Oral And Dental Health In Diabetes Patients

Diabetes, known to the general population as ” sugar disease” and one of the most common chronic diseases in the world, occurs when the insulin hormone produced is not used effectively or the pancreas does not produce enough insulin hormone. There are two different types of diabetes: failure to produce insulin causes type 1 diabetes (insulin-dependent) and insulin resistance causes type 2 diabetes (non-insulin-dependent). As a result, in both types of diabetes, the person cannot use the glucose that enters the blood from food, and then the blood sugar rises. In this case, ” hyperglycaemia” occurs. Abnormalities in insulin levels and increased blood sugar cause vascular, metabolic, immunological and Neuropathic changes. Because of these complications, diabetes patients have a low quality of life and a high morbidity rate. In addition, the most common health problems in diabetes patients include oral, dental and gum disease. Studies have shown that most patients with diabetes have had at least one of the oral, dental and gum diseases for 5 years or more.

In diabetics, the increased sugar content in the blood and saliva causes infection of the vascular beds and other tissues. The oral mucosa, teeth and gums are directly affected by this inflammation. In addition to chronic, low-grade inflammation, a deficiency of the immune system triggers the onset of infection of the gums, periodontium and teeth in these patients. On the other hand, a diabetic’s poor oral health and periodontal disease will focalise the infection, increasing the need for insulin and raising blood sugar. With the increased blood sugar, inflammation and immune deficiency in the tissues increase and a vicious cycle is created. From this incident we know that there is a controlled relationship between gums, oral health and blood sugar.

Common oral and dental problems in diabetes patients

1. Dry mouth, also known as “xerostomia”; With the decrease and darkening of salivary secretion, the effect of washing and facilitating chewing is lost. Saliva is one of the alkaline body fluids with many functions such as speech, taste formation, maintenance of oral health, regulation of oral flora, facilitation of digestion and antimicrobial action. The reduction of saliva facilitates the adhesion of food to the tooth surface and prepares the ground for tartar formation. Advanced dry mouth can lead to delayed wound healing, pain and increased inflammation. These individuals may complain of difficulty speaking, chewing and swallowing.
2. Fungal infections may occur due to deteriorated oral flora as a result of dry mouth and high sugar content in saliva. The formation of redness and cracks at the lip joint may indicate this problem. Leaving removable dentures in the mouth all day and smoking may accelerate fungal growth. Diabetics should remove their dentures at night and not smoke. Medication can also be used to treat fungus.
3. Diabetics develop a change in taste with impaired glucose and sucrose perception. In these patients, sugar intake may increase and hyperglycaemia may worsen.
4. Gum disease: Due to the high level of glucose in the blood, thickening and clogging of the vessels reduces the oxygen-carrying capacity of the blood and impairs the nutrition of the tissues. This causes the gums to detach from the teeth and leads to gum recession. In the small pockets between the gums and the teeth, new bacteria foci form over time. This situation can lead to tooth loss. The patient experiences bad breath and pain. Tooth loosening and bleeding of the gums also occur. Along with these gum diseases, intraoral inflammation also develops, making sugar control difficult and creating a vicious circle. Advanced gingivitis can only be treated surgically.
5. Caries develops in patients with uncontrolled diabetes, i.e. in patients with uncontrolled blood sugar, when the high sugar level in the saliva prepares the ground for bacteria.
6. Stomatitis and glossitis occur with delayed wound healing and exacerbation of inflammation in uncontrolled diabetic patients. These
   patients experience pain.

Oral and dental care in patients with diabetes

Effective oral health practices should be implemented to control diabetes. Oral health and hygiene of people with diabetes directly affect their quality of life. Diabetics should assess their oral health once a month by considering the following points;

• Presence of persistent bad breath
• Slight bleeding of the gums when brushing and flossing
• Inflammation of teeth and gums
• Redness, swelling and sensitivity of the gums
• Loosening of teeth or loss of teeth
• Wounds that do not heal for a fortnight
• Change in the position of the teeth when biting

Diabetes patients should have learned about the following situations related to oral health in self-management training;

• Blood sugar should be under control
• Oral hygiene should be daily and regular
• Toothpaste containing fluoride should be used
• Teeth should be brushed at least 2 times a day after each meal or in the morning and evening for 2 minutes.
• The tongue should be brushed along with all tooth surfaces.
• The toothbrush used should have soft bristles.
• Toothbrushes should be changed every three months.
• Dental floss should be used regularly
• The floss should be carefully positioned between two teeth and cleaned from front to back, touching the tooth in the shape of the letter “C”. Not too much pressure should be applied to the gums. A little bleeding is normal, it will improve with time.
• After flossing, the mouth should be rinsed with water.
• For extra protection, fluoride and antimicrobial mouthwashes should be used.
• The mouth should be rinsed at the end of each meal.
• Acidic foods should not be consumed after brushing the teeth.
• Moisturisers with vitamin E should be used for painful sores and bleeding on the lips.
• Water should be drunk frequently to relieve dry mouth.
• Sugar-free chewing gum can also be chewed after meals for dry mouth. Chewing gum stimulates saliva secretion and helps moisten the inside of the mouth.
• Since the risk of fungal infection increases in patients with dry mouth, eating yogurt products can take advantage of the active yeast in their contents.
• Meals should be eaten unseasoned and warm.
• Alcohol and caffeine, which exacerbate symptoms, should not be consumed.
• Oral health should be assessed in consultation with a dentist or diabetes advisor and risk-reducing strategies developed.

Dental treatments for diabetes patients

• For these people, fasting blood glucose levels should be measured the day before or the day of the dental appointment.
• All diabetics, whether under control or not, should have regular dental check-ups (every 3 or 6 months).
• The best time for dental treatment in patients with diabetes is in the morning hours after breakfast.
• The time of the procedures should be kept short, if the procedure is longer, a break should be taken and the patient should be provided with a snack.
• Before coming to the clinic, the patient must have eaten breakfast and taken medication or used the insulin injection. During dental treatment, blood glucose can rise with stress, so insulin should not be skipped with the thought of not eating after treatment.
• Children with diabetes are much more susceptible to infections. If tooth extraction is required in these children, importance should be given to pre- and post-extraction nutrition and antibiotic supplementation is required.
• Before any surgical procedure, the patient’s blood glucose level should be regulated. If the patient’s blood sugar is high, only an emergency infection intervention should be performed.
• The most important rule for dental treatment of diabetics is to work atraumatically. Minimally invasive methods should be the priority for all interventions.
• Local anaesthetics needed for dental treatment should be administered in a controlled manner.
• When using dental implants in diabetics, it should be taken into account that the structural integration process between the living alveolar bone and the dental implant takes longer than in normal individuals.

Diabetics can keep their diseases under control and improve their quality of life with regular medication, controlled diet, healthy lifestyle and oral and dental health that is not neglected. At the same time, the barriers to intraoral surgery are minimised.

We wish you healthy days