How Diabetes Affects Oral Health?

How Diabetes Affects Oral Health
More Than a Sweet Tooth – If the sugar level is high in your blood, it’s high in your saliva too. Bacteria in plaque, a sticky film, use sugar as food. Some of this bacteria can cause tooth decay, cavities, and gum disease, If the tooth is not treated, it can also lead to tooth loss.

You may have less saliva, causing your mouth to feel dry. (Dry mouth is also caused by certain medicines.) Your gums may become inflamed and bleed often (signs of gum disease). Infections in your mouth can take longer to heal.

How does poor oral health affect diabetes?

12 Jul The Connection between Poor Oral Health and Diabetes – Posted July 12, 2014 in Whats New How Diabetes Affects Oral Health The human body is an enclosed environment that operates smoothly until foreign bacteria and viruses enter and threaten the balance of the system. There are limited ways in which such adversaries to health can enter the body: through the lungs, breaches (wounds) in the skin, and the mouth.

  • Most people do not relate the mouth with interior infections, but the truth is that many billions of bacteria grow and thrive in the mouth, some of which are beneficial and some of which are detrimental.
  • Harmful bacteria and the toxic waste byproducts they create in the mouth normally breach the protective barriers of the body through the circulatory system.

This normally occurs through poor oral health when bacteria are allowed to multiply causing gingivitis (swelling and bleeding gums), dental caries (tooth decay and cavities) and periodontitis (deterioration of the tissue surrounding the teeth). When gums bleed, tooth enamel is compromised, or bone is damaged from these dental problems, doorways are opened for harmful bacteria to enter into the circulatory system.

  1. Diabetes is one of the health problems complicated by oral bacterium.
  2. It has been found that tissue inflammation caused by oral bacteria (both in the mouth and internally) weakens the body’s ability to utilize insulin and control of blood sugar.
  3. This has a cyclic effect since high blood sugar actually provides ideal conditions for oral bacteria to grow, thus compounding the problem.

Another cyclic effect occurs between diabetes and poor oral health conditions as well. Gum disease, particularly periodontitis, is exasperated by diabetes because the immune system is weakened which is used to fight oral infections. Therefore, people with diabetes must not only practice good oral hygiene to ward off gum disease and minimize bacterial risk, but they must also control their blood glucose levels which can increase gum disease risk significantly if they are unbalanced.

What is the most common oral manifestation of diabetes?

Diminished salivary flow is a common oral feature of diabetes and may or may not include symptoms of a burning sensation in the mouth or tongue and concomitant enlargement of the parotid salivary glands (8).

Are there any dental problems associated with diabetes?

Gum disease -, also called periodontal gum disease, is the most common and serious mouth problem related to diabetes. Untreated, the disease advances in stages, from inflamed gums to tooth loss. High levels of blood glucose increase the risk that gum disease will progress from mild to severe.1 How Diabetes Affects Oral Health Gum disease advances in stages, from inflamed gums to tooth loss.

How can diabetes affect dental treatment?

How to keep your mouth healthy – Here’s what you need to think about to protect your teeth and gums. It is what you do every day that counts.

Check your blood sugars – regularly check them and try to keep them in your target range.Brush twice a day – If you have gum recession, use interspace brushes rather than floss to clean between your teeth.See your dentist – having diabetes doesn’t mean you get free dental treatment but you need to book regular check-ups. Ask for your Basic Peridontal Examination scores and what they mean to help you to monitor your own gum health.Choose the right food and drink – follow a healthy, balanced diet which is low in sugar.Don’t smoke – smoking weakens your immune system, making it harder for you to fight a gum infection. And once you have gum disease, smoking makes it harder for your gums to heal. Get help with giving up smoking,Keep your dentures clean. Do not wear them when you are asleep. Make sure you clean them regularly as a build-up of fungi can lead to a type of thrush in the soft tissues under your denture.

Remember to talk to your diabetes healthcare team for more advice if you need it. And give our helpline a call if you’re worried about complications and need more support.

Can diabetes cause tooth decay?

Poor Oral Hygiene can lead to Diabetes, Heart Disease and More – Longmeadow Family Dental Care.

How does sugar affect the oral cavity?

Sugars and tooth decay What is tooth decay? Tooth decay, or ‘dental caries’, occur when acid from within the mouth attacks the enamel and dentine of the teeth causing holes or cavities to form. The acid is produced by bacteria that are found within the plaque – a sticky and thin film that repeatedly forms over the teeth.

