Oral Health and Diabetes

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What is diabetes?

Diabetes is a serious condition in which the level of glucose in the blood is too high due to decreased production of insulin and/or increased resistance to its effects. Insulin is a hormone produced by the pancreas that is needed to convert sugar, starches and other foods into energy. Normally, insulin helps get sugar from the blood into the body's cells, where it is used for energy. In the case of diabetes, not enough insulin is produced, and/or the cells do not respond to it properly, so the cells do not get the fuel they need and the blood sugar stays too high. High blood sugar sets off processes that can lead to complications such as heart, kidney and eye disease, or other serious problems.

Diabetes can affect the health of your mouth

Research has shown that people with poor diabetes control are more likely to develop problems in the mouth.1 Some of the very first symptoms of diabetes, such as dry mouth, may be detected by your dentist well before diabetes is diagnosed by your doctor, so regular dental check-ups are very important.

Early research has shown that people with diabetes may be at more risk of infections, including gum disease, thrush infections in the mouth (especially if wearing dentures) and tooth decay. It is also likely that poor oral health can make diabetes control more difficult,2 which is why it is so important for people with diabetes to keep their mouth healthy.

Tips for keeping your mouth healthy

- Brush your teeth thoroughly twice a day to remove bacterial plaque from teeth which helps preventing and treating gingivitis and periodontitis 
- Clean between the teeth at least once a day with floss or inter-dental brushes to remove bacterial plaque 
- Use a fluoridated toothpaste with antibacterial and/or anti-inflammatory properties 
- See your dentist and dental hygienist on a regular basis so they can check the health of your teeth and gums and treat any problems early before they become too advanced 
- Smoking makes many oral problems worse. So, if you do smoke, ask about help with quitting.

What is the link between diabetes and gum disease?

There are two main forms of gum disease: gingivitis and periodontitis. 
Gingivitis is gum inflammation and is caused by a build up of plaque on the teeth at the point where the tooth and gum meet. The bacteria in plaque cause the gums to become inflamed, and the gums look red and swollen and may bleed when you brush your teeth. 
Periodontitis is a more severe form of gum disease, and usually develops after several years. The gums recede (making the teeth look longer), the bone that holds the teeth in place is gradually destroyed, and the teeth may start to become loose.

Researchers have now confirmed that people with poor diabetes control are 2 times more likely to develop periodontitis compared to people who do not have diabetes.1 On the other hand, people with good diabetes control are not at increased risk for developing periodontitis.

Common types of diabetes

Type 1 diabetes 
- More common in younger people, develops due to reduced production of insulin by the pancreas 
- Usually treated with insulin injections.

Type 2 diabetes 
- l More common in middle age, but also seen in younger people too 
- Associated with lifestyle factors, such as obesity, lack of exercise and increased consumption of fatty and sugary foods 
- Results from resistance to the effects of insulin and decreased production of insulin 
- Usually treated by a combination of dietary changes, medications and sometimes insulin.

Diabetes facts and figures3

- Diabetes is predicted to affect 380 million people around the world by 2025 
- Every 10 seconds a person dies from diabetesrelated causes 
- Up to 60% of type 2 diabetes is preventable by adopting a healthy diet, increasing physical exercise, managing blood pressure and cholesterol levels and not smoking.

If you have diabetes, what you can do

- See your doctor and discuss ways to ensure good diabetes control. Individual targets for diabetes control should be planned by you and your doctor working together 
- Talk to your dentist or hygienist about gum disease and whether it is a potential problem for you and your overall health 
- Make sure you visit your medical and dental professionals on a regular basis.

Warning signs of gum disease:

- Red and swollen gums that bleed often after brushing 
- Gums that have receded or pulled away from the teeth, exposing the roots 
- Loose teeth 
- Teeth that have moved, creating spaces, or look longer than they used to.

Tips for good oral health if you have diabetes

- Maintain good oral hygiene and visit a dental professional regularly 
- Make healthy food choices 
- Maintain good diabetes control (work with your doctor to achieve this) 
- Don't smoke.

4 steps to help prevent gum disease, good oral hygiene is essential

1. Brush twice daily for at least 2 minutes each time with a soft bristle brush 
2. Use a fluoridated toothpaste with antibacterial and/or anti-inflammatory properties 
3. Clean between the teeth everyday, with floss or an inter-dental toothbrush 
4. Visit your dentist regularly.

References 
1. Mealey BL, Ocampo GL. Diabetes mellitus and periodontal disease. Periodontol 2000 2007;44:127-153. 
2. Taylor GW, Borgnakke WS. Periodontal disease: associations with diabetes, glycemic control and complications. Oral Dis 2008;14:191-203. 
3. International Diabetes Federation. 2007. www.idf.org Diabetes Australia. www.diabetesaustralia.com.au

This leaflet is for informational purposes only. It is not intended as professional advice or a substitute for advice from trained medical or dental professionals.