Dry Mouth and Diabetes

Friday, December 1, 2006

by Frank Varon, DDS

We often take our teeth for granted, but the mouth is the first part of the digestive process. It’s amazing how what we put into it and what comes out of it can get us in so much trouble.

Most of us don’t realize that the health of our mouths affects our diabetes control, and that our diabetes control affects our oral health.

We should avoid saying “dental health” and say instead “oral health,” since there is a two-way street between systemic health and oral health.

Dry Mouth

One of the most common oral health problems for diabetics is dry mouth or altered salivary flow (or xerostomia, if you like medical terms). The teeth and muscles in the mouth, face and jaw chew the food into smaller pieces to facilitate digestion in the stomach and intestine. The saliva has several functions. It prevents infection by controlling bacteria in the mouth. It moistens and cleanses the mouth by neutralizing acids produced by dental plaque, and it washes away the dead skin cells that accumulate on the gums, tongue and cheeks. It helps with the digestion, making it possible to chew, taste and swallow food. Dry mouth occurs when there is not enough saliva (real or perceived) to keep your mouth moist, which is important for health, comfort and for speaking. Diagnosis of dry mouth is difficult due to the subjective nature of this condition.

In most cases, dry mouth is due to side effects of medications. There are over 500 prescription and nonprescription medications that have been found to cause dry mouth. Medications that treat high blood pressure or other heart problems are used by many patients to manage complications of diabetes. Other drug groups that cause dry mouth are those used for depression, anxiety and allergies, as well as diuretics, anti-psychotics, muscle relaxants, sedatives and anti-inflammatory medications. Caffeinated beverages also cause dry mouth, and these should be limited.

Precautions

Ask your pharmacist about side effects of your medications in order to avoid any possible problems. It is important that diabetes patients drink water frequently while on these medications, as well as for their general health. Also, be sure to see your dentist and dental hygienist for an oral examination and dental prophylaxis at least every six months to minimize or prevent the development of oral health problems. Optimal oral health will improve your diabetes control and your quality of life.

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Dental Care for Dry Mouth Patients

The diabetes patient with dry mouth along with his or her oral health team will have to develop a routine for optimal oral health. Here are some simple ways to accomplish that goal:

Perform oral hygiene at least four times daily, after each meal and before bedtime

Rinse and wipe the mouth immediately after meals.

Brush and rinse removable dental appliances after meals.

Use only toothpaste with fluoride. Some toothpastes (such as Biotene) are formulated for dry mouth.

Keep water handy to moisten the mouth at all times.

Apply prescription-strength fluoride at bedtime as prescribed.

Avoid liquids and foods with high sugar content.

Avoid overly salty foods.

Limit citrus juices (orange, grapefruit, tomato), as well as diet sodas.

Avoid rinses containing alcohol. Several nonalcoholic mouthwashes are now available on the market.

Use a lip balm or moisturizer regularly.

Try salivary substitutes, gels or artificial saliva preparations. These may relieve discomfort by temporarily wetting the mouth and replacing some of the saliva constituents.

In severe cases, use of pilocarpine might be used under a physician’s care.

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The most common reasons for a dry mouth in a diabetes patient are

Side effects of medication

Neuropathy (autonomic)

Lack of hydration

Kidney dialysis

Hyperglycemia

Mouth breathing

Smoking

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Some clinical signs of dry mouth

Loss of moisture, glistening of the oral mucosa

Dryness of the oral membranes

Irritated corners of the mouth (cheilitis)

Gingivitis

Difficulty wearing dentures

Mucositis

Mouth sores

Yeast infection (Candidiasis), especially on the tongue and palate

Dental cavities: increased prevalence and located in sites generally not susceptible to decay

Caring for Your Teeth and Gums

Tuesday, March 1, 2005

by Steven V. Edelman, MD, and Cyndee R. Fena, RDH, MT

The sixth major complication of diabetes is periodontal disease.

Periodontal disease, or pyorrhea, is a painless disease of the supporting tissues of the teeth, gums and bones of the mouth.

It is estimated that 80 percent of the adult population in the United States has periodontal disease.

Once you have periodontal disease, it is almost impossible to eradicate it completely.

However, with the help of your dentist and hygienist, you can slow down its progression with early detection and aggressive treatment.

Aside from periodontal disease, the mouth is vulnerable to these other problems that can affect people with diabetes:

Altered taste often affects people with diabetes; it may result from a change in salivary chemistry, dry mouth or the presence of yeast.

Dryness of the mouth may result from inactive or defective salivary glands. Dryness is also a manifestation of poorly controlled diabetes.

Yeast (candida) in the mouth is a fungal infection associated with elevated glucose levels and is a frequent complication of diabetes.

Oral neuropathy, or numbness of the mouth, is a rare complication characterized by a burning sensation in the mouth or on the tongue.