When sugar is consumed it interacts with the bacteria within the plaque to produce acid, This acid is responsible for tooth decay because it slowly dissolves the enamel creating holes or cavities in the teeth. Tooth decay can lead to tooth abscesses, which may result in the tooth having to be removed,

Despite the decreasing levels of tooth decay over the past decades, it still remains one of the most common problems in the UK, second only to the common cold, It is estimated that 1 in 3 adults suffers from dental caries and close to 1 in 4 children equally suffer from some form of tooth decay,

  1. Sugar and tooth decay: Sugars in food and drinks play a major role in the development of dental caries.
  2. Bacteria within the plaque use the sugar as energy and release acid as a waste product, which gradually dissolves the enamel in the teeth,In 2010, the World Health Organisation (WHO) commissioned a systematic literature review to answer a series of questions relating to the effects of sugars on dental caries.

The systematic review showed consistent evidence of moderate quality supporting a relationship between the amount of sugars consumed and dental caries development. There was also evidence of moderate quality to show that dental caries is lower when free sugars intake is less than 10% of energy intake.

Dental caries progresses with age, and the effects of sugars on the dentition are lifelong. Even low levels of caries in childhood are of significance to levels of caries throughout the life-course. Analysis of the data suggests that there may be benefit in limiting sugars to less than 5% of energy intake to minimise the risk of dental caries throughout the life course,

Furthermore, the Scientific Advisory Committee on Nutrition (SACN) in the UK recently published a draft report in 2014 indicating a clear link between the consumption of sugars-containing foods and sugars-containing beverages and the incidence of dental caries both in deciduous and permanent teeth.

SACN reviewed 11 cohort studies that identified a relationship between consumption of sugars-containing foods and the incidence of dental caries in deciduous dentition in children. They also reviewed seven cohort studies that presented evidence on the relationship between dental decay in children and sugars-sweetened beverages.

A greater frequency of consumption was also found to be associated with higher incidence of dental caries,Free sugars are now found in almost all food and are the most important factor in the deterioration of oral health. It is especially problematic in children who have become accustomed to sugar at an early age.

Tooth decay is the leading cause for hospitalisation among 5-9 year olds in the UK, with 26,000 children being hospitalised each year due to tooth decay – in other words, 500 each week, Who is at risk of tooth decay? Everyone is at risk of tooth decay, but children and adolescents are most at risk. Dental caries are the most common cause of tooth loss in young people,

Plaque begins to build up on teeth only 20 minutes after we begin eating and if it is not removed effectively, tooth decay starts. People who regularly consume sugar have a higher risk of developing dental caries, particularly if the food they eat is sticky or consumed in between mealtimes.

Sugars-containing snacks and sugars-sweetened beverages have particularly bad effects on teeth. People who smoke and consume alcohol are also more at risk, The prevalence of dental caries is also associated with social factors – where adults from lower income households are more likely to suffer from dental caries than those from higher income households (37% compared with 26%),

Dietary Advice: We currently consume far too much sugar in our diets. The report published by the WHO and by the SACN highlight the need for a reduction in sugars intake to 5% of our energy intake. This is the equivalent of 7 teaspoons/cubes or 30g of sugar per day for an adult.

  1. The recommendation for children is 24g for children aged 5-11 and 19g for children aged 4-6.
  2. This 5% limit is far below the current intake which is of 11.9% in children aged 1.5 to 3; 14.7% in children aged 4 to 10; and 15.6% in children 11 to 18.
  3. It is also thought that adherence to the 5% recommended sugar intake would halt the increase in obesity,

Other ways to reduce dental caries include :

Brushing teeth thoroughly twice a day with fluoride-containing toothpaste as well asflossing daily. Reducing the amount of sugars-containing sticky food, and rinsing the mouth with water if they are consumed. Reduce snacking; which helps reduce the production of acid in the mouth. Reduce the consumption of sugars-sweetened beverages. Only eat sugary foods at mealtimes.

NB. Whole fruit is not harmful for your teeth. References: NHS Choices, 2014. “Tooth Decay,” URL:, British Dental Health Foundation, nd. “Dental Decay,” URL:, MedlinePlus, 2014. “Dental Cavities,” URL:, Bader JD, Rozier G, Harris R, et al.2004. Dental caries prevention: The physician’s role in child oral health systematic evidence review,

Rockville, Md. Agency for Healthcare Research and Quality (US). Steele,J & O’sullivan, I, 2011. Adult dental health survey 2009: The Health and Social Care Information Centre. Steele, J & Lader, D.2004. Social factors and oral health in children: Children’s Dental Health in the United Kingdom, 2003. Scientific Advisory Committee on Nutrition.2014.

