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Diabetes and Dental Care: Learn Everything You Need To Know

Diabetes, affecting millions of Americans, increases the risk for multiple dental problems. If you are diabetic, be sure your health condition is reflected in your dental records. Your dentist will want to carefully monitor your oral health needs.

Diabetics must pay special attention to the following conditions related to oral health:

Tooth Decay

High glucose levels in saliva help bacteria to thrive, repeatedly attacking teeth with cavity-causing acids. Brushing at least twice a day with fluoride toothpaste and flossing daily is vital.

Gum Disease

Diabetes reduces the body's resistance to infection and gum tissues are frequently affected. Diabetics may experience more frequent and severe cases of periodontal disease. See your dentist if you notice any of these symptoms: your gums are tender, red, swollen, or bleed easily; your gums have pulled away from the teeth; or you notice any pus between the teeth and gums when the gums are pressed. Other indicators are chronic bad breath or a bad taste in your mouth; any changes in your bite or fit of partial dentures; or permanent teeth that become loose. Since diabetes can impair the healing process, abscesses can develop, so it is important to schedule regular periodontal exams.

Oral Fungal Infections

People with high glucose levels who smoke or frequently take antibiotics are more prone to develop oral candidiasis, or thrush. This is a condition where white or red patches in the mouth become ulcerated and attack the tongue with a painful, burning sensation. Swallowing can be difficult and your ability to taste can be impaired. Antifungal medications can be prescribed by your dentist.

Taste Impairment

A diminished sense of taste can influence food choices. Diabetics have reported that their perception of sweetness is lessened. As a result, selecting sweet-tasting, refined carbohydrate foods puts diabetics at greater risk for developing both general health and dental problems.

Dry Mouth: Diabetic patients often complain about dry mouth due to salivary gland dysfunction related to the disease. Constant dryness irritates the soft tissues causing inflammation and pain. It can also increase the likelihood of tooth decay and gum disease.

Saliva substitutes available in pharmacies can relieve discomfort. Sugarless gum, sugarless mints, and drinking plenty of water also are useful in combating dry mouth. Additionally, restrict consumption of caffeine and alcohol.

Mouth Lesions

Pimple-like sores, generally painless, dot the mouth tissues. In a more severe condition, the tissue becomes painfully ulcerated. No permanent cure is available, but your dentist can prescribe medication to relieve the condition.

Since diabetics are more prone to conditions that jeopardize oral health, regular dental check-ups and periodontal screenings are essential. More frequent evaluations may be needed to ensure optimum oral health.

Bad breath, or halitosis, is a signal that something is not right inside your mouth. It may be as simple as the need to pay more attention to your daily oral hygiene, or it may indicate tooth decay, gum disease, or another medical problem. Whichever it is, bad breath is a red flag: take another look at your mouth!

Bad breath is a social problem; if you have bad breath, you may notice that people actually back away as you talk to them. Mouth odors are embarrassing, and they tell other people that you aren't taking care of yourself. Sometimes people are not aware that their breath smells bad; be alert to how other people react when they're close to you, and be grateful if a friend or family member lets you know about the problem.

Commercial products claim they will make your breath fresher, but the only way to make sure your breath permanently fresh is to practice good oral hygiene. In fact, too many breath mints and hard candies with sugar will lead to tooth decay. If you are constantly using breath mints, breath sprays, or mouth rinses in an effort to cover up your bad breath, realize that you may have a dental or medical problem that needs addressing.

There are a number of reasons you may experience a bad taste in your mouth, and even be able to smell your own breath. Food may be lodged between your teeth if you are not brushing at least twice daily and flossing regularly. Food particles can be very tiny and can wedge themselves between teeth and below the gum line; brushing after meals is important and flossing is imperative to get at the particles that the brush can't reach. Brush your tongue or use a tongue scraper. As odd as it will feel at first, bacteria collects on the tongue and can contribute to bad breath. If you wear removable dentures, take them out at night and clean them thoroughly before you wear them again.

If you neglect your daily hygiene over time, bad breath can become a symptom of more serious dental problems. Teeth that are not cleaned properly become a place for bacteria to reside as food particles stay in your mouth and decay. Bacteria attack your teeth and gums and cause cavities and gum disease. If this is happening, gum disease will cause an unpleasant odor.

Perhaps you believe that you are brushing and flossing on a regular basis, but are still experiencing bad breath. If you have teeth that are crooked or crowded, it may be hard for you to clean between them. If you wear dentures that are not fit properly, they may be trapping food or irritating your mouth. Or perhaps your bad breath is caused by another medical problem: drainage from your sinuses, gastrointestinal problems, kidney or liver problems, or other medical conditions.

