Diabetes Education Program
Assess the level of control of
|What was your last level of glycosylated
hemoglobin (Hb1Ac)? (More than 6% means poorly controlled diabetes)
|Have you changed medications lately? |
|What is the name and phone number of your
endocrinologist and physician? |
|Are you taking insulin? |
periodontal disease improves metabolic control of diabetes
Diabetes is a complex disease with both vascular and metabolic
components. A back and forth connection exists between diabetic control
and oral infections. When periodontal infection is established,
metabolic control of diabetes is worsened. When diabetesis
exacerbated, periodontal infection progresses. During the 3-month study,
subjects in the control group received no periodontal treatment. Test
group subjects received oral hygiene
instructions and scaling and root planing with local anesthesia.
Baseline, post-treatment and three-month data included clinical
indices and blood tests. Only a few in the test and
control groups had moderately deep pockets. The others had gingivitis.
Following treatment statistically significant differences were observed
between the groups. The differences were not large, but did show
improved glycemic control following non-surgical therapy.
Clinical Implications: Oral hygiene instructions and non-surgical
treatment of periodontal disease in type 2 diabetics can result in
better metabolic control of the diabetes.
Kiram, M., Arpak, N., Ünsal, E., Erdogan, M.: The Effect of Improved
Periodontal Health on Metabolic Control Type 2 Diabetes Mellitus. J
Clin Perio 32: 266-272, 2005. Cited: Perio Reports 2005 April
Poorly Controlled Diabetes Can Lead To Tooth
Americans with poorly controlled diabetes are at
higher risk for severe periodontal disease, which can lead
to tooth loss.
Researchers from the Harvard School of Dental
Medicine and the University of Michigan School of Dentistry
analyzed national data on more than 4,300 adults ages 45 to 90
with type 2 diabetes. They found that people with poorly
controlled diabetes were nearly three times more likely than
those with better-controlled diabetes to have severe periodontal
Periodontal disease is an infection of the
gums, ligaments and bone surrounding the teeth. It can lead to
bleeding gums, receding gums and loose teeth. Teeth eventually
may fall out or need to be removed.
People with diabetes also can be at increased
risk for other oral problems — including gingivitis
(the first stage of periodontal disease), dry
mouth, fungal infections and
slow wound healing — if they do not take steps to control
their blood-sugar levels.
The study was published in the June issue of Community
Dentistry and Oral Epidemiology. By Nancy VolkersInteliHealth
News Service. June 2002
disease may even be more important than obesity or age as a factor in
the onset of diabetes in adults, Adult-onset diabetes, or Type
2 diabetes, accounts for 90 percent of the estimated diabetes cases in
the United States and is almost always caused by lifestyle.
This study along with 2
others revealed results that blood sugar levels could be reduced and
kept at a lower level most effectively with a single dose of oral
antibiotic and repeated application of a topical antibiotic to the
"The study shows
that in this group of severe diabetics we were able to increase
glucose control with repeated treatment of their periodontal infection".
This study underscores the importance of prevention and early treatment
of gum disease in people who are at risk of developing diabetes.
In a third study, the University of Buffalo researchers showed that
using antibiotics to treat gum disease decreases two markers of
inflammation throughout the body. The inflammatory markers area
associated with the development of arteriosclerosis and other chronic
Sara Grossi, clinical assistant professor of oral
biology at the University of Buffalo in New York. March
Most Adult Diabetics
In United States Have Hypertension
Nearly three-quarters of adult diabetics in the United
States have hypertension.
Regardless of age, sex, race or ethnic origin, all may
benefit from efforts to prevent it.
Dry Mouth More Common in People with
This study established a link between diabetes,
neuropathy and dry mouth. Diabetics
according to this study report:
More symptoms of dry mouth and impaired
Diabetes who smoke
and snack frequently had more symptoms of dry mouth.
Those taking mediations
that tend to dry mouth had lower salivary flow.
Those who were not well controlled
reported more dry mouth symptoms.
These observations could be due to a
decreased responsiveness of the nerves that stimulate the production of
saliva. Saliva washes the sugar out of the mouth after eating and
when this ability is decreased it can lead to:
abscesses originating in a
soft tissue lesions in the mouth and
Dental Product Report, Dr Trevor Orchard,
NIH, pg 30, Dec 2001
November is National Diabetic Month
DIABETES EPIDEMIC SURGES
When you have diabetes, your chances of getting gum
There are more
bacteria in your mouth right now than there are people on Earth.