Halitosis, or bad breath, often occurs when periodontal disease is present. Bad breath is worsened by dry mouth. Strong breath mints may help, but they only mask the problem, not solve it.

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Ask Yourself About These Warning Signs of Periodontal Disease

Do your gums bleed easily when brushing or flossing?

Do you have loose teeth?

Are your gums red, swollen or tender?

Do you have unusually bad breath?

Do you have tartar formation (creamy brown, hard masses on tooth surfaces)?

Have you noticed a change in the way your teeth fit together when you bite?

Do you feel pain when you chew?

Are your teeth sensitive to temperature?

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Guidelines for Basic Oral Hygiene

Brush your teeth at least twice a day

Floss your teeth at least once a day

Avoid harsh mouthwashes

Have your teeth cleaned regularly

---------------------------------------------------------------------Precautions for Visiting the Dental Office

Be sure your dentist knows you have diabetes and what medications you take.

Make your appointment at an appropriate time to avoid hypoglycemia (for those on insulin therapy).

Bring your glucose meter to your appointment.

Try to have your blood glucose levels in goal range during dental office visits.

Avoid long appointments; ask if a lengthy procedure can be split into separate visits.

Diabetes and Dentistry

Sunday, March 1, 1998

by Miranda Schwartz

No one enjoys going to the dentist, but for people with diabetes, getting that cleaning and check-up are especially important. The link between diabetes and oral health can't be ignored. In fact, dental problems in people with diabetes are so rampant that Mark Finney, DDS, believes oral disease should be referred to as "the sixth 'opathy' of diabetes," deserving of the attention given to retinopathy, neuropathy, nephropathy and the like.

While everyone is prone to periodontitis, or diseases of the tissues surrounding the teeth and gums, people with diabetes often have more severe cases that can both cause and predict additional diabetic complications.

Defining Periodontitis

Periodontitis or periodontal diseases involve inflammation and destruction of the tissues supporting and surrounding the teeth, including the gums and supporting bone. Periodontitis destroys the periodontal ligaments or connective tissue fibers that attach the tooth to the bone causing resorption of the alveolar bone (tooth socket). Consequently, the gums swell, redden, change shape, bleed, teeth loosen and pus forms. With the loss of soft tissue and bony support, deep periodontal pockets may form that foster bacterial growth.

The formation of plaque on the teeth is the first step toward periodontal disease. Plaque, the white sticky substance that collects between teeth, is often the start of periodontitis. Made of microorganisms, dead skin cells and leukocytes (infection fighting white blood cells), it can be removed by brushing and flossing regularly. If it is allowed to build up, it will harden and turn into tartar. Tartar can only be removed with a professional cleaning at the dentist's office. Both plaque and tartar make the gums vulnerable to infection.

If an infection enters the gums it is referred to as gingivitis, the first stage of periodontitis. Bacteria that collect and breed at the gum line and the groove between the gum and the tooth cause the gums to redden, swell and bleed. This response is normal but can also lead to periodontitis. Gums affected by gingivitis often bleed and are sensitive, but not always. Other signs include swollen gums, loose teeth, a bad taste in the mouth and persistent bad breath.

The Relationship to BG Control

BG control and good oral hygiene seems to be the key to avoiding most dental complications. Everyone is at risk of developing periodontal disease, but all people with diabetes, regardless of age or type of diabetes, are more susceptible. There are several reasons for this.

For one, people with diabetes have more sugar in the mouth which provides a more hospitable environment for hostile bacteria. This makes all forms of periodontal disease more likely.

High and fluctuating BGs are also a big factor in the increased risk of periodontal disease. Poor BG control means higher degrees of periodontitis and more vulnerability to complications.

It also makes healing more difficult once an infection sets in. Just like diabetics with poor BG control have a hard time healing wounds and infections on their feet, their bodies have a hard time fighting infections and healing wounds in the mouth.

At the same time, on-going infections may make BG control more difficult. Inflammation and infection affect BG control no matter where they occur. But the mouth is often overlooked as most doctors do not look in the mouth.

Once an infection takes root a vicious cycle ensues making metabolic and infection control a struggle. This cycle can have drastic consequences. If oral infections get out of control they can lead to BG control problems serious enough to land a person with diabetes in the hospital, to say nothing of the damage to the teeth and gums.

Gum infections can also impact insulin needs. Authors of a study cited in September's 1997's Practical Diabetology concluded that when an infection is rampant, patients with diabetes often have increased insulin requirements. If periodontal disease is treated and gingival inflammation is eliminated, these insulin needs often decrease.

Collagen, which is a building block of the tissue that attaches teeth to bones and the surrounding soft tissue, is also affected by diabetes. Diabetes' effect on collagen metabolism, according to Finney, "may make an infection potentially more destructive."