“Draft Carbohydrates and Health Report” pp.98-99. Templeton, S.K.2014. “Rotten teeth put 26’000 children in hospital,” The Sunday Times. URL:, National Diet and Nutrition Survey Results from Years 1, 2, 3 and 4 (combined) of the Rolling Programme.2008/2009 – 2011/2012.

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How does diabetes cause dry mouth?

– The NIDDK list dry mouth among the most common problems that people living with diabetes experience. Its high prevalence in this population may be due to:

Dehydration: People with diabetes are prone to dehydration. Increased blood sugar levels: In those with diabetes, a person’s blood glucose levels can become too high, The term for this is hyperglycemia, and it can cause a person to experience dry mouth. Kidney conditions: Over time, high blood glucose can lead to kidney disease, which can cause dry mouth. Diabetes medication: Some medications that a person can take to help control diabetes can cause dry mouth as a side effect.

Also, according to Johns Hopkins Medicine, approximately two-thirds of those with diabetes have high blood pressure or use medications to help control hypertension. Dry mouth can occur as a side effect of these medications.

Why do diabetics get mouth ulcers?

Diabetes and oral fungal infections – Oral thrush (candidiasis) is a fungal infection. It is caused by an overgrowth of the yeast, Candida albicans, which lives in the mouth. Some conditions caused by diabetes such as high glucose in saliva, lowered resistance to infection and dry mouth (low saliva levels) can encourage the overgrowth of these fungi, leading to oral thrush.

How does diabetes increase the risk of periodontitis?

L. Casanova, F.J. Hughes and P.M. Preshaw provide practical guidance for the dental team in assessing and managing periodontal status in people with diabetes. Introduction Periodontitis and diabetes are both highly prevalent conditions, and the association between these two common diseases has been recognised by dental professionals for many years.

Epidemiological studies have clearly identified that diabetes is a major risk factor for periodontitis, increasing the risk approximately three-fold compared to non-diabetic individuals, particularly if glycaemic control is poor.1 In recent years, the precise relationship between periodontitis and diabetes has been the subject of much interest, given that both conditions are highly prevalent, and also because it has become increasingly clear that there are interactions between the two diseases that have important clinical implications for dental professionals, physicians and, most importantly, patients.