If those germs settle into your gums, you've got
gum disease. "Not me?" you say. Here are the facts:
A Big Plaque Attack
When you have gum disease, germs work to destroy
your gums (gingiva) and the bone around your teeth. It starts
with plaque. Plaque is a sticky film of food, saliva, and germs. Plaque
loves to settle in at the gum line. There germs get busy making your
gums red, tender, and likely to bleed.
The goal of your daily tooth brushing and flossing is
to clean away plaque. When plaque stays put, it hardens into tartar.
Tartar builds up under the gum line. More plaque forms over the tartar.
Only your dentist can get tartar off your teeth.
If plaque and tartar are not cleaned away, even gentle
brushing can cause your gums to bleed. This is called gingivitis.
It is the first stage of gum disease. You can fight gingivitis with:
|daily good brushing and flossing habits|
|getting your teeth
cleaned at least twice a year at your dentist's office|
If you ignore gingivitis, the gum disease gets worse.
The more severe form of gum disease is called periodontitis.
When you reach this stage, your gums begin to pull away from your teeth.
Pockets form between your teeth and gums. These fill with germs and
pus and deepen. When this happens, you may need gum surgery to save
your teeth. If nothing is done, the infection goes on to destroy the
bone around your teeth. The teeth may start to move or get loose.
Your teeth may fall out or need to be pulled.
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As if this is not enough, diabetes can make things
worse. Plaque is the main bad guy of gum disease. But diabetes can also
be a culprit. Diabetes may weaken your mouth's germ-fighting powers.
High blood sugar levels can help the gum disease get worse. At the same
time, gum disease can make diabetes
harder to control.
Often gum disease is painless. You may not even know
you have it until you have some serious damage. Regular dentist
visits are your best weapon.
When you schedule your visit to the dentist, plan to:
|Tell your dentist you have diabetes. Also,
share any problems with infections or trouble keeping your blood
sugar levels under control.|
|Eat before you go to see your dentist. The
best time for dental work is when your blood sugar level is in a
normal range and your diabetes medicine action is low. If you take
insulin, a morning visit after a normal breakfast is best.|
|Take your usual medicines before your dentist
visit, unless your dentist or doctor tells you to change your
dose for dental surgery. Your dentist should consult with your
doctor to decide about adjustments in your diabetes medicines or to
decide if an antibiotic is needed before surgery to prevent
|Stick to your normal meal plan after dental work.
If you can't chew well, plan how to get the calories you need. You
may need to use your sick-day meal plan that uses more soft or
|Wait to have dental surgery until your blood
sugar is in better shape, if your diabetes is in poor control.
If your dental needs are urgent (pain or swelling), talk to your
dentist and doctor about having dental treatment in a hospital or
special setting where you can be checked on during and after
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More on the Mouth
Diabetes also makes you prone to other mouth
Oral infections. An oral infection is a cluster
of germs causing problems in one area of your mouth. Here are some
|Swelling or pus around your teeth or gums or
any place in your mouth. Swelling can be large or as small as a
|Pain in the mouth or sinus area that doesn't
|White or red patches on your gums, tongue,
cheeks, or the roof of your mouth.|
|Pain when chewing.|
|Teeth that hurt when you eat something cold,
hot, or sweet or when you chew.|
|Dark spots or holes on your teeth.|
Infections can make your blood sugar hard to
control. By planning ahead and discussing a plan of action with your
dentist, you will be prepared to handle needed adjustments.
Fungal infections. Having diabetes means you are more
prone to fungal infections such as thrush.
If you tend to have high blood sugar levels or take antibiotics often,
you are even more likely to have this problem. Thrush makes white (or
sometimes red) patches in areas of your mouth. These can get sore or
turn into ulcers. If you think you have a fungal infection, talk to your
Poor healing. If your diabetes is
poorly controlled, you heal more slowly and you increase your
chance of infection after dental surgery. To give yourself the best shot
at healing well, keep your blood sugar under control before, during, and
Dry mouth. Some people with diabetes
complain of dry mouth. This may be
caused by medicines you take. You may notice a dry mouth if your blood
sugar levels are high. A dry mouth can increase your risk of cavities,
because there's less saliva to wash away germs and take care of the
acids they create.
