VOLUME 8 NUMBER 4 • NOVEMBER 2011
167
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Diabetes Educator’s Focus
ORAL HEALTH IN DIABETES
O
ral care is particularly important for the
patient with diabetes. Emerging research
suggests that the relationship between
serious gum disease and diabetes is two way. Dia-
betics are more susceptible to serious gum disease,
but serious gum disease may have the potential to
affect blood glucose control and contribute to the
progression of diabetes.
Good blood glucose control is key to managing
and preventing mouth problems. Poor blood glucose
control impairs the functioning of white blood cells,
necessary for defence against bacterial infections
that can occur in the mouth. The less well controlled
the blood sugar levels, the more likely oral health
problems will arise, resulting in more frequent and
more severe oral disease.
Daily brushing and flossing, regular dental check
ups and good blood glucose control are the
best defence against the oral complications of
diabetes.
The smoking diabetic patient faces an even
greater risk (20 ×) for the development of thrush
and periodontal disease. Smoking impairs blood
flow to the gums and may affect wound healing
in this area.
harmful wastes from the cells. The infection-fighting
ability of the immune system becomes impaired and
results in poor healing of oral tissue.
Gingivitis (early-stage gum disease) and periodontal
disease, a bacterial infection of the gum and bone that
hold the teeth in place, can lead to painful chewing
difficulties and even tooth loss. Plaque build up along
the gum line hardens and the gums pull away from the
teeth. Pockets of infection below the gum cause bone
loss, which may result in loosening of the teeth.
The frequent use of antibiotics in diabetes makes
the patient particularly prone to developing fungal in-
fections of the mouth and tongue. Thrush (
Candida
)
thrives on the high levels of sugar in the saliva, cre-
ating painful areas that may turn into ulcers. Thrush
presents as white (sometimes red) patches in the
mouth, including the palate. It is easily scraped away,
but will rapidly regrow.
The diabetic patient faces a higher
risk of a number of oral conditions
Xerostomia (dry mouth) is a common diabetes-relat-
ed condition that may be a side effect of medicines
taken. A dry mouth may make the patient more sus-
ceptible to cavity formation, as there is less saliva
to wash away bacteria and the acids they produce.
Xerostomia can lead to further discomfort; the devel-
opment of ulcers and tooth decay, and infections of
the gums and salivary glands. Simple interventions
such as drinking more fluids and chewing sugar-free
gum may help keep the saliva flowing.
Diabetic patients are at increased risk of gum in-
flammation. A common complication of diabetes is
the thickening of blood vessels, affecting blood flow
and slowing the inflow of nutrients to and removal of
Dentist alert: warning signs for the
patient to act on
Often gum disease is painless. The patient may not
even realise he/she has gum disease until some se-
rious damage has been incurred, so regular visits to
the dentist are of great importance. It is essential to
pay special attention to any changes in oral health. If
one or more of the following problems present, there
may be tooth damage and/or gum disease:
pain in the mouth/sinus area that does not go
•
away
white or red patches on the gums, tongue,
•
cheeks or roof of the mouth
S Afr J Diabetes Vasc Dis
2011:
8
:
167–168.
