Dental and oral care for Diabetic Patients

An estimated 30.3 million Americans live with diagnosed diabetes. Approximately 1.7 million new cases are diagnosed each year and 8.1 million people live with diabetes and don’t even know they have it. Having good oral and dental care is essential for patients with diabetes. Research suggests people with diabetes are at higher risks of oral and dental problems, such as periodontal disease, oral infections, tooth decay, delayed healing of oral sores, and other problems. Medically, patients with diabetes are at higher risks of problems with the eyes, nerves, kidney, heart and other parts of the body.

What is diabetes?  Diabetes affects the body’s ability to process sugar. 

• Type 1 diabetes is a chronic condition in which the pancreas produces little or no insulin. Insulin is a hormone needed to allow sugar (glucose) to enter cells to produce energy.
• Type 2 diabetes is the most common type of diabetes and it is a disease that occurs when your blood glucose (blood sugar) is too high. 

Symptoms of untreated diabetes affect oral and dental health

• Dry mouth (less production of saliva)
• Higher risk of dental decay due to less saliva in the mouth
• Inflamed and bleeding gums
• Problems of tasting foods
• Delayed wound healing in the mouth
• Susceptible to infections inside of the mouth

Periodontal disease and diabetes

Periodontal disease is the most common dental disease affecting patients with diabetes. Diabetic patients have poor blood sugar control, and it causes the patients to be more susceptible to oral infections and gum diseases.

*July 2013 issue of JADA (Journal of American Dental Association) wrote findings on the latest research into how gum disease could affect diabetes. 

They found that, compared with those with healthy gums, people with severe gum disease:

• Have higher long-term blood sugar levels (A1c);
• Might be at a higher risk of developing type 2 diabetes;
• Maybe at a higher risk of developing pregnancy diabetes;
• Have a harder time controlling their type 2 diabetes;
• Are at a higher risk of experiencing harm to eyes and kidney, as well as heart attack and stroke if they have diabetes

*JADA 144 (7) http://jada.ada.org July 2013

 Diabetes and oral health issues

• According to the American Diabetes Association, diabetic patients are more likely to suffer from dry mouth and/ or to develop a fungal infection in the mouth
• Dry mouth can be a side effect of medications patients take to control diabetes. Dry mouth increases the chance of developing oral infection and/ or dental decay
• High blood sugar levels and high sugar levels in the saliva create an ideal environment for plaque to grow. Excess plaque increases the risks of oral infection and periodontal disease 
• inflammation, sensitivity, and irritation along the gums 
• taste buds do not work as well
• wounds or mouth sores may have delayed healing

Dental health care/Dental considerations for people with diabetes

• Best time to receive dental care is morning appointment because blood glucose levels tend to be under better control at this time of the day
• Dental procedures should be as short and as stress-free as possible
• Dentists and staff are trained to work with diabetic patients. The dental office should have a protocol for managing diabetic patients
• Coordination with the patient’s physician may be needed to determine the patient’s health status and determine whether the dental treatment can be safely and effectively performed
• Elective dental treatment may need to be delayed until the diabetes is considered stable
• Review the patient’s medical history, medications, take vital signs, and oral evaluation

Recommendation of dental treatment for diabetic patients

• Oral examination and teeth cleaning 2x/year. Your dentist may recommend more than 2 cleanings per year depending upon your periodontal condition
• Patients with diabetes may benefit from periodontal therapy (scaling and root planning) in conjunction with good oral health maintenance at home

Everyday dental care tips

• Keep blood sugar as close to normal as possible
• Reduce sugars and starches from your diet, eat healthy foods and exercise regularly
• If you have dry mouth, try a mouthwash without alcohol
• Brush your teeth at least 2x/day. Brush your teeth after every meal. Wait at least 30 minutes after eating before brushing to protect any tooth enamel that’s been softened by the acid in the food
• Use a toothbrush with soft bristles. Use fluoridated toothpaste.
• Floss at least once a day 
• Rinse daily with an antiseptic mouth wash
• Treat dental infections immediately. 
• Provide your medical and oral health history to both your medical and dental care providers
• Quit smoking

Medical complications of Patients with Diabetes

Diabetic patients with elevated levels of blood glucose (blood sugar) can increase the incidence and severity of complications such as heart disease, stroke, kidney disease, blindness, amputations, and other medical problems. 

Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA. She is experienced in all phases of dentistry. She treats patients of all ages. If you are pre-diabetic or have been diagnosed with diabetes, don’t wait and call our office for a dental and oral evaluation. With proper medical and dental care, both diabetes and periodontal disease can be treated and be well under control. Call our office at 626-335-5114 or visit us at www.annaleedds.com

Periodontal Disease = Gum Disease

Periodontal disease is also known as gum disease is a bacterial infection of the gum tissues and bone that hold the teeth in place.  It is caused by the bacteria in plaque, a sticky and colorless film that forms on the teeth. The early stages of gum disease can often be reversed and maintained with proper brushing, flossing and regular dental cleaning & check up with the dentist.  Gum disease that is left untreated would lead to tooth loss and other periodontal complications and problems.

This is the American Academy of Periodontology (AAP) classification of Periodontal Disease:

Type I  Gingivitis

·       Earliest stage of gum disease

·       No loss of attachment, no bone loss

·       Bleeding on probing may be present

·       At this early stage in gum disease, damage can be reversible since there is no bone loss.

·       Proper brushing, floss and regular dental cleaning help to remove plaque

Type II  Early Periodontitis

·       Pocket depths or attachment loss: 3-4mm.  Bone loss is present.

·       Periodontal pockets are formed as the dental tissues (gums and supportive ligaments) begin to pull away from the tooth.  These pockets trap bacteria and causes gum infection

·       Localized area of gingival recession; gums pull away and exposes the root

·       Bleeding on probing may be present

·       Damages caused by gum disease is irreversible

Type III  Moderate Periodontitis

·       Pocket depths or attachment loss: 4-6mm.   Bone loss is present.

·       Bleeding on probing

·       Furcation involvement

·       Teeth show mobility (loose)

·       Damages cause by gum disease is irreversible

Type IV  Advanced Periodontitis

·       Pocket depths or attachment loss: greater than 6mm.   Bone loss is present.

·       Supporting tissues and bone are destroyed. 

·       Bleeding on probing

·       Furcation involvement

·       Teeth show increased mobility (loose).  Some teeth are so loose that they may need to be extracted.

·       Damages caused by gum disease is irreversible

Signs of Periodontal Disease

·       Gums are red, swollen or tender

·       Gums that bleed during brushing or flossing

·       Teeth that look longer due to gum recessions

·       Formation of deep pockets between teeth and gums

·       Loose or shifting teeth

·       Persistent  bad breath or bad taste in the mouth

·       Changes of the teeth fit together when biting (occlusion)

·       Changes of the fit of the partial denture

Gum disease can occur at any age.  If gum disease is detected and treated at early stages, it can be reversed and maintained.  Currently, there is no cure for gum disease. 

If you notice any signs of periodontal disease, please contact Glendora Dentist, Dr. Anna Lee for a dental checkup.  You don’t have to lose teeth to periodontal disease.  Dr. Anna Lee can help to save your teeth. Call and schedule a free consultation at 626-335-5114 or visit us at www.annaleedds.com

Prevention of Periodontal Disease (Gum Disease)

        

Gum disease, also known as periodontal disease, is usually caused by plaque, a sticky film of bacteria that forms between the gums and the teeth. If plaque is not removed with brushing and flossing between the teeth, gum tissues that surround the teeth would become irritated and inflamed. The inflamed gum tissues can progress to affect the bone that surrounds and supports the teeth, which can result in tooth loss.  According to the Centers for Disease Control and Prevention (CDC), about half of American adults have gum disease and many of them end up losing at least one tooth and often several.  CDC also reports that three out of every four older Americans has gum disease.

There are 4 general stages of Gum Disease:

·       Stage 1:  Gingivitis is the early stage of gum disease caused by plaque buildup between the gums and teeth

              Gums bleed easily when brushed or when probed gently during examination

              Gums are inflamed and sensitive to touch

              Possible bad breath and bad taste

              No bone loss, reversible gum disease

·       Stage 2:  Early Periodontitis has slight bone loss that supports the teeth

               Gums may begin to pull away from the teeth

               Bleeding, puffiness and inflammation more pronounced

               Bad breath, bad taste

               Non-reversible gum disease

·       Stage 3:  Moderate Periodontitis-more bone loss

               Gum boils or abscesses may develop

               Teeth look longer as gums begin to recede

               Teeth may begin to drift, showing spaces

               Bad breath, bad taste

               Non-reversible gum disease

·       Stage 4:  Advanced Periodontitis-most severe stage of the gum disease

               Severe bone loss, receding gums, roots may be exposed and are sensitive to hot and cold

               Visible pus surrounding the teeth and gums, loose teeth

               Non-reversible gum disease