This narrative review aims to summarise our current understanding of the relationship between diabetes and periodontitis and to discuss the clinical implications of these findings for the dental professional. Relevant literature was identified from Medline and PubMed database searches together with scrutiny of reference lists from published articles. How Diabetes Affects Oral Health Credit: ©IPGGutenbergUKLtd/iStockphoto/Thinkstock Periodontal disease Inflammatory periodontal diseases are the most common chronic inflammatory conditions of man, affecting – if including gingivitis as well as periodontitis – up to 90% of the world’s population.2 When considering severe periodontitis (which typically refers to the presence of pocketing ≥6 mm), the prevalence is generally estimated to be around 5-15% of adults globally.3 Consistent with this are the findings of the 2009 Adult Dental Health Survey for England, Wales and Northern Ireland, which identified that 8% of adults have at least one pocket of 6 mm or deeper.4 The inflammation in the periodontal tissues that characterises periodontitis is initiated by the accumulation of the subgingival biofilm; however, susceptibility to disease is determined by a number of factors independent of the absolute levels of plaque. Pre-eminent among these are the major environmental risk factors for periodontitis, tobacco smoking 5 and diabetes.6 The tissue damage that results from the chronic inflammation in the periodontal tissues (loss of attachment, breakdown of periodontal ligament fibres and alveolar bone resorption) is largely irreversible. It is also typically painless, so may remain unnoticed for many years unless the patient is seen by a dental healthcare professional. The consequences of periodontitis, such as gingival bleeding, compromised aesthetics, recurrent periodontal infections, tooth mobility and tooth loss, may all have negative impacts on daily living and quality of life, with implications for function, comfort, self-confidence, social interactions and food choices.7 – 9 Diabetes Diabetes is a group of metabolic disorders characterised by hyperglycaemia (elevated blood sugar). The main types of diabetes are type 1 diabetes, type 2 diabetes and gestational diabetes. Type 1 diabetes (in the past, referred to as insulin-dependent diabetes, or juvenile diabetes) describes a condition in which there is a failure to produce insulin as a result of autoimmune destruction of the insulin-producing β-cells in the pancreas. Genetic susceptibility is a major risk factor in type 1 diabetes, and in susceptible individuals, the onset of diabetes appears to be triggered by environmental factors such as viral infections and diet, rather than being related to lifestyle factors. The onset of type 1 diabetes is usually in childhood or young adulthood. Type 1 diabetes constitutes about 5–10% of all cases of diabetes, but accounts for more than 90% of diabetes cases in young people less than 25-years-old. Complications arise as a result of hyperglycaemia and include acute conditions such as diabetic ketoacidosis, as well as chronic disorders such as nephropathy, neuropathy, cardiovascular disease, and acute coronary syndrome. Many patients with type 1 diabetes do not develop serious long-term complications, however, particularly if their blood glucose levels are well controlled. The condition is typically managed by blood glucose monitoring and insulin therapy.10 Type 2 diabetes (previously referred to as non-insulin-dependent diabetes, or adult onset diabetes) results from insulin resistance; that is, there is reduced responsiveness of the cells in the body to insulin, leading to a reduced capacity to transfer glucose out of the circulation and into cells. This leads to hyperglycaemia (elevated blood glucose levels). In the early stages, insulin secretion by the β-cells of the pancreas may be normal, but this can diminish over time, leading to insulin deficiency as well as insulin resistance. Type 2 diabetes constitutes 90–95% of all diabetes cases, and is typically associated with lifestyle factors such as overweight/obesity and lack of exercise, as well as genetic factors. The management of type 2 diabetes typically involves combinations of lifestyle change, weight loss, dietary modification, oral hypoglycaemic drugs and, in severe cases, insulin injections. The age of onset of type 2 diabetes was previously typically considered to be in the 40s and 50s, but increasing numbers of cases in younger age groups are now being identified. Gestational diabetes is a form of diabetes that occurs in pregnant women without a previous history of diabetes who develop hyperglycaemia during their pregnancy. It is characterised by reduced insulin secretion as well as insulin resistance, and usually improves after pregnancy, though a small proportion of affected women may be found to have diabetes (usually type 2) after their pregnancy. The adverse effects of diabetes are associated with the hyperglycaemia that characterises the condition. Diabetes has negative impacts on multiple body systems and disease states throughout the body, including cardiovascular disease, renal disease, peripheral vascular disease, ocular disease and neuropathy. The level of glycaemic control is routinely assessed by measuring glycated haemoglobin (HbA1c) in the blood. This has traditionally been expressed as a percentage, being the percentage of haemoglobin that has glucose molecules absorbed onto the haemoglobin molecule, that is, the percentage of haemoglobin that is ‘glycated’. However, the way that HbA1c values are reported has now switched from a percentage to a measurement in mmols/mol ( Table 1 ). The lifespan of a red blood cell is typically around three months, and therefore HbA1c measurements give an indication of the level of glycaemic control over that period. In a non-diabetic person, HbA1c is typically around 5.5% (37 mmol/mol). In people with diabetes, HbA1c levels of <7.0% (53 mmol/mol) would typically indicate good glycaemic control (though many clinicians will strive to work with their patients to achieve HbA1c <6.5%, 48 mmol/mol). Levels of 8-9% (64-75 mmol/mol) or higher indicate poor glycaemic control. The complications of diabetes are closely linked to the level of glycaemic control, and it has been shown that each 1% reduction in HbA1c has been associated with measurable reductions in risk of diabetes complications, a 21% reduction in deaths related to diabetes, a 14% reduction for myocardial infarction, and a 37% reduction for microvascular complications of diabetes.11 It is, therefore, extremely important to work with patients to optimise their glycaemic control. Table 1 Measurement of blood glucose: what do the numbers mean? We are currently witnessing a global epidemic of type 2 diabetes, with huge increases in the numbers of people affected in countries throughout the world. This has major implications for provision of healthcare services, as well as individual impacts in terms of life expectancy, morbidity, quality of life and healthcare costs. It is estimated that currently 347 million people suffer from diabetes worldwide 12 and this figure is predicted to rise to approximately 439 million, almost 10% of adults, by 2030. In the UK it is estimated that about 6.5% of the total population are affected by diabetes.13 The effects of diabetes on periodontal disease Epidemiological studies have consistently shown that diabetes is associated with increased risk of periodontitis. The majority of research has focused on type 2 diabetes, although type 1 diabetes appears to have an identical effect on risk for periodontitis. The magnitude of the increased risk of periodontitis is known to be dependent on the level of glycaemic control, as it is with the risk of all complications of diabetes. Thus, in well controlled diabetes with HbA1c of around 7% (53 mmol/mol) or lower, there appears to be little effect of diabetes on risk for periodontitis. However, the risk increases exponentially as glycaemic control deteriorates. Overall, the increased risk of periodontitis in patients with diabetes is estimated to be between 2–3 fold — that is, it increases the risk for periodontitis by 2–3 times.1, 14 Diabetes increases the prevalence of periodontitis, the extent of periodontitis (that is, number of affected teeth) and the