Diabetes and Oral Health

How does diabetes affect the mouth?

People who have diabetes know the disease can harm the eyes, nerves, kidneys, heart and other important systems in the body. Did you know diabetes can also cause problems in your mouth?

Tooth and gum problems can happen to anyone, but risk for these problems is increased when you have diabetes. A sticky film of bacteria, called plaque, builds up on your teeth and can lead to gum disease and other oral health complications. High blood glucose helps this bacteria grow.

• Periodontal (gum) disease - People with diabetes are at special risk for mouth infections, especially periodontal (gum) disease, an infection of the gum and bone that hold the teeth in place. Periodontal disease can lead to painful chewing difficulties and even tooth loss. Periodontal disease may also make it hard to control your blood glucose (blood sugar). Red, sore, and bleeding gums are the first sign of gum disease. These problems can lead to periodontitis. Periodontitis is an infection in the gums and the bone that holds the teeth in place. If the infection gets worse, your gums may pull away from your teeth, making your teeth look long.
• Dry Mouth & Thrush - Often a symptom of undetected diabetes, dry mouth can cause soreness, ulcers, infections, and tooth decay. Dry mouth happens when you do not have enough saliva - the fluid that keeps your mouth wet. Diabetes may also cause the glucose level in your saliva to increase. Together, these problems may lead to  a fungal infection called thrush, which causes painful white patches in your mouth.

Smoking makes these problems worse.

How do I know if I have damage to my teeth and gums?

If you have one or more of these problems, you may have tooth and gum damage from diabetes:

• red, sore, swollen gums
• bleeding gums
• gums pulling away from your teeth so your teeth look long
• loose or sensitive teeth
• bad breath
• a bite that feels different
• dentures (false teeth) that do not fit well

Diabetes can cause serious problems in your mouth.
You can do something about it.

People with poor blood glucose control get gum disease more often and more severely than people whose diabetes is well controlled. Daily brushing and flossing, regular dental check-ups and good blood glucose control are the best defense against the oral complications of diabetes.

• Take time to check your mouth regularly for any problems. Sometimes people notice that their gums bleed when they brush and floss, others notice dryness, soreness, white patches, or a bad taste in the mouth. All of these are reasons to visit your dentist.
• Use dental floss at least once a day. Flossing helps prevent the buildup of plaque on your teeth. Plaque can harden and grow under your gums and cause problems. Using a sawing motion, gently bring the floss between the teeth, scraping from bottom to top several times.
• Brush your teeth after each meal and snack. Use a soft toothbrush. Turn the bristles against the gum line and brush gently. Use small, circular motions. Brush the front, back, and top of each tooth.
• If you wear false teeth, keep them clean. Tell your dentist if your dentures (false teeth) do not fit properly.
• Communicate with your dentist. Call your dentist right away if you notice problems with your teeth and gums: if you have red, sore, or bleeding gums; gums that are pulling away from your teeth; a sore tooth that could be infected; or soreness from your denture, or some other problem. Be sure your dentist knows that you have diabetes.
• Get your teeth cleaned and your gums checked by your dentist twice a year.
• Listen to your dentist. If your dentist tells you about a problem, take care of it right away.
• Don't smoke. If you smoke, talk with your doctor about ways to quit smoking.

How can my dentist help take care of my teeth and gums?
Work together to maintain your oral health!

It's important to have good communication with your dentist, and to follow-up with regular visits. To help take care of your teeth and gums, your dentist can:

• clean and check your teeth and gums twice a year
• teach you the best way to brush and floss your teeth
• tell you if there are problems with your teeth or gums and what to do about them
• make sure false teeth fit well

Plan Ahead for Dental Work
Those with diabetes may need to take special precautions before and after a visit to the dentist.

You may be taking a diabetes medicine that can cause low blood glucose, also called hypoglycemia. Talk with your doctor and dentist before a visit about the best way to take care of your blood glucose during the dental work. You may need to bring some diabetes medicine and food with you to the dentist's office.

If your mouth is sore after the dental work, you might not be able to eat or chew for several hours or days. For guidance on how to adjust your normal routine while your mouth is healing, ask your doctor:

• what foods and drinks you should while healing after dental work
• if and how you should change your diabetes medicines
• how often you should check your blood glucose

What should I do each day to stay healthy with diabetes?

For More Information

Diabetes Teachers (nurses, dietitians, pharmacists, and other health professionals)
To find a diabetes teacher near you, call the American Association of Diabetes Educators toll-free at 1-800-TEAMUP4 (832-6874), or look on the Internet at www.diabeteseducator.org and click on "Find a Diabetes Educator."

Dietitians
To find a dietitian near you, call the American Dietetic Association toll-free at 1-800-877-1600, or look on the Internet at www.eatright.org and click on "Find a Nutrition Professional."

Government
The National Institute of Dental and Craniofacial Research (NIDCR) is part of the National Institutes of Health. To learn more about tooth and gum problems, write or call the NIDCR's information clearinghouse, the National Oral Health Information Clearinghouse (NOHIC), at 1 NOHIC Way, Bethesda, MD 20892-3500, 301-402-7364; or see www.nidcr.nih.gov/OralHealth/OralHealthInformation.

To learn more about diabetes and oral health, please see: http://diabetes.niddk.nih.gov/dm/pubs/complications_teeth/teeth.pdf