Oral and Dental Problems Seen in Diabetics
High blood sugar levels in diabetic patients cause thickening and blockage in the blood vessels, thus reducing the blood’s oxygen-carrying capacity and negatively affecting the nourishment of tissues. This condition reduces the resistance of the gums to inflammation. Gingivitis causes the gums to separate from the teeth. Over time, the small pockets that form between the tooth and the gum allow new bacterial foci to develop, and tooth loss may occur. During this process, the patient experiences loosening and pain in the teeth, as well as bleeding in the gums and an acetone odor in the mouth. At the same time, infections in the mouth make blood sugar control more difficult, and the situation becomes a vicious cycle. Especially in diabetics whose blood sugar is uncontrolled, the high sugar level in saliva prepares the ground for bacteria to settle and multiply, leading to cavities. In this group of patients, due to the thickening and decrease in the amount of saliva secretion, the washing and chewing-facilitating effect of saliva on the teeth is lost. Saliva deficiency can lead to plaque development and subsequent tartar formation. Dry mouth can cause the patient to feel pain, delay wound healing, increase inflammation, and as a result, lead to tooth loss. Diabetic patients are susceptible to fungal infections in the mouth due to the sugar in their saliva. This problem manifests itself as cracks and redness at the corners of the lips.
For the prevention of gum diseases, first of all, good blood sugar control and regular oral care are necessary.
- Teeth should be brushed at least twice a day for 2 minutes. (Due to the presence of snacks in diabetics, an increase in the number of brushings may be necessary.) A soft brush should be used, and the tongue should also be cleaned.
- Dental floss should be used at least once a day to remove bacteria between the teeth, and the mouth should be rinsed with water after the procedure.
- Fluoride and chlorhexidine mouthwashes should be used in patients with widespread decay and gum problems.
- If dry mouth cannot be prevented, the mouth should be rinsed frequently, or artificial saliva preparations recommended by the dentist should be used.
- In addition to brushing teeth and using dental floss to protect oral health, it is necessary to have a dental check-up every six months.
Does diabetes hinder tooth and gum treatment?
Diabetes itself and insulin use do not pose an absolute obstacle or danger for intraoral interventions. However, diabetic patients must have their fasting blood sugar levels measured one day before going to the dentist and inform the dentist of this information. (Remember that in uncontrolled diabetes, wound healing is delayed and inflammations worsen at high blood sugar levels. Before any surgical intervention, it is desired that the patient’s blood sugar level be below 180 mg/dL. Only emergency infection interventions can be performed in patients with blood sugar levels above 180 mg/dL, because infection further increases blood sugar.)
- Drug treatment should be continued for 24-48 hours after a surgical procedure in the mouth.
- It should be noted that if there is a problem in the mouth or many decayed teeth, this situation can create a focus of infection and raise blood sugar, and problems should be dealt with without delay.
- Tooth and gum treatment is a stressful phenomenon for patients. Therefore, painkillers and sedatives may be beneficial before and after the operation.
- It is important for these types of patients to have their procedures done early in the morning under local anesthesia. The treatment performed should not disrupt the patient’s eating habits and medication times. In some extensive surgical interventions, both the eating habits and the dosage of medications can be changed by consulting the patient’s physician. If necessary, dental treatment can also be performed under general anesthesia.