severity of the disease. It has been reported that patients with diabetes may present to the dental professional with multiple recurring periodontal abscesses, and although this may sometimes be the case, it is not typical. Thus, there is not normally any particular characteristic clinical presentation of periodontitis in patients with diabetes other than the normal clinical features of the condition. In addition to the effects of diabetes on periodontitis, various other oral conditions may also be associated with diabetes. Many patients with diabetes may also take calcium channel blocker drugs such as amlodipine and nifedipine for hypertension, and this may result in gingival overgrowth in some cases. Occasionally, medications can also have other oral manifestations, such as lichenoid mucosal reactions to metformin. Other oral consequences of diabetes may include xerostomia resulting in increased risk for caries, candidal infections and chronic mouth ulcers. How Diabetes Affects Oral Health Credit: ©alexluengo/iStockphoto/Thinkstock The mechanisms that link diabetes and periodontitis are not completely understood, but involve aspects of inflammation, immune functioning, neutrophil activity, and cytokine biology.15 Both type 1 and type 2 diabetes are associated with elevated levels of systemic markers of inflammation.16 Diabetes increases inflammation in periodontal tissues, with higher levels of inflammatory mediators such as interleukin-1β (IL-1β) and tumour necrosis factor-α (TNF-α).17, 18 Periodontal disease has been associated with higher levels of inflammatory mediators such as TNF-α in people with diabetes.19 Accumulation of reactive oxygen species, oxidative stress, and interactions between advanced glycation end products (AGEs) in the periodontal tissues and their receptor (RAGE, the receptor for advanced glycation end products) all contribute to increased inflammation in the periodontal tissues in people with diabetes. A detailed review of the pathogenic mechanisms that link diabetes and periodontitis is beyond the scope of this article but this subject area has been recently reviewed.15 The effects of periodontal disease on diabetes Evidence to support a negative impact of periodontal disease on diabetes was first postulated following studies of the Gila River Indian Community, a population of Native Americans with a high prevalence of diabetes. It was noted that severe periodontitis was associated with increased risk of poor glycaemic control (HbA1c >9.0%, 75 mmol/mol) at follow-up (minimum of two years later), suggesting that periodontitis may be compromising diabetes control.20 Other studies have reported increased prevalence of diabetes complications, such as cardiovascular complications, retinopathy, neuropathy and proteinuria in people with advanced periodontitis.21 – 24 More recent studies of people with type 2 diabetes from the Gila River Indian Community identified that the incidences of macroalbuminuria were 2.0, 2.1 and 2.6 times as high in those who also had moderate periodontitis, severe periodontitis, or who were edentulous, respectively, compared to those with no/mild periodontitis (p <0.05). Furthermore, the incidences of end-stage renal disease (ESRD) were 2.3, 3.5 and 4.9 times as high for those with moderate or severe periodontitis, or who were edentulous, respectively (p <0.05). The authors concluded that moderate and severe periodontitis and edentulousness predicted the occurrence of nephropathy (characterised by macroalbuminuria and ESRD) in a ‘dose-dependent' manner in the individuals with type 2 diabetes.25 The impact of periodontitis on deaths from cardiovascular complications and diabetic nephropathy has also been investigated in a longitudinal study of Pima Indians with type 2 diabetes. Age- and sex-adjusted death rates (deaths per 1,000 person-years) were 3.7 for those with no/mild periodontitis, 19.6 for those with moderate periodontitis and 28.4 for those with severe periodontitis. After adjustment for known confounders, it was shown that diabetic individuals with severe periodontitis had 3.2 times increased risk of cardiorenal mortality (ischaemic heart disease and diabetic nephropathy combined) compared with the reference group (those with no periodontitis, mild and moderate periodontitis combined).26 Changes in HbA1c in non-diabetic individuals who were monitored for a period of five years have also been associated with the presence of periodontitis. In a longitudinal study, the (non-diabetic) participants with the most advanced periodontitis at baseline were found to have a five times greater increase in their HbA1c values over five years (change in HbA1c 0.106 ± 0.03%) compared to those who did not have periodontitis at baseline (change in HbA1c 0.023 ± 0.02%).27 This is the first study to suggest that periodontitis results in increased HbA1c levels in individuals who do not have diabetes, and is continuing further to identify whether this translates into an increased occurrence of incident diabetes (new cases of diabetes). The effect of periodontal treatment on diabetes control A large number of studies have now been carried out to investigate the effects of treating periodontitis on glycaemic control in people with diabetes. Some of these have been performed as randomised controlled trials, in which periodontal treatment was compared to no periodontal treatment (or delayed periodontal treatment) in people with diabetes and periodontitis. To date, up to seven systematic reviews and meta-analyses have been published which investigated in detail the outcomes of these studies, and a consistent finding has been that periodontal treatment is associated with reductions in HbA1c of the order of 0.4%.28 – 34 One of these studies was a Cochrane review, which similarly identified a reduction in HbA1c of approximately 0.4% following non-surgical periodontal therapy.33 Although such an improvement in HbA1c may appear to be relatively modest, it may, in fact, have very significant clinical impacts, because, as reported above, every 1% reduction in HbA1c is associated with a measurably reduced risk for diabetes complications.11 Furthermore, periodontal treatment is a relatively straightforward clinical intervention, that doesn't have unwanted effects that might be associated with additional medications taken as part of diabetes therapy. However, it is recognised that not all clinical trials which assessed the impact of periodontal therapy on glycaemic control have identified similar findings, and in particular, a recent multi-centre study of over 500 patients failed to demonstrate any benefit of periodontal treatment on glycaemic control.35 However, this study has been criticised on account of three main issues: (i) for recruiting patients with moderately good glycaemic control already (HbA1c <9%, 75 mmol/mol) who would therefore have limited potential for improvement following periodontal treatment; (ii) for achieving only a relatively poor response to the periodontal treatment; and (iii) for having a very overweight/obese study population (average body mass index of approximately 35 kg/m2 in the treatment group, indicating marked obesity, which would mask any decrease in inflammatory response resulting from periodontal treatment).36 It is clear that further evidence is required to address the specific question of the impact of periodontal treatment on glycaemic control. Implications for the dental professional In 2007, the World Health Organisation (WHO) Executive Board acknowledged the intrinsic link between oral health, general health and quality of life.37 It has been suggested that oral health is a neglected area of global health, and an editorial in The Lancet proposed that promoting and improving oral health should be part of the routine agenda of healthcare policymakers and clinicians.38 Periodontal disease and diabetes are directly and independently associated chronic diseases of high prevalence in the population, and the global prevalence of type 2 diabetes, in particular, is rising dramatically. In 2000, the US Surgeon General referred to a ‘silent epidemic' of oral and dental diseases, and stressed the importance of oral health as being essential for general health and well-being.39 A patient with diabetes may have a number of specific direct implications for the dental professional:

