According to a study published in the Journal of the American Dental Association, the risk of tooth loss is greater among diabetics than for non-diabetics-especially among the elderly.
The study was based on an analysis of data for more than 2,500 Americans who were over 50 years of age. The researchers discovered that diabetics (both type 1 and type 2) were missing an average of nearly ten teeth each compared to less than seven teeth for non-diabetics.
They also found that diabetics are twice as likely to have lost all their teeth. Among the subjects of the study, 28% of the diabetics had no teeth at all, compared to just 14% of non-diabetics.
The study also discovered that, while those who have poorly controlled diabetes are most likely to experience tooth decay, even diabetics who have their disease under control are more likely to suffer from gum disease compared to non-diabetics.
Unless you have been in a fight, falling teeth are nearly always due to gum disease. However, the damage diabetes does to your mouth is not limited to falling teeth.
How diabetes affects your mouth and teeth
Your mouth includes your teeth, your gums, your jaw, and tissues such as your tongue, the roof and bottom of your mouth, and the inside of your cheeks. All of these can be affected by diabetes.
The most common problems diabetics get in their mouths are:
- tooth decay (cavities)
- early gum disease (gingivitis)
- advanced gum disease (periodontitis)
- thrush
- dry mouth (xerostomia)
- burning mouth syndrome
These problems are not confined to those of us who have diabetes, of course. It's just that being diabetic makes it more likely that you will suffer from one or more of these conditions.
Plaque
Your mouth naturally contains many types of bacteria, and your saliva contains glucose. The glucose nourishes the bacteria.
If you are failing to control your diabetes, the level of glucose in your saliva will be elevated, making it a rich medium in which harmful germs can grow.
The germs and saliva form a sticky film on your teeth called plaque which binds to the surface of your teeth. This happens whether you are diabetic or not.
You can also get plaque from consuming food or drink containing sugar or starches because these deposit residues as they pass through your mouth.
If you don't remove plaque regularly it will harden over time into a substance called tartar and collect under the gum line. Tartar makes it more difficult to brush between your teeth and it needs to be removed by regular cleaning using the correct technique.
Plaque affects your teeth and gums. Some types cause tooth decay or cavities. Other types of plaque cause gum disease, a very common form of infection.
Gum disease can happen more often, be more severe, and take longer to heal if you have diabetes. In turn, having gum disease can make your blood glucose hard to control. Some studies suggest that treating your gum disease can make it easier to control your blood glucose.
Tooth decay (cavities)
Plaque contains acids. These acids attack the hard, outer surface (enamel) of your teeth. This can create cavities or holes in the enamel.
The higher your blood glucose level, the greater the supply of sugars and starches in your food and drink, the more acid there will be eating away at your teeth. Thus diabetics who fail to control their blood glucose levels are more prone to cavities than non-diabetics.
Early gum disease (gingivitis)
The longer plaque and tartar remain on your teeth, the more they irritate the gingiva, the part of the gum around the base of the teeth. In time, your gums become red and swollen. Bleeding will often occur while you are brushing your teeth.
This is gingivitis, or inflammation of the gums. It is the first stage of gum disease. If it is not treated, you teeth will begin to decay.
You can avoid gingivitis by bushing and flossing your teeth daily, and by having your teeth cleaned regularly by your dentist.
Infections spread much more easily when you have diabetes and high blood glucose levels. Keeping your blood sugar under control reduces the rate at which this happens. Unfortunately, when your body begins to fight an infection, blood glucose levels usually rise in response thus accelerating the spread rate.
When gingivitis is not treated, it can develop into periodontitis, a much more serious form of gum disease which destroys the soft tissue and bone that support your teeth.
Advanced gum disease (periodontitis)
In periodontitis, the gums pull away from the teeth and form pockets or spaces which become infected. Your body fights the germs as the plaque spreads and grows below the gum line.
However, the germs and your body's response to the infection start to break down the bone and tissue that hold your teeth in place. Eventually, periodontitis causes your gums to pull away from your teeth. Your teeth will loosen and may even fall out.
Not only will your gums be red and swollen and prone to bleeding but you may have pus between your teeth and gums, as well as bad breath that you just can't get rid of.
In addition, your teeth may tend to move away from each other. You will probably notice changes in the way they fit together when you bite or the fit of your dentures is becoming uncomfortable.
The solutions range from deep cleaning by your dentist, through prescription medicines, to gum surgery. If periodontitis is not treated, the gums, bones and tissue that support the teeth will be destroyed and teeth will have to be removed.
Periodontitis tends to be more severe among people who have diabetes because diabetes lowers the ability to resist infection and slows healing.
An infection such as periodontitis may cause your blood sugar level to rise, which makes controlling your diabetes more difficult. Treating periodontitis, however, can help improve blood sugar control.
Thrush
Thrush in the mouth manifests itself as sore, white (sometimes red) patches on your gums, tongue, cheeks, or the roof of your mouth. These patches can turn into open sores.
Thrush is due to the spreading of a natural fungus. It is more common amongst people who have poor blood glucose control.
The solution is prescription medicines. If you wear dentures, removing them during the night and for part of the day may help, as will keeping them clean. If they don't fit well, get them fixed.
Dry mouth (xerostomia)
Dry mouth is a lack of saliva in your mouth, which raises your risk of gum disease and tooth decay.
You feel that your mouth is almost always dry. The feeling may come along with a dry, rough tongue, cracked lips, oral sores and infections, and difficulties chewing, swallowing, or talking.
Your doctor or dentist can prescribe medicine to keep your mouth wet. You also need to avoid tobacco, caffeine, alcohol and spicy or salty foods.
To increase the flow of your saliva you can use sugarless gum or mints or take frequent sips of water. Rinsing your mouth with a fluoride mouth-wash may help.
Burning mouth syndrome
This is a complex mouth problem in which you have a burning feeling in the mouth. Your mouth will feel dry and painful and will have a bitter taste. The symptoms may get progressively worse over the course of a day.
The cause of burning mouth syndrome is not known but is thought to be linked to nerve damage, painful dentures, hormonal changes, dry mouth, and a poor diet. The only solution is to seek medical advice.
How does smoking affect the mouth?
Tobacco products-cigarettes, cigars, and pipes-are bad for anyone's mouth. But if you have diabetes and smoke, you are increasing your risk of developing gum disease.
This is because smoking-besides causing cancer, cardiovascular diseases and lung diseases such as emphysema-can damage gum tissue and cause swollen or receding gums. It can also speed up bone and tissue loss, leading to falling teeth. Smoking contributes to the development of mouth ulcers and raises your chances of getting cancers and fungal infections in your mouth and throat.
In summary, smoking makes any problems you have within your mouth much worse. It also discolours your teeth and makes your breath smell bad.
Dental hygiene, diabetes, and cholesterol
Diabetes can cause excess cholesterol to build up in the bloodstream.
If your gums have an infection that isn't treated promptly, bacteria from the infected gums can flow into the bloodstream. This may speed up the rate at which your arteries are clogged by cholesterol, putting you at the front of the queue for a heart attack or stroke.
The only solution is to make sure that you control your diabetes, look after your teeth and your gums, and visit your dentist regularly.
Summary
People with poorly-controlled diabetes are more susceptible to dental problems.
They are more likely to have infections of their gums and the bones that hold the teeth in place, because diabetes can reduce the blood supply to the gums.
In addition, high blood sugar may cause dry mouth and make gum disease worse, because the decrease in saliva can cause an increase in tooth-decaying bacteria and the build-up of plaque.
Smoking exacerbates all these problems.
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