Diabetes and Your Smile

By Laura Martin, Case Western Reserve University School of Dental Medicine

Did you know that 29.1 million people living in the United States have diabetes? That’s 9.3% of the population. Approximately 1.7 million new cases are diagnosed each year—and 8.1 million people living with diabetes don’t even know they have it.

Diabetes affects your body’s ability to process sugar. All food you eat is turned to sugar and used for energy.

- In Type I diabetes, the body doesn’t make enough insulin, a hormone that carries sugar from your blood to the cells that need it for energy.

-In Type II diabetes, the body stops responding to insulin. Both cases result in high blood sugar levels, which can cause problems with your eyes, nerves, kidneys, heart and other parts of your body.

So what does this have to do with that smile of yours — and how can you protect it? First, it’s important to understand the signs of diabetes and the roles they play in your mouth.

The Symptoms of Untreated Diabetes

The warning signs of diabetes affect every part of your body. After a blood test, you may be told by a doctor that you have high blood sugar. You may feel excessively thirsty or have to urinate a lot. Weight loss and fatigue are other common symptoms. Diabetes can also cause you to lose consciousness if your blood sugar falls too low.

If diabetes is left untreated, it can take a toll on your mouth as well.

Here's how:

*You may have less saliva, causing your mouth to feel dry. (Dry mouth is also caused by certain   medications.)
*Because saliva protects your teeth, you’re also at a higher risk of cavities.
*Gums may become inflamed and bleed often (gingivitis).
*You may have problems tasting food.
*You may experience delayed wound healing.
*You may be susceptible to infections inside of your mouth.
*For children with diabetes, teeth may erupt at an age earlier than is typical.

Why People with Diabetes Are More Prone to Periodontal (Gum) Disease

All people have more tiny bacteria living in their mouth now than there are people on this planet. If they make their home in your gums, you can end up with periodontal disease. This chronic, inflammatory disease can destroy your gums, all the tissues holding your teeth and even your bones.

Periodontal disease is the most common dental disease affecting those living with diabetes, affecting nearly 22% of those diagnosed. Especially with increasing age, poor blood sugar control increases the risk for gum problems.  In fact, people with diabetes are at a higher risk for gum problems because of poor blood sugar control. As with all infections, serious gum disease may cause blood sugar to rise. This makes diabetes harder to control because you are more susceptible to infections and are less able to fight the bacteria invading the gums.

How Your Dentist Can Help You Fight Diabetes

Regular dental visits are important. Research suggests that treating gum disease can help improve blood sugar control in patients living with diabetes, decreasing the progression of the disease. Practicing good oral hygiene and having professional deep cleanings done by your dentist can help to lower your HbA1c. (This is a lab test that shows your average level of blood sugar over the previous three months. It indicates how well you are controlling your diabetes.)

Your Diabetes Dental Health Action Plan

Teamwork involving self-care and professional care from your dentist will be beneficial in keeping your healthy smile as well as potentially slowing progression of diabetes.

Here are  things you can do to for optimal wellness:

*Control your blood sugar levels by using your diabetes-related medications as directed.
* Changing to a healthier diet and exercising more can help. Good blood sugar control will also help your body fight any bacterial or fungal infections in your mouth and help relieve dry mouth caused by diabetes.
*Avoid smoking.
*If you wear any type of denture, clean it each day.
*Make sure to brush twice a day with a soft brush and floss correctly daily.
*See your dentist for regular checkups.

This artical first appeared in mouthhealthy.org

The Link Between Medications and Cavities

You may wonder why you’re suddenly getting cavities when you haven’t had them in years. As we get older, we enter a second round of cavity prone years. One common cause of cavities in older adults is dry mouth. Dry mouth is not a normal part of aging. However, it is a side-effect in more than 500 medications, including those for allergies or asthma, high blood pressure, high cholesterol, pain, anxiety or depression, Parkinson’s and Alzheimer’s diseases.This is just one reason why it’s so important to tell your dentist about any medications that you’re taking. Your dentist can make recommendations to help relieve your dry mouth symptoms and prevent cavities.