Keeping your teeth and mouth healthy
requires a team effort.
You're the most important person on this team to do
the day-to-day mouth care. Remember, good dental health can create
a healthy mouth and a smile that will last a lifetime.
Source: For more information on diabetes, visit American Diabetes
Store or follow the hyperlinks to these related books : Complete
Guide to Diabetes and The Uncomplicated Guide to Diabetes Complications.
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The oral complications
of diabetes involve the teeth, periodontal tissues,
oral soft tissues, salivary glands or
temporomandibular joints (TMJ).
Dental Caries can occur more often
due to generalized lack of self-care or secondary to sustained hypoglycemia
with low salivary flow and high salivary
Gum disease is know as the sixth
clinical complication of DM which includes loss of gingival attachment, abnormal
pockets around teeth, and gingivitis.
Severity of periodontal disease appears to be related to age, duration
of the DM and glycemic control. Gum disease in patients with DM is
approximately 2.6 time normal. In both type 1 and type 2 DM,
poor oral hygiene and poor control of DM appear to contribute to
Oral Soft Tissue Lesions in type 1 DM have
increased incidence of candidal and noncandidal lesions with candida
albicans, glossitis, denture stomatis and angular cheilitis.
Xerostomia is due to changes in the
composition of the saliva, salivary flow rates and an increase in
salivary glucose levels in adults with Diabetes. Poorly controlled
patients have more impairment of salivary flow than better controlled
patients. Some diabetic medications
cause dry mouth like ACE inhibitors. Reduced salivary flow
associated with DM may be a clinical manifestation of neuropathy.
Oral Neuropathies is burning tongue syndrome or burning mouth syndrome
and can occur frequently in type 2 DM.
Once the diagnosis of DM is made, your goal is toward long term control
of blood glucose, which can reduce or delay these complications.
Managing Patients with Diabetes, Part 2,
Dr. Jerome Rothstein, Dentistry Today, July 2001 pgs 62-65.
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of Insulin-dependent Diabetes and Oral Soft Tissue
In a study that evaluated
soft tissue lesions of Type 1 diabetes (early onset insulin-dependent
diabetes) with non-diabetic patients, it was found that 45% of the 405
patients with type 1 diabetes had at least one lesion. Seven lesions
were identified as appearing more frequently in this group. Three
of these lesions were non-candidal: fissured tongue, irritation fibroma
and traumatic ulcer. 15 % of this group had Candidiasis. Thus the
rate of soft tissue candidal lesions are greater with Type 1
Dentistry Today April 2001 pg 44
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periodontal disease, diabetes connection
Bethesda, Md. —
Study results from the Marquette University School of Dentistry
suggest chronic periodontal disease may
increase the risk of developing Type 2 diabetes.
The new research, presented at
the Periodontal-Systemic Connection Symposium currently underway
here, ties the incidence of diabetes in
patients with periodontal disease to the release of bacteria
into the bloodstream that triggers a reaction from the immune
Immune system cells can release
proteins called cytokines that can disrupt production of
insulin, the hormone that is key to diabetes, the
"In the pancreas, the cells
responsible for insulin production can be damaged or destroyed
by high levels of cytokines," said Dr. Anthony Iacopino
from the Marquette University School of Dentistry. "Once
this happens, it may induce Type 2 diabetes, even in
otherwise healthy individuals with no other risk factors for
The research also points to high
cholesterol, or lipid, levels as a risk factor for people who
are already diabetic developing periodontal disease. "Low
fat diets, lipid lowering drugs and exercise are vitally
important for diabetics who want to improve their quality of
life, as well as their oral health," Dr. Iacopino noted.
ADA Online News April 2001
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More on: Chronic
Periodontal Disease Could Lead to Diabetes
Periodontal Disease is Associated with the
Development of Glucose IntoleranceJ Dent Res 83(6): 485-490, 2004 The
Severity of Periodontal Disease is Associated with theDevelopment
of Glucose Intolerance in Non-diabetics: The Hisayama Study
September 14, 2007