Diabetes Mellitus And Its Impact On Dental Care

By Dr. Chakradhar, MDSPublished Updated

Diabetes mellitus and its impact on dental and oral health

Diabetes mellitus is a chronic metabolic disorder that results in increased blood sugar levels beyond normal (a fasting blood sugar level of 99 mg/dL or lower is normal). During digestion, food is metabolized into sugars and released into the blood. Insulin released from pancreatic cells helps transportation of these sugars to body cells for conversion into energy. When insulin production is insufficient or body cells do not respond to insulin, blood sugar levels rise above normal values. These high sugar levels will have ill effects on multiple organs in the body.

Types of diabetes mellitus explained

Types of diabetes mellitus

There are 3 types of diabetes: Type 1, Type 2, Gestational diabetes

Type 1 diabetes

This is commonly seen in children and young adults due to insufficient production of insulin.

Type 2 diabetes

This is the most common type of diabetes. Seen in adults over 45 years of age. This is due to the poor response of body cells to insulin signals. Insulin production is normal in the body but its utilization is abnormal.

Gestational diabetes

Is commonly seen during pregnancy and becomes normal after delivery of the child.

Impact of diabetes on oral health

Diabetes mellitus affects the cardiovascular, renal, optical and neuromuscular. Along with general health diabetes also causes severe oral problems.

Impact of diabetes on oral health including gum disease and dry mouth

Gum diseases

Periodontitis is the destruction of supporting tissues of teeth that involves periodontal ligament, bone and gingiva. Periodontitis is considered as the sixth complication of diabetes. Uncontrolled diabetes results in severe gum and periodontal diseases due to defective defence mechanisms (defective neutrophil activity) and degenerative changes in the periodontal ligament.

Dry mouth

Reduced saliva production known as hypo-salivation or xerostomia is one of the most common problems seen in diabetes mellitus patients. Hyposalivation or xerostomia is more severe in patients with poorly controlled diabetes than in controlled diabetes. The reason behind the hyposalivation was unclear. Few studies show that diabetic neuropathy is reason for impaired function of salivary glands. Few histological studies showed that it is due to the degeneration of salivary gland cells.

Dental caries

Incidents of dental caries are high in diabetes, especially uncontrolled diabetes. Saliva protects the teeth by neutralizing the acid produced by Carlo genie bacteria. Hyposalivation and altered salivary composition in DM patients increases the risk of dental caries.

Oral mucosal lesions

Dry mouth and defective immune system in uncontrolled diabetes increases the incidence of oral candidiasis infection. Fissured tongue, oral ulcers and burning mouth are other common findings noticed in diabetes.

Delayed wound healing

Structural changes in collagen and defective immune system in diabetes results in delayed wound healing in diabetes patients. It takes a long time for the healing of extraction sockets and other oral lesions in DM patients, especially in uncontrolled DM. Osseointegration in implants procedure also affected in uncontrolled DM.

Altered taste sensation

Diabetic patients usually have altered or decreased taste sensation compared to non-diabetics. Sensory nerve Neuropathy or dry mouth could be the reason for this complaint.

Pulp necrosis

In controlled diabetes accumulation of glycation end products in the pulp tissue of teeth leads to structural changes and inflammatory reactions leading to pulp necrosis. These cases require Root Canal Treatment.

Peri-implant diseases

Incidents of peri-implant disease is high in patients with uncontrolled diabetes in whom missing teeth are replaced with implants. Peri implant mucous affects the soft tissue around the implant and peri-implant affects the bone around the implant. This will decrease the stability of the implant and leads to failure.

Dentist recommendations for diabetic patients

 

Frequently asked questions

Persistently raised blood glucose impairs the immune cells that normally control plaque bacteria, reduces blood supply to the gum tissue and slows healing. The result is that plaque which a non-diabetic person would tolerate produces a stronger, more destructive inflammatory response. Periodontitis is now widely described as the sixth complication of diabetes.

Often, yes. Untreated periodontitis maintains a low-grade inflammatory load that increases insulin resistance. Studies of non-surgical periodontal therapy have shown measurable reductions in HbA1c following treatment. It is not a substitute for medication or diet, but it is a modifiable factor that many diabetic patients and their physicians overlook.

Dry mouth, or xerostomia, is common in diabetes and is worsened by several medications. It matters because saliva buffers acid, washes away food debris and carries antibacterial proteins. Without enough of it, decay rates rise sharply, dentures stop fitting comfortably and fungal infections such as oral thrush become more frequent.

Yes, provided your diabetes is reasonably controlled. Well-managed diabetes is not a barrier to implants, extractions or surgery, and success rates are comparable to those in non-diabetic patients. Poorly controlled diabetes is the concern, because healing is slower and infection risk higher, so we will ask about your recent HbA1c before planning surgery.

More often than the standard six months. A three to four monthly review and professional clean is a common recommendation for diabetic patients, because gum inflammation can progress faster and needs catching earlier. If you have active periodontitis, the interval may be shorter still until the condition is stable.

Gums that bleed when you brush, persistent bad breath, gum recession or teeth that feel loose or have started to drift, recurrent mouth ulcers or thrush, a burning sensation in the mouth, and any wound in the mouth that has not healed within two weeks. Any of these warrants an appointment rather than watchful waiting.
Dr. Chakradhar, MDS – MDS - Periodontics | Implantologist, Ravi's Dental Care & Implant Centre, Visakhapatnam

Written and medically reviewed by

Dr. Chakradhar

MDS — Periodontics | Implantologist

Periodontist at Ravi's Dental Care & Implant Centre, MVP Colony, Visakhapatnam, treating gum disease, recession and the oral-systemic links that affect medically compromised patients.

Full profile & credentials →

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