DIABETES AND DENTAL CARE
Taking good care of your teeth and gums on a daily basis is an important step in reducing the risk of future dental problems. This is even more important when you have diabetes. DL Magazine dietitian and diabetes educator, Dr Kate Marsh, explains the link between diabetes and dental health and provides tips for keeping your teeth and gums healthy.
DENTAL HEALTH – WHAT GOES WRONG?
When we eat, remnants of food together with saliva and bacteria cause the development of plaque. If not removed properly (with regular brushing and flossing) this plaque hardens into tartar, which builds up around the gumline, making it harder to brush and clean between the teeth.
At this stage, the gums can become red, swollen and tender and are likely to bleed during brushing and flossing. This stage of gum disease, known as gingivitis, can be improved by regularly cleaning with your dentist and taking more care with your brushing and flossing at home.
If not treated, gingivitis can lead to periodontitis. At this stage, the gums pull away from your teeth, causing a gap between your teeth and gums which can become infected. Without treatment, the infection destroys the bone around your teeth and you may require gum surgery or could even lose your teeth.
DID YOU KNOW?
Despite the well-established link between diabetes and periodontal disease, a 2019 systematic review of 26 studies published in the Australian Dental Journal found that 73% of people with diabetes were unaware of the link between their diabetes and periodontal health.
WHY AM I AT RISK?
There are several reasons people with diabetes are at greater risk of gum disease. When blood glucose levels are high, this encourages the activity of bacteria in the mouth, which contributes to decay and the development of plaque. High blood glucose levels can also reduce the body’s resistance to infections and studies have found that people with diabetes who have higher blood glucose levels are more at risk of periodontal disease. Unfortunately, this can be a vicious cycle as having an infection can make it harder to manage your blood glucose levels, which can lead to a worsening of periodontal disease and other diabetes-related complications. Other contributing factors include increased inflammation, oxidative stress and the development of Advanced Glycation Endproducts (AGEs) when blood glucose levels are high.
HOW DO I KNOW IF I HAVE A PROBLEM?
Gum disease is often painless, particularly in the early stages. This is one reason regular dental checkups are important. However, there are some warning signs to watch for:
✱ Bleeding gums when you brush or floss your teeth
✱ Red, swollen, or sore gums
✱ Receding gums (gums that have pulled away from the teeth)
✱ A dry mouth and/or oral thrush
✱ Bad breath
✱ Loose or separating teeth
✱ Change in your bite or jaw alignment
✱ Changes in the fit of your dentures
If you experience any of these problems, it is essential that you see your dentist as soon as possible.
WHAT CAN I DO?
There are several things you can do to reduce the risk of developing periodontal disease:
➤ Keep your blood glucose levels well managed.
➤ Don’t smoke.
➤ Practice good dental hygiene, including brushing and flossing daily (see box: Top Tips for keeping your teeth and gums healthy)
➤ Have regular check-ups with your dentist. How often you need a check-up depends on a number of factors including your age, dental history and general health, but your dentist will be able to advise you. Diabetes Australia recommend that you have a dental check at least once a year if you have diabetes.
➤ Make an appointment with your dentist as soon as possible if you notice any signs of tooth decay or gum disease (see box: When to see your dentist).
When to see your dentist
Besides regular check-ups, see your dentist if you have any of the following:
■ Bleeding gums when you brush or floss
■ Red, swollen or painful gums
■ Receding gums (i.e. gums that have pulled away from the teeth)
■ Loose teeth
■ Pus between your teeth and gums
■ Bad breath or a bad taste in your mouth that won’t go away
■ A change in your bite or jaw alignment, or in the fit of your dentures
TOP TIPS FOR KEEPING YOUR TEETH AND GUMS HEALTHY
Brush your teeth at least twice per day (in the morning and before bed) using a toothbrush with soft, rounded bristles. This should take around two minutes.
Floss between your teeth daily.
Change your toothbrush or toothbrush head every 3 months.
Avoid soft drinks, including the diet variety, as their acidic effect can wear away the enamel on the surface of your teeth. If you choose to drink them, use a straw.
Avoid snacking frequently over the day – a break of at least two hours between eating or drinking allows your saliva to neutralise acids in the mouth.
If you do snack, choose fruit, yoghurt, cheese, and raw vegetables in place of lollies, cakes, and biscuits.
Avoid sucking on lollies, nibbling foods or sipping sweet drinks over long periods of time.
Drink plenty of water, particularly after eating.
Chew sugar-free gum after meals to increase saliva production, which protects against tooth decay.
For more information on diabetes and dental care, download a free fact sheet from the NDSS: https://www.ndss.com.au/wp-content/uploads/factsheets/fact-sheet-looking-after-your-dental-health.pdf