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Patients with (particularly type 1) diabetes may be at risk of hypoglycaemic episodes while attending the dental surgery People with diabetes are at higher risk of oral disease, particularly periodontitis, and particularly if their diabetes is poorly controlled Patients with undiagnosed diabetes may present at the dental surgery and provide an opportunity for referral for opportunistic screening based on the presence of periodontal disease and other diabetic risk factors Patients with diabetes may experience some improvement in their glycaemic control following successful periodontal treatment.

The management of medical emergencies involving diabetic patients in the dental practice setting, particularly hypoglycaemic episodes, has been addressed in detail 40, 41 and will not be repeated in this paper. Regarding increased susceptibility to periodontitis in people with diabetes, this has a number of implications for dental management. Firstly, it is important that diabetic patients are aware of the potential impact their condition may have on their oral and periodontal health. Patients who are newly diagnosed with diabetes should be told about this impact and we should continue to urge our medical colleagues to recommend a dental examination to their patients. Unfortunately, many patients with diabetes and also many medical clinicians are unaware of the links between periodontitis and diabetes, and of the potential benefits that periodontal treatment may have for diabetic patients.42, 43 Routine periodontal assessment should be performed in all patients, including those with diabetes. Ask the patient about their level of glycaemic control: many will be able to tell you their most recent HbA1c measurements. If the patient does not have periodontitis, then long term preventive care and monitoring should be undertaken (that is, same as for all patients). Diabetic patients should also be evaluated for the other potential oral complications of diabetes, including caries, dry mouth, burning mouth, candidal infections and co-morbidities such as those associated with medications. If periodontitis is diagnosed, it should be managed as appropriate. This would typically involve (similar to non-diabetic patients) patient education and empowerment, oral hygiene instruction, non-surgical therapy (root surface debridement), and monitoring of treatment outcomes. Effective periodontal treatment is particularly important in people with diabetes, given that periodontitis has potential negative impacts on glycaemic control and diabetes complications, and that periodontal treatment has been associated with improvements in HbA1c. In most cases, conventional (non-surgical) periodontal treatment is very effective in diabetic patients, including optimisation of plaque control to control the inflammation that leads to periodontal destruction along with a major emphasis on self-management and patient education. There is little or no evidence to suggest, for example, that diabetic patients require antibiotics as part of periodontal therapy. The escalating human and economic burden of diabetes requires a multidisciplinary approach for the prevention, diagnosis and management of the disease and its complications including periodontitis. Many cases of diabetes in the UK are undiagnosed and therefore, the dental health professional may have a useful role to play in opportunistic screening of dental patients for risk of diabetes. A study from the USA has demonstrated that a combination of age (over 45), presence of periodontal disease and at least one other diabetic risk factor (for example, positive family history, self-reported BMI >25, hypertension) was very successful in identifying undiagnosed cases of diabetes.44 Recently, a diabetes screening programme was undertaken in dental patients in different clinical settings in the UK (general dental practices, a dental hospital clinic, and a dental school outreach clinic).45 The dental clinicians performed the screening procedure, and patients who were determined to be at moderate or high risk of diabetes were recommended to visit their medical GP for further investigation. This study identified that dental professionals who were trained in the screening procedure valued this process, as did the patients, who received the diabetes screening in the dental setting very favourably. The major downside was the time required to perform the screening, which added around 20 minutes to the length of each dental appointment. Clearly that would not be practical within current contractual arrangements for NHS dental practices, but it does highlight that dental healthcare teams could potentially play an important role in screening their dental patients for systemic conditions such as diabetes. Conclusions Diabetes increases the risk for periodontitis (particularly if poorly controlled) and evidence suggests that advanced periodontitis also compromises glycaemic control. Periodontal treatment has been associated with improvements in glycaemic control (with HbA1c reductions of approximately 0.4% reported in systematic reviews and meta-analyses), though more research is required to investigate this further. Oral health (including periodontal health) is a fundamentally important component of general health, and particularly so in diabetes. Periodontal assessment is as important in people with diabetes as it is in people who do not have diabetes, and people with diabetes should be made aware of their increased risk for periodontal disease. The dental team has an important role to play in the management of people with diabetes. An emerging role for the dental team is envisaged in which, through the use of relatively simple screening tools, they may help to identify patients at high risk of diabetes.

