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.