Here are some common recommendations:

* Use over-the-counter oral moisturizers, such as a spray or mouthwash.
* Consult with your physician on whether to change the medication or dosage.
* Drink more water. Carry a water bottle with you, and don’t wait until you’re thirsty to drink. Your      mouth needs constant lubrication.
* Use sugar-free gum or lozenges to stimulate saliva production.
* Get a humidifier to help keep moisture in the air.
* Avoid foods and beverages that irritate dry mouths, like coffee, alcohol, carbonated soft drinks, and    acidic fruit juices.
* Your dentist may apply a fluoride gel or varnish to protect your teeth from cavities.

Gum Disease

Many older adults have gum, or periodontal disease, caused by the bacteria in plaque, which irritate the gums, making them swollen, red and more likely to bleed. One reason gum disease is so widespread among adults is that it’s often a painless condition until the advanced stage. If left untreated, gums can begin to pull away from the teeth and form deepened spaces called pockets where food particles and more plaque may collect. Advanced gum disease can eventually destroy the gums, bone and ligaments supporting the teeth leading to tooth loss. The good news is that with regular dental visits gum disease can be treated or prevented entirely.

Mouth Cancer

According to the American Cancer Society, there are about 35,000 cases of mouth, throat and tongue cancer diagnosed each year. The average age of most people diagnosed with these cancers is 62. During dental visits, your dentist will check for any signs of oral cancer. Regular dental visits are important because in the early stages oral cancer typically does not cause pain and early detection saves lives. Some symptoms you may see include open sores, white or reddish patches, and changes in the lips, tongue and lining of the mouth that lasts for more than two weeks.

Paying for Dental Care after Retirement  

Many retirees don’t realize that Medicare does not cover routine dental care. Begin to plan for your dental expenses in advance of retirement so you don’t have to let your dental health suffer once you’re on a fixed income. Organizations like AARP offer supplemental dental insurance plans for their members.

Discount dental plans are another option that typically have a lower monthly fee than traditional dental insurance. You select a dentist within the plan network who has agreed to provide certain services for 10 to 60 percent less than the typical fee. You pay the reduced fee out-of-pocket, and there is no claim paperwork to fill out. You can search for a dental plan at the National Association of Dental Plans website. Many dentists offer no interest or low interest financing plans that may be a better option than paying for your dental work on a household credit card with a higher interest rate. If you have concerns about continuing your dental care due to a limited income, talk to your dentist. He or she may be able to offer solutions.

Do I Need to Take an Antibiotic before a Dental Procedure?

If you have a heart condition or artificial joint, be sure to tell your dentist. You may think it’s not relevant. After all, what do your heart and joints have to do with your teeth? But, there are conditions with a high risk of infection and an antibiotic is recommended prior to some dental procedures.

Dentists follow recommendations that have been developed by the American Heart Association and the American Academy of Orthopedic Surgeons in cooperation with the American Dental Association. Talk to your dentist about how these recommendations might apply to you.

Care giving for a Disabled or Elderly Loved One

You may have a parent, spouse or friend who has difficulty maintaining a healthy mouth on their own. How can you help?

                        Two things are critical:

-Help them keep their mouth clean with reminders to brush and floss daily.
-Make sure they get to a dentist regularly.

These steps can prevent many problems, but tasks that once seemed so simple can become very challenging. If your loved one is having difficulty with brushing and flossing, talk to a dentist or hygienist who can provide helpful tips or a different approach. There are dentists who specialize in caring for the elderly and disabled. You can locate a specialist through the Special Care Dentistry Association’s referral directory. For those who wear dentures, pay close attention to their eating habits. If they’re having difficulty eating or are not eating as much as usual, denture problems could be the cause.

When you’re caring for someone who is confined to bed, they may have so many health problems that it’s easy to forget about oral health. However, it’s still very important because bacteria from the mouth can be inhaled into the lungs and cause pneumonia.

If you are a representative for a nursing home resident who needs dental care and is enrolled in Medicaid, there is a regulation, called an Incurred Medical Expense, that may help pay for medically necessary care as determined by a dentist. The Medicaid caseworker at the nursing facility and the dentist providing care can work together to apply the Incurred Medical Expense to pay for needed dental benefits.

This article appeared on ADA mouthhealthy.org