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Does sugar change PH in mouth?

Sugar Changes Mouth Acidity When you consume sugar, your saliva interacts and begins to break it down. As the naturally occurring bacteria in your saliva mix with the sugar, they create acid, which drives up the PH. This imbalance can lead to a more acidic environment in your mouth.

Does high sugar affect teeth?

The higher your blood sugar level, the higher your risk of: Tooth decay (cavities). Your mouth naturally contains many types of bacteria. When starches and sugars in foods and beverages interact with these bacteria, a sticky film known as plaque forms on your teeth.

What sugars cause dental caries?

6. Sugar Substitutes and Dental Caries – The development of noncaloric sugar substitutes, marketed for weight control, is big business in the United States. Commercial development of these products, from the laboratory to marketing, is time consuming and expensive.

  • Aspartame, a dipeptide composed of two naturally occurring amino acids, became available in the United States in 1982,
  • One of the main conclusions from the aforementioned Vipeholm study was that sugars in sticky foods consumed between meals was associated with high caries activity.
  • These findings stimulated research on nonacidogenic sugar substitutes (sweeteners) that do not cause pH falls in dental plaque,

It was not until 20 years later, however, that systematic studies carried out in Europe on alternate sweeteners for caries control were published, It is imperative to remember that the usefulness of a sugar substitute has to be looked upon not only from a cariological but also from a nutritional, toxicological, economic, and technical point of view.

