Dental Care For People With Diabetes
Diabetes is of growing concern in the UK. As well as the 3.2 million people already diagnosed it is estimated a further 630,000 people have the condition.
It’s very likely that a number of the readers of this page will have diabetes so will have more insight than others on its symptoms and consequences. Among the general public and even some health-care professionals diabetes is often misunderstood with the result that patients don’t always receive the degree of attention and support they deserve.
The symptoms of diabetes have been recognised since at least the time of the Ancient Egyptians. The main symptoms include passing urine more often than usual, especially at night, increased thirst, extreme tiredness and unexplained weight loss. Other symptoms include genital itching or regular episodes of thrush, slow healing of cuts and wounds and blurred vision. Delayed healing among people with diabetes can be a problem after surgical procedures. The word itself comes from the Greek; loosely translated as ‘to pass through’ or ‘to siphon’, referring to the excessive need for urination experienced by sufferers. In the middle ages physicians divided the condition into ‘diabetes mellitus’ (sweet) and ‘diabetes insipidus’ (tasteless). Have a wild guess at how these early clinicians examined their patients’ urine. (And doctors nowadays think they’ve got it tough?!)
There are two main types of diabetes; Type 1 and Type 2 diabetes.
In Type 1 diabetes the pancreas does not produce any insulin and accounts for about 10 per cent of all adults with diabetes. It is treated by daily insulin injections, a healthy diet and regular physical activity. Type1 diabetes can develop at any age but usually appears before the age of 40, and especially in childhood. It is the most common type of diabetes found in childhood.
In Type 2 diabetes there is not enough insulin or the insulin is there but not working properly and usually appears in people over the age of 40, though in South Asian people, who are at greater risk, it often appears from the age of 25. It is also increasingly becoming more common in children, adolescents and young people of all ethnicities. Type 2 diabetes accounts for between 85 and 95 per cent of all people with diabetes and is treated with a healthy diet and increased physical activity. In addition to this, medication and/or insulin are often required.
Effects in the Mouth
In the mouth diabetes may manifest in a number of ways. Hyperglycaemia can give rise to dry mouth and its related symptoms which can include soreness of the skin of the mouth, taste disturbances, difficulty with eating and swallowing, difficulty wearing dentures, dry lips, the tongue sticking to the inside of the cheeks and lips as well as an increased risk of tooth decay and gum disease.
Apthous ulcers (mouth ulcers) are more common in people with diabetes.
Infection with candida albicans (thrush) is more prevalent, especially among denture wearers. Secretion of glucose in the saliva enables a variety of micro- organisms to thrive, increasing the risk of tooth decay and gum disease.
Infection and surgical procedures challenge the immune system and can lead to difficulty with maintaining blood glucose levels. These factors can result in delayed healing and recovery, for example, after a tooth extraction.
Diabetes is the leading cause of preventable sight loss in people of working age in the UK. Within 20 years of diagnosis nearly all people with Type 1 and almost two thirds of people with Type 2 diabetes have some degree of eye damage. This is of importance as impaired vision impacts directly on a patient’s ability to maintain good oral hygiene. Similarly, diabetic neuropathy, experienced by up to 50% of sufferers can lead to altered sensation in the fingertips and loss of dexterity.
Some medicines either used to treat diabetes or its complications can cause problems in the mouth. It is essential that the dental practice has your current list of medications is to recognise and treat these conditions.
Gum disease deserves special mention as there seems to be a two-way mechanism involved where people with diabetes are more prone to gum disease and gum disease itself has a negative impact upon diabetes.
The Oral Health Assessment
The examination begins as usual by feeling the head and neck for swollen glands and a full soft tissue examination. Symptoms of dry mouth may be discovered as well as ulceration and infection. Any soft tissue conditions we find will be noted and further investigations made.
Next comes the examination of the gum condition, checking for plaque, bleeding and pocketing. Results are compared to findings at previous examinations to help formulate an appropriate treatment plan.
The teeth are examined with the aid of x-rays if appropriate. Active tooth decay is noted and the risk of root decay assessed.
All the findings of the examination are collated and a treatment plan is formulated. We will discuss this plan with you and make our recommendations.
Dry mouth: In mild cases frequent sips of water may be adequate to allay symptoms. In more severe cases including sticky tongues, sore mouth or taste disturbances artificial saliva may help.
Apthous ulceration: Treatments are designed at easing symptoms. Numbing surface pastes may make ulcers more comfortable but there is little evidence they accelerate healing. Ulcers that do not heal within 3 weeks must be considered suspicious and referred for a specialist opinion.
Candida: Thrush infections must always be treated because of the rare but possible risk of malignant change and spread to other parts of the body. Treatment usually involves local application of antifungal pastes. To prevent re-infection on insertion of contaminated dentures leaving the dentures in a mild antiseptic solution (like those used for disinfecting babies’ bottles) when out of the mouth can break the cycle.
Gum Treatment: Treatment must be thorough. All deposits of plaque and tartar must be removed. We will provide in-depth instruction in oral hygiene techniques. Patients with visual impairment or dexterity issues will have oral hygiene advice tailored to their individual needs. We may ask you to keep a diet diary to identify special risk factors and may recommend frequent visits to the hygienist. Protecting your gum condition may protect your general health. This is why we take this aspect of your care so seriously.
Tooth Decay: This will be treated in the normal way whenever possible. The risk of root decay will be assessed and regular fluoride treatments provided as necessary.
Diabetes can have far-reaching effects on your general health including the health of your mouth. Importantly, the health of your mouth can affect your diabetes so it is really important that you understand the need for comprehensive dental care. The good news is that with proper diagnosis and treatment the adverse effects of diabetes can be minimised.
For more information about diabetes we recommend you visit Diabetes UK.
Call Diabetes UK 0345 123 2399 (Mon-Fri 9am-7pm)