Diabetes: Add One More to Your Medical Team
Diabetes is a chronic disease which affects your body’s ability to process sugar. The resulting high blood sugar can cause problems with many parts of the body, can lower your resistance to infection and can slow the healing process.
Diabetics are at greater risk for developing oral health problems. While the oral conditions associated with diabetes can occur in patients without the disease, there are findings which raise our level of suspicion that diabetes is an underlying factor. Dr. Giacalone and Dr. Nevy have often been the first healthcare professionals to recognize that our dental patient has diabetes. The patient is referred to their primary medical doctor for confirmation of the diagnosis and treatment.
The most common oral health problems associated with diabetes are:
- Gum disease: Diabetics are at greater risk for developing both types of gum disease, gingivitis (early form of the disease where no bone is lost) and periodontal disease (bone loss present). Both gingivitis and periodontal disease are inflammatory diseases. Disease begins when bacteria in the plaque (the sticky colorless film that continuously forms on the teeth) causes the gums to become inflamed. Toxins produced by bacteria in the plaque irritate the gums. The toxins stimulate a chronic inflammatory response. The body mounts a defense to rid itself of the disease producing bacteria and their toxic by-products, and in doing so destroys itself in the process. The bone that supports the teeth is destroyed, Plaque is able to migrate further down the root surface harboring more dangerous bacteria as it does so. The more the disease progresses, the more aggressive the response. A vicious cycle can take place unless treatment is rendered. Without intervention teeth may be lost. Since diabetes impairs one’s ability to fight infections and to heal, fighting gum disease is more difficult.
Not only does diabetes put an individual at higher risk for gum disease, but conversely, gum disease makes diabetes harder to control. Blood sugar increases with infection. In my career I have had more than a few diabetic patients who were sent to our practice to have all sources of dental infection diagnosed and treated for the purpose of getting blood sugar under control. After dental treatment the blood sugar indeed was easier to manage.
- Fungal infections: Since diabetes compromises the immune system, a diabetic is prone to developing fungal infections. The most common fungal infection is candida or thrush. It often appears as a white film on the tongue, palate, cheeks or throat. Symptoms include painful sores and difficulty swallowing.
- Infection and delayed healing: When a diabetic patient requires oral surgery, the dental surgeon usually consults with the patient’s primary medical doctor or endocrinologist to access the patient’s status. A well-controlled diabetic without other serious medical compromises can often have dental procedures including dental implants with the same success as healthy patients. Many times antibiotics before and after surgery are used to assist the patient,compromised by diabetes ,with infection control. Blood sugar is monitored as well as other vital signs at the time of surgery. Sometimes the medical team must work together to improve the blood sugar before surgery can be performed. In severe cases, non-elective dental surgery must be done in a hospital setting to better manage the medical complexities that may arise.
- Poor Nutrition: Tooth replacement which will allow for proper chewing and digestion of healthy whole foods is important for all but more so for the diabetic. Tooth replacement with implants, implant retained dentures, well –designed, well- fitted removable partial and full dentures is essential to proper nutrition.
Diabetics should make their dentist part of their medical team to help control blood sugar and maximize quality of life.