DIABETES AND ORAL HEALTH

Diabetes is a metabolic disorder where there is an increase in blood sugar levels. In our body blood sugar level is controlled by insulin which is produced by the pancreas.

Diabetes can occur either because the pancreas is not able to produce insulin or the body is not able to respond to the insulin produced.

THREE TYPES OF DIABETES

TYPE 1 DIABETES : (INSULIN-DEPENDENT DIABETES MELLITUS)

Caused because enough insulin is not produced by the pancreas resulting in insulin deficiency. It accounts for 5 -10 % of all diabetes. It most commonly occurs in children and young adults.

The individual requires an injection of insulin to be taken in order to keep blood sugar level in control.

TYPE  2 DIABETES : (NON-INSULIN-DEPENDENT DIABETES MELLITUS)

Caused because of decreased insulin secretion , resistance in insulin action or increased glucose production in liver. It accounts to 90 -95 % of all cases of diabetes. Adults are most commonly affected.

GESTATIONAL DIABETES : Blood sugar level increases during pregnancy .occcurs in 2 – 5 %  of all pregnancies but disappears after delivery . women having gestational diabetes during pregnancy have an increased risk of having type 2 diabetes later in life.

CLASSIC SYMPTOMS OF DIABETES :

POLYURIA: INCREASED URINATION

POLYDYPSIA: INCREASED THIRST

POLYPHAGIA: INCREASED HUNGER 

We are all aware that diabetes affects our kidneys, eyes, heart, etc. but the effect of diabetes on our teeth, gums, and jaw bone (alveolar bone) is not a very well-known fact.

ORAL CHANGES IN DIABETIC PATIENT

• Saliva plays a major role in neutralizing the acids produced by the oral bacteria. This decreases the chances of decay. But in uncontrolled diabetic patient, the flow of saliva is decreased (dry mouth) hence chances of tooth decay increase.
• Wound healing is impaired because blood flow is compromised in diabetes. hence after any dental procedure like extraction,flap surgery etc wound healing is quite delayed. Because of poor blood supply and wound healing dental implants are avoided in diabetic patient.
  • If a person is diabetic and a smoker then this combination will make the wound healing worse because even in a smoker blood flow is compromised.
• Drying and cracking of oral mucosa is observed.
• ANGULAR CHELITIS: it is a bacterial or fungal infection causing inflammation of corner of lip (image)

• Burning of mouth and tongue

• Candidiasis : fungal infection of the mouth and tongue caused by candida albicans

(WRITE ABOUT GINGIVITI)

Periodontitis will cause loss of attachment between gums  and teeth , increased gum bleeding leading pocket formation  (pockets are spaces created between gums and teeth causing more food lodgement) 

Gradually there is  bone loss (i.e. the bone that holds the tooth in place gets infected and starts to reduce)

LOSS OF BONE , POCKET FORMATION AND BONE LOSS LEADS TO MOBILITY (LOOSENING) OF TEETH ND THEY EVENTUALLY FALL OFF .

STUDIES HAVE SHOWN THAT DIABETES DOE NOT DIRECTLY CAUSE GINGIVITIS OR PERIODONTITIS.

But in uncontrolled diabetes the defence mechanism of the body is compromised and so the susceptibility of infection increases . Hence the body is not able to fight against the local factors that gingivitis or periodontitis .

HOWEVER IF DIABETES IS WELL CONTROLLED ALL THESE CHANGES WILL NOT BE SEEN THE ORAL MUCOSA WILL BE NORMAL , DEFENCE MECHANISM WILL BE GOOD AND THERE WILL BE NO INCREASE IN CHANCES OF TOOTH DECAY.

PREVENTION AND MANAGEMENT

• A diabetic person should take more care of the oral cavity because they are more susceptible to tooth and gum problems. The  best way to avoid oral health problems is to keep a check on blood sugar level
• You can do this with medication, daily exercise, and diet control.
• Visit your dentist every 4 – 6 months for a regular check-up and scaling
• Brush twice daily using the right brushing technique
• Floss between teeth and use mouthwash
• If ant dental procedure like extraction (removal of tooth) or gum surgery has to be carried out your dentist will tell you to check your blood sugar levels. Both fasting and post-lunch sugar levels should be checked.
• Show your dentist the sugar reports and the medications you are already taking.
• After any surgical procedure, meticulous oral hygiene has to be maintained.
• If you are a smoker quit the habit now