The connection between oral health and overall heath is perhaps nowhere clearer than in the case of diabetes. Diabetics are at a higher risk of oral and dental problems, and fully 25% of Canadians are either diabetic or pre-diabetic. Notably, diabetes increases the risk of infection and slows healing—a particularly bad combination for oral health.

Diabetes and Its Types

Diabetes is a disease that is characterized by the inability of the body to produce adequate amounts of insulin, a hormone that controls the amount of glucose (a sugar) in the blood. Three types of diabetes exist:

• Type 1 Diabetes

Usually appearing in children and adolescents, Type 1 diabetes occurs when the pancreas (the body’s organ that produces insulin) is unable to produce any insulin at all, or just trace amounts. Type 1 diabetes represents about 10% of cases of diabetes.

• Type 2 Diabetes

Typically (though not always) appearing in older adults, Type 2 diabetes occurs when the pancreas produces insufficient insulin or the body does not properly use the insulin it produces. About 90% of diabetes is Type 2.

• Gestational Diabetes

Occurring in three to nine percent of pregnancies, gestational diabetes affects this small percentage of women temporarily, usually resolving after the end of the pregnancy. A woman does not need to be diabetic before pregnancy for gestational diabetes to occur.

Circular Interplay of Causes and Effects

The connections between diabetes and oral health are particularly problematic because they create a feedback loop of self-reinforcing problems: diabetes leads to increased rates of infection (including increased numbers of oral infections); and increased infections make treating diabetes more difficult. Bacteria from severe gum disease can also increase blood sugar levels, sometimes leading to diabetes, and that same bacteria can also enter the bloodstream, leading to further health problems.

Impacts of Diabetes on Oral Health

Infections

Infections, generally characteristic of diabetes, can lead to gum infections.

Tooth decay

While starches and sugars in the mouth can feed plaque bacteria, leading to tooth decay, high levels of sugars in the mouth and blood are also consequences of diabetes. Plaque bacteria in the mouth produce acids as they digest these sugars, demineralizing the teeth and irritating the gums.

Fungal infections

Diabetes can also enhance the climate for fungal infections in the mouth. Infections such as thrush (a yeast infection) can be treated with anti-fungal mouthwashes and anti-fungal medications, and by controlling sugar levels, a method made harder by diabetes.

Dry mouth (xerostomia)

Diabetes can reduce saliva flow, leading to dryness in the mouth. Such increased dryness contributes to increased tooth decay that can be treated with regular drinks of water, chewing sugarless gums, and using mouth moisturizers.

Prevention and Care

A number of methods and approaches can help diabetics with their oral health:

• managing the diabetes itself through controlling sugar levels

• attending regular dental visits for cleaning and inspection for gingivitis and infection

• vigilance for early signs of gum disease, watching for inflammation of the gums, soreness, bleeding and swelling

• avoiding tobacco

• maintaining good oral hygiene by brushing twice daily (after meals); regular flossing, cleaning or scraping the tongue, and removing and thoroughly cleaning dentures

When diabetes combines with maintaining good oral health, dental professionals are key. They can monitor and maintain records, advise on dental care and home use products, make recommendations on diet and avoiding the use of tobacco products, and liaise with other medical professionals if needed.