Diabetes, if uncontrolled, can worsen your oral health in many ways. A sustained increase in blood-glucose levels increases the risk of gum disease (periodontal disease), dry mouth, tooth decay, oral thrush and changes to taste. In this blog, we will discuss these issues relating to diabetes further, and why the diabetic patient should maintain both their blood-glucose levels as well as their oral health to prevent progression of disease.
Gum disease, also known as periodontal disease, refers to infection involving the structures that support teeth including gums and bone. This leads to inflammation and, during the later stages of the disease, break down of these structures, which leads to gum recession, bone loss and mobile teeth.
In those with consistently elevated blood glucose levels, their risk of developing severe gum disease is significantly increased. This relationship is bi-directional, meaning that poor gum health can lead to more difficulty controlling blood glucose levels. Therefore, by maintaining good gum health, diabetes can be more easily controlled – and vice versa!
Diabetes can lead to a reduction in salivary flow and subsequently dry mouth. This salivary gland dysfunction may be associated with sialadenosis, a type of swelling of the salivary glands. A reduction in saliva increases the risk of tooth decay and oral thrush.
Saliva is a protecting factor against tooth decay. A reduction in saliva flow, in conjunction with an increased risk of gum disease can additionally increase the risk of tooth decay. As gum disease may lead to gum recession, the root of the tooth is exposed. This section of the tooth is not covered by a protective layer of enamel, making it more prone to decay. A risk factor for poor diabetic control is a high-sugar diet – as with tooth decay. Therefore, it is important to control blood-sugar levels to help prevent tooth decay.
Oral thrush refers to an infection within the mouth by fungi (also known as oral candidiasis). Poorly controlled diabetes can contribute to an increased risk of oral thrush by reducing the salivary flow (reducing flushing of the fungi from the mouth), suppressing the immune system (preventing elimination of the fungi) and through a high level of glucose within saliva, which feeds the fungi and contributes to its growth.
Sense of taste
Although the cause is unknown, there is a link between diabetes and changes to the taste sensation. This may manifest as a reduced ability to taste (hypogeusia), which in turn can affect the diet. While the relationship between diabetes and oral health may often be looked over, it is important to maintain good control of your blood sugar to prevent complications occurring within your mouth. Similarly, maintaining optimal gum health will facilitate diabetic control.
What can you do to combat these symptoms?
Blood-glucose levels need to be maintained within a healthy range – this can be achieved through avoiding high-sugar diet. To counteract a dry mouth, regular sips of water and chewing gum can help. If dentures are used, they should be cleaned nightly and left to dry overnight. The importance of twice-a-day brushing, cleaning in between teeth every night, and regularly visiting the dentist is paramount for the diabetic patient who is at higher risk of oral health issues.
Dental Health Services Victoria. (2020). Oral health issues linked with diabetes. Retrieved from https://www.dhsv.org.au/dental-advice/general-dental-advice/people-with-diabetes
Diabetes Australia. (2020). Dental Health. Retrieved from https://www.diabetesaustralia.com.au/dental-health
Lamster, I., Lalla, E., Borgnakke, W., & Taylor, G. (2008). The relationship between oral health and diabetes mellitus. Journal of the American Dental Association (1939), 139 Suppl, 19S-24S.
Ship, J. (2003). Diabetes and oral health: An overview. Journal of the American Dental Association (1939), 134 Spec No, 4S-10S.
The University of Iowa. (2018). Gum (Periodontal) Disease. Retrieved from https://www.dentistry.uiowa.edu/patient-care-periodontal
The University of Iowa. (2019). Sialosis or Sialadenosis of the Salivary Glands. Retrieved from https://medicine.uiowa.edu/iowaprotocols/sialosis-or-sialadenosis-salivary-glands
Therapeutic Guidelines Limited. Oral Dental Expert Group. (2019). Therapeutic guidelines. Oral and dental (Version 3.. ed.). North Melbourne: Therapeutic Guidelines Limited.