second half of pregnancy.

Some of the food you eat is broken down into glucose (sugar) and released into your bloodstream. When blood sugar levels increase, your pancreas releases the hormone insulin, which tells your cells to use the blood sugar for energy. Diabetes results when your body does not produce enough insulin or can't use the insulin it makes as well as it should.

Without enough insulin, or if your cells stop responding to it, too much sugar remains in your bloodstream, and the viscosity of your blood increases. Over time, this can lead to serious problems in your heart, eyes, kidneys, nerves, and other body systems.³ In addition, poorly controlled diabetes weakens certain white blood cell functions, which are the body's main defense against infections. The presence of higher blood sugar levels can also lead to greater inflammation throughout your body.

Diabetes and your oral health

Your mouth can be seriously affected by diabetes but is often overlooked. Studies have shown that diabetes can increase your risk of severe periodontal disease by three times.⁴ This is mainly due to increased inflammation and the reduced circulation of healing and immune cells through the small blood vessels of your oral tissues. Untreated, periodontal disease can result in deterioration of the tissues and bone that support your teeth. This can lead to:

• Bleeding
• Pain
• Tooth decay
• Bacterial infections
• Fungal infections (thrush)
• Poor healing
• Dry mouth
• Tooth loss
• Bad breath
• Difficulty chewing
• Poor nutritional choices

While diabetes can negatively affect your oral health, poor oral health can also negatively affect your diabetes. Periodontal disease elevates blood sugar levels, making diabetes and related problems harder to manage.⁵ Studies have shown that over time properly treated and maintained gum disease significantly lowers blood sugar in people with Type 2 diabetes.⁶

Make oral health a priority: You should practice a lifetime of good oral hygiene, regular dental visits, and addressing any issues through treatment or lifestyle changes. Maintaining a healthy oral routine will reduce the risk of diabetes impacting your oral health and your oral health impacting your diabetes.

• Make sure you are brushing at least twice a day with a soft-bristled brush and fluoride toothpaste. If your gums bleed, don't stop brushing your teeth. Bleeding gums may be a sign of inflammation or plaque build-up below your gum line, which requires more attention, not less.
• Flossing at least once a day helps remove plaque from between teeth where brushes do not reach.
• If you wear dentures, remove and clean them every day.
• Drink water containing fluoride. If your dentist feels that you are not getting enough fluoride from your water sources, they may suggest fluoride supplements.
• Keep all of your dental appointments as recommended. If your diabetes is not well-controlled, your dentist may suggest more frequent visits.

Inform your dentist: Systemic diseases such as diabetes can have symptoms that display in your mouth. That's why it's so important to visit your dentist regularly. Based on your symptoms, your dentist may be the first healthcare provider to suspect the symptoms could be related to elevated blood sugar levels. Your dentist may conduct a diabetes screening, including a glucose level reading, as part of their examination. They will discuss their findings with you, and based on their determinations, may refer you to a physician for further tests.

• When your dentist or hygienist conducts a health history and current health status with you, be sure to tell them if you have been diagnosed with pre-diabetes or diabetes. Also, discuss any other common risk factors for diabetes, such as obesity, high blood pressure, high cholesterol, or a family history of diabetes. You should also mention if you had gestational diabetes during a past pregnancy or delivered a baby weighing over nine pounds.

• Let your dentist know if you've noticed any of the symptoms of periodontal disease or other peculiar issues, such as bleeding, rashes, swollen gums, mouth sores, loose teeth, or dentures that no longer fit properly.

• If you have been diagnosed with diabetes, be sure to provide your dentist and physician with each other's contact information. Also, ask your dentist to send your oral exam results to your doctor after every dental visit. This is important so they can keep each other informed of your treatment progress and educated about possible disease interactions.⁷

Prepare for your visit: Ask your dentist to walk you through their office safety protocols specific to diabetic patients, including staff training on recognizing signs of low blood sugar and how to take appropriate action.

Try to get morning appointments as the risk for low blood sugar tends to be lower than during other parts of the day. Be sure to eat normally prior to your appointment and take your medications as usual.⁸

Dental treatment with diabetes: Dental treatment for people with both diabetes and periodontal disease typically begins with X-ray images and probing of the gums to determine periodontal disease severity. Based on the results, your dentist may continue to monitor the situation, perform a non-surgical cleaning of your teeth (scaling and root planing), or refer you to a periodontist for further evaluation and additional treatment.⁹

If your diabetes is well-controlled, most non-surgical and surgical dental procedures can be performed without additional risks. If a procedure is expected to affect your ability to eat for a period of time following the treatment, you and your dentist should establish a plan in advance to balance your medications and food intake. For surgical procedures, your dentist may recommend antibiotics to reduce the risk of post-operative infections.

For patients with poorly or marginally controlled diabetes, your dentist will exercise their clinical judgment when determining if a procedure should be performed. Your dentist may consult with your physician to better understand your risks and the stability of your general health before dental procedures are performed. More invasive procedures and purely elective procedures such as cosmetics may need to be delayed until your diabetes is better controlled.²

Thrush: If you have a fungal infection (thrush) in your mouth, your dentist or doctor may prescribe a medicine to kill the fungus. Your dentist may also prescribe a special solution to eliminate the fungus from dentures or bridges.⁹

Dry mouth: Dry mouth is a condition that reduces the ability of your salivary glands to keep your mouth wet. Healthy saliva flow is important to washing away bacteria, reducing salivary acid levels, and preventing mouth sores or ulcers. If you are suffering from dry mouth, your dentist may prescribe a medicine to increase your saliva flow. They may also work with you and your physician to determine if there are alternative medications that may reduce your symptoms if medications are causing your mouth to be dry.⁹

Nutrition: Controlling your diabetes, and therefore reducing your risk of periodontal disease, includes a combination of weight loss, healthy diet, exercise, and medication as prescribed. Severe periodontal disease can loosen your teeth and make chewing difficult, leading to unhealthy food choices. Be sure to talk to your dentist and physician about ways to ensure you can maintain a healthy nutritional balance.

Lifestyle choices: Avoid alcohol, drug use, and tobacco use.

Elective procedures: To reduce the risk of infection, you may want to consider delaying invasive elective procedures until your diabetes is well-controlled and your dentist agrees the procedures pose no additional risk.

Pre-diabetes: As part of your regular physical exams, your physician should periodically test your blood sugar (HbA1c) levels to determine if your blood glucose levels are increasing or decreasing over time. If you have pre-diabetes, you should manage your dental health in the same way you would if you were diagnosed with diabetes.³

Gestational diabetes: Gestational diabetes is an intolerance to glucose that occurs in the second half of pregnancy in about 4% of women who don't otherwise have diabetes. Gestational diabetes is caused by hormones in the placenta and results in insulin resistance or insulin deficiency. Gestational diabetes usually resolves itself after giving birth, but those who have had gestational diabetes are at an increased risk of developing Type 2 diabetes later in life.²

Kidney disease: Diabetes can be a major contributor to kidney disease (chronic renal disease or CRD). High blood sugar damages cells and blood vessels in your kidneys, so they don't filter out waste as well. About one in three adults with diabetes has CRD. Kidney disease can make you prone to or exacerbate many of the same oral conditions as diabetes, such as tooth decay, periodontal disease, poor healing, inflammation, bleeding, and dry mouth.⁶