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As diabetes educators, we are aware of the correlation between diabetes and dental disease, but we need to bring this to the attention of our patients more frequently. Oral care is especially important for maintaining healthy teeth and gums. Tooth decay and gum disease occur when bacteria in the mouth mix with the sugars and starches in the food eaten to form placque. the placque clings to the surface of the teeth and gum line causing red, tender and bleeding gums, tooth decay and dissolving toot enamel. If it is not removed by brushing and flossing, the placque, which is a gummy film made up of bits of food, saliva and bacteria, then turns to tartar which can oly be removed professionaly.
Bacteria in the mouth thrive on sugar, inviting the growth of bacteria that cause dental diseases such as gingivitis, periodontal disease and even tooth loss, making it more difficult to control blood glucose. Periodontal disease is associated with the development of type 2 diabetes.
Patients should be encouraged to brush after meals and especially at bed time or as least rinse, even after snacking between meals. A sof bristle brush with rounded edges should be used to provide gentle brushing, which should include the tongue. Flossing at least once a day helps to rid placque at the gum line and remove food from hidden places that a brush cannot reach. Dental appliances should be removed and brushed or rinsed once daily as well. Patients should be encouraged to see their dentist for checkups once every 6 months and reminded to tell the dentist that they have diabetes. However, often dentists can suspect diabetes in an undiagnosed patient by detecting a sweet smelling breath or dry mouth and can predict how well the patient’s blood glucose is controlled.
Dry mouth occurs when there is an insufficient amount of saliva to keep the mouth moist. Saliva aids in digestion and helps to prevent infection by washing bacteria from the mouth as well as dead skin cells that accumulate on the gums, tongue and cheek. Dry mouth can also alter taste. Saliva moistens and irrigates the mouth by neutralizing acids that are produced by the placque. Smokers, mouth breathers and those on dialysis are candidates to develop dry mouth.
Food choices and eating habits can help or hinder the health of the mouth. Foods that help to build strong muscles, bones and a healthy body also help the gums and teeth to be healthy. Dairy products for Vit D and phosphorous, breads and cereals for Vit B and iron, fruits and vegetables for Vit C and folic acid and lean meats and poultry that provide iron, protein, magnesium and zinc, all help to protect against gum and tooth disease. Cheese, sugar free gum and peanuts help to increase saliva, thus decreasing the formation of plaque.
The side effects of some medications can cause dry mouth, especially those used to treat heart problems and hypertension. Other culprits are those used for anxiety, sedatives, diuretics, depression, muscle relaxants, anti-psychotics and anitinflammatory conditions. Patients should avoid caffeinated beverages, foods and liquids that have a high sugar or salt content, diet sodas and citrus juices. Adequate amounts of water should be encouraged to irrigate the mouth and prevent dehydration. A lip balm is also recommended.
Good oral hygeine is important in maintaining healthy gums and teeth and can help control hyperglycemia and should be consistently brought to the attention of our patients with diabetes.
Submitted by Annette Karnash