  • When evaluating a nonsugar sweetener in relation to dental caries, it is important to consider the potential for metabolism by oral microorganisms and dental plaque, the influence of consumption on cariogenic microorganisms, and the risk of microbial adaptation to the sweetener.
  • Sugar substitutes can be categorised into two major groups: intense sweeteners (noncaloric) like aspartame, saccharin, sulfame, glycyrrhizin, and so forth and bulk sweeteners (caloric) like sorbitol, xylitol, mannitol, and so forth,

Intense sweeteners are not metabolized to acids by oral microorganisms; thus they cannot cause dental caries. However, it is important to remember that other ingredients, such as citric or phosphoric acids in beverages, may cause dental erosion. In some food products, intense sweeteners are added as well as sugars, for example, to fruit-flavored soft drinks, and the naturally occurring sugars in the drink (fructose, glucose, and sucrose) may cause caries,

  • One of the disadvantages of the bulk sweeteners is that they are only partially absorbed in the small intestine and thus may induce osmotic diarrhea,
  • For this reason food and drinks containing bulk sweeteners are not recommended for children under 3 years of age in whom they may also cause stomach problems when used in sugar-free medicine if the daily intake is high.

Among the bulk sweeteners the most commonly used are sugar alcohols like xylitol, sorbitol, and so forth. Field studies on xylitol, carried out in Russia, Hungary, and Estonia, have shown that xylitol is noncariogenic. Moreover, four clinical trials of xylitol in chewing gum have been conducted, namely, Turku chewing-gum study, the Ylivieska study, the Montreal study, and, most recently, the Belize study,

All these studies have shown that the use of xylitol helps in the prevention of dental caries. Beside these four chewing-gum studies there is also clinical evidence that xylitol candies are as effective as xylitol gum in caries prevention and that it is economically feasible to include xylitol in school-based caries control programs,

The Belize study is the first clinical trial of xylitol that enables the caries-preventive action of xylitol to be compared with sorbitol, and the results indicate that xylitol is superior in reducing caries. These findings should now be validated in randomized studies that account for dietary habits, oral hygiene practice, and socioeconomic status in other populations.

What are the effects of poor oral health?

Oral health refers to the health of the teeth, gums, and the entire oral-facial system that allows us to smile, speak, and chew. Some of the most common diseases that impact our oral health include cavities (tooth decay), gum (periodontal) disease, and oral cancer.

More than 40% of adults report having felt pain in their mouth within the last year, and more than 80% of people will have had at least one cavity by age 34. The nation spends more than $124 billion on costs related to dental care each year. On average, over 34 million school hours and more than $45 billion in productivity are lost each year as a result of dental emergencies requiring unplanned care.

Oral conditions are frequently considered separate from other chronic conditions, but these are actually inter-related. Poor oral health is associated with other chronic diseases such as diabetes and heart disease. Oral disease also is associated with risk behaviors such as using tobacco and consuming sugary foods and beverages.

Is there a relationship between oral health and diabetic neuropathy?

Several oral complications including burning mouth syndrome, dry mouth, and impairment of the senses taste and smell are less-known manifestations of diabetic neuropathy and often overlooked.

What is the relationship between diabetes and periodontal disease?

What causes gum disease in people with diabetes? – Diabetes causes blood vessel changes. The thickened blood vessels can reduce the flow of nutrients and removal of wastes from body tissues. This reduced blood flow can weaken the gums and bone. This puts them at greater risk for infection.

  1. Diabetes that is not controlled well leads to higher blood sugar (glucose) levels in the mouth fluids.
  2. This promotes the growth of bacteria that can cause gum disease.
  3. On the other hand, infections from untreated periodontal disease can cause the blood sugar to rise and make it harder to control diabetes.

Another factor, smoking, is harmful to oral health even for people without diabetes. But a person with diabetes who smokes is at a much greater risk for gum disease than a person who doesn’t have diabetes. These diabetes-related factors, together with poor oral hygiene, can lead to periodontal disease.

How does poor oral hygiene affect oral health?

What’s the connection between oral health and overall health? – Like other areas of the body, your mouth teems with bacteria — mostly harmless. But your mouth is the entry point to your digestive and respiratory tracts, and some of these bacteria can cause disease.

Normally the body’s natural defenses and good oral health care, such as daily brushing and flossing, keep bacteria under control. However, without proper oral hygiene, bacteria can reach levels that might lead to oral infections, such as tooth decay and gum disease. Also, certain medications — such as decongestants, antihistamines, painkillers, diuretics and antidepressants — can reduce saliva flow.

Saliva washes away food and neutralizes acids produced by bacteria in the mouth, helping to protect you from microbes that multiply and lead to disease. Studies suggest that oral bacteria and the inflammation associated with a severe form of gum disease (periodontitis) might play a role in some diseases.