Here's what you can do to "investigate" on your own. Write down what you're eating and notice whether your breath smells bad because of certain foods. Garlic and onions actually cause odor, but the odor is coming from your lungs as you breathe, not from your mouth itself. The odor from these foods is temporary, and will be gone once the food is out of your bloodstream.

Are you dieting? Hunger can contribute to bad breath, because of the chemical changes as your body turns fat and protein into the energy it needs. Taking prescription or over-the-counter medications? Add these to the record of what you're eating to see whether there's a relationship between your medications and your bad breath. And don't forget to tell your dentist if there's been a change in your overall health since your last visit.

Suffering from dry mouth? Saliva provides constant rinsing in our mouths and washes away food particles. Your dentist may recommend more liquids, sugarless candy to stimulate natural saliva, and perhaps some of the commercial products that are available to combat dry mouth.

If bad breath continues after you have done your best job of regular brushing and flossing, start with your dentist. He or she can tell you whether the odor is caused by an oral problem; if it is not, then your dentist will suggest you see your doctor for a physical check-up.

Regular dental check-ups will help keep your mouth healthy and working well. Your dentist can spot dental problems before they cause trouble, including problems that cause bad breath.

By Brian J. Gray, DDS, MAGD, FICO

Find a Dentist To Evaluate Your Risk Factors For Oral Cancer

Oral and oropharyngeal cancers are malignancies that include the lips, tongue, lining of the cheeks (buccal mucosa), floor of the mouth, gum (gingiva), the area behind the lower wisdom teeth (retromolar trigone), the roof of the mouth (hard and soft palates), the back of mouth and throat (oropharynx), and the sides of the throat (tonsil areas).

Oral and oropharyngeal cancers are most often diagnosed in older adults (average age at diagnosis is between 60 and 63), with over 95% of the oral cancer cases occurring after the age of 45. Men are diagnosed with oral and oropharyngeal cancer twice as often as women. Over the past several decades, the overall number of oral and oropharyngeal cancers has not changed; however, the number of men being diagnosed with the disease is decreasing and the number of women with the disease is increasing.

All forms of tobacco and excessive use of alcohol have been identified as major risks factors for oral and oropharyngeal cancers, and are suspected to account for 75% of all oral and oropharyngeal cancers in the United States. Sun exposure is a risk factor for lip cancer, while smokeless (snuff or spit) tobacco increases the risk for cancers inside the lips and cheek. Other risk factors for oral and oropharyngeal cancer are vitamin A deficiency and Plummer-Vinson Syndrome (a very rare iron deficiency).

The American Cancer Society estimates that 7,800 people will die because of oral or oropharyngeal cancer in the year 2000. Overall, people surviving five years after a diagnosis of oral and oropharyngeal cancer have shown little improvement; half of the people diagnosed with this disease survive five years. Deaths due to oral and oropharyngeal cancer vary greatly with the stage (spread) of the cancer at diagnosis. Oral and oropharyngeal cancers that are detected and treated early, and are localized, have greatly improved survival compared to those that have spread.

Early localized oral and pharyngeal cancers often are not bothersome and therefore go undetected until the cancer has spread. About half of oral and oropharyngeal cancers have spread to the lymph nodes (spread to the neck) at the time of diagnosis or treatment. Three sites within the mouth are high-risk for the development of oral and oropharyngeal cancer: the floor of the mouth, the sides of the tongue, and the soft palate complex (soft palate, inside the retromolar trigone, and tonsil area).

Detection of an oral and oropharyngeal cancer also identifies an individual who is at high risk for developing or having a cancer of the respiratory system and upper digestive tract (larynx, lung, and esophagus).

Warning signs and symptoms of oral and oropharyngeal cancer:

• A mouth sore that does not heal
• A lump or thickened mass in mouth or neck
• A red or white patch in mouth
• A sore throat or feeling that something is caught
• Voice change
• Difficulty chewing or swallowing
• Difficulty moving the jaw or tongue
• Numbness
• Swelling
• Loosening of teeth
• Weight loss

Pain may not be present with early oral and oropharyngeal lesions. Traumatic oral lesions will resolve or greatly improve after the cause of the trauma is removed (such as a sharp tooth or denture). A biopsy, to rule out or confirm a malignancy, is indicated if an oral lesion persists after two weeks. A dentist and/or physician should evaluate all suspicious lesions.

By Denise J. Fedele, DMD, MS