Maintaining Your Health on Mackinac
Dental Care Is Essential, Especially for People With Diabetes
By Yvan Silva, M.D.

Dr. Silva is a professor of surgery at Wayne State University and a resident of Woodbluff on Mackinac Island.

The statistics on the prevalence of adult-onset diabetes and the multiple co-morbidities that ensue continue to be of concern. Counting the numbers, 20.8 million American children and adults, representing 7% of the population, have diabetes; 14.6 million are diagnosed, while 6.2 million are undiagnosed. A further 54 million adults and two million teens have pre-diabetes.

Five years ago, the total economic cost of diabetes was $132 billion, including direct medical costs and indirect costs attributed to work loss, disability, and premature mortality.

The risk of death among diabetics is about twice that of people of similar age without diabetes. Heart disease and stroke cause about 65% of deaths in people with diabetes, and it is the leading cause of new cases of blindness among adults age 20 to 74. Another important statistic is that diabetes is the leading cause of kidney failure, accounting for about 45% of new cases each year, and 60% of non-traumatic lower limb amputations occur in people with diabetes.

Dental health in people with diabetes has not been sufficiently emphasized, and it is important for dental health to find its place in the overall care of the condition. Almost onethird of diabetics suffers from periodontal disease, defined as a loss of attachment of the gums to the teeth, measuring five millimeters or more. Given that infections pose a severe threat to the lives of people with diabetes, it is also most important that active measures be undertaken in the maintenance of proper dental health.

Human mouths are full of bacteria. People with diabetes are at increased risk from the ravages of bacterial infection because high blood sugar levels promote bacterial overgrowth and inability of the immune system to resist bacteria. Incorporated into saliva and food particles, bacteria form colorless, sticky "plaque" on teeth. Plaque begins to harden and form tartar that irritates the gums - this requires removal by a dental professional. Gingivitis results from the continuing accumulation of plaque and tartar. This inflammatory state causes the gums to become red, swollen, and bleed easily. Left untreated, gingivitis can advance to periodontitis, damaging soft tissue and bone supporting the teeth, leading to tooth loss. Of particular importance is the possibility of tooth root infections, pockets of abscess formation, and risk of bacteria entering the bloodstream.

As with all medical problems that affect diabetics, maintaining blood glucose levels at optimal levels is imperative. Gum diseases can progress without causing pain, but there are warning signs that warrant dental consultation. Bleeding gums, when brushing or flossing, is an important sign. This bleeding is not normal, and although this may be painless, gums should be checked by a dentist. Similarly, red, swollen, and tender gums are abnormal. Pus that appears between the teeth and gums when the gums are manually massaged, gums that pull away from the teeth to expose more of the roots, loosening of the teeth, changes in the bite when you eat, or the fit of partial dentures or bridges are further signs. Bad breath is often evidence of advancing dental disease.

Dry mouth is another common problem of people with diabetes. It increases the risk of tooth decay and periodontal disease because there is less saliva to wash away bacteria and accumulating plaque. Restricting alcohol and caffeine will help relieve dry mouth, as well as taking frequent sips of water, or chewing sugarless gum, mints, or ice chips. Dentists may recommend a saliva substitute, rinsing with a fluoride mouthwash, or topical applications of fluoride at home or in the dental office to help prevent tooth decay.

The development of fungal infections in the mouth is more common in diabetics. Commonly known as thrush, it can affect people with high blood sugar levels, those on antibiotics, those who smoke, and those who wear dentures around the clock, who are more prone to the condition. White or reddish patches develop, leading to chafing and progressive infection. Professional dental attention is indicated.

Dental care is an everyday essential, especially for people with diabetes. Control of blood sugar is the most important goal. To prevent gum disease, the recommendations are: brushing at least twice a day, flossing at least once a day, and professional dental cleaning at least twice a year. Proper techniques for brushing and flossing are best learned from a professional dentist, and meticulously followed.