Diabetes and Oral Health: A Two-way Street

Diabetes mellitus is a condition affecting millions of people worldwide. The Type 2 epidemic continues to grow with the concurrent rise of obesity and deteriorating lifestyle behaviors.

What remains a lesser known fact is that there exists a “two-way” relationship between diabetes and oral health, with one influencing the other.

How does diabetes affect the mouth?

Diabetes alters the immune response of the body to bacterial challenges. It also impairs the ability of the tissues to repair themselves, leading to a slow and often complicated healing of wounds. These mechanisms increase the vulnerability to oral infections.

A review of several clinical studies published in the Journal of Diabetes Research, 2016, revealed oral and dental health problems in 45-88% of Type 2 diabetes patients.

The most common oral changes seen in a diabetic mouth are inflamed gums which bleed on toothbrushing, frequent occurrence of abscesses, rapid bone destruction, and early tooth loss.

Dry mouth can develop in diabetics due to various reasons: excessive urination, salivary gland disorder, or the use of antihypertensive drugs.A reduced flow of saliva increases plaque levels, causing a growth of caries-producing bacteria and leading to dental decay. 

Diabetes also increases the risk of developing fungal infections and lichen planus.

A common complaint among diabetes patients is burning mouth syndrome, an oral manifestation of peripheral neuropathy. This condition can inhibit the ability to maintain a proper diet and glucose control.

Smokers with diabetes have a 20 times higher risk of oral infections than nonsmokers.

Noteworthy is that a well- controlled diabetic is at no greater risk of infection than is the nondiabetic.

How does the mouth affect diabetes?

The effects of oral diseases do not remain confined to the mouth. In April 2016, the American Association of Diabetes Educators   described the relationship between diabetes and oral health as “bi-directional.”They acknowledged a close association between diabetes and oral infections, with one exacerbating the other.

Diseased gums contain a reservoir of bacteria. The toxic products released by these pathogens enter the bloodstream and initiate a series of inflammatory events which reduce the body’s ability to utilize insulin. This state of “insulin resistance” causes an increase in blood sugar levels.

So, what’s the message?

It is not possible to treat diabetes without ensuring the oral and dental health of people with the disease.

A series of consensus reports published jointly in 2013, by the European Federation of Periodontology and the American Academy of Periodontology, have provided some oral health recommendations for diabetics

• People with diabetes should undergo oral health screenings as a matter of routine.
• Because of the high risk of gum disease, preventive measures coupled with frequent recall visits are necessary to ensure stabilization of gum health.
• To avoid a dry mouth, one should stay hydrated, chew sugar-free gum and avoid alcoholic and carbonated beverages.
• Nutrition plays a crucial role in the management of diabetes. To ensure maximal chewing efficiency, one should seek rehabilitation of decayed, damaged or missing teeth.
• Smoking cessation is a pre-requisite to control diabetes as well as to maintain oral health.
• Home oral care should include meticulous toothbrushing along with the use of alcohol-free antiplaque mouthwashes.
• Individuals using appliances with artificial teeth should give careful attention to their hygiene and disinfection. They should also be aware of the necessity to periodically replace them.

Diabetes is a chronic condition and patients are required to manage their disease for decades. Achieving good glycemic control needs daily vigilance. Oral health problems interfere with the regulation of blood glucose levels. Good oral and dental health is crucial to managing diabetes effectively.