Diabetes mellitus is a complex and insidious syndrome characterised by abnormalities in carbohydrate, lipid and protein metabolism.

This may be related to the destruction of special cells in the pancreas (Type 1), or from impaired insulin function, related commonly to obesity and lifestyle factors (Type 2).  Type 1 diabetes represents only 10-15% of primary diabetes cases in Australia.

About diabetes

Diabetes can cause extensive disability, poor quality of life, functional impairment and premature death, especially if the disease remains undiagnosed or poorly managed.  Diabetes is associated with a range of complications and functional impairment; including coronary artery disease and peripheral vascular disease, stroke, diabetic neuropathy, gangrene leading to amputations, renal failure, male impotence and blindness. Smoking makes these complications worse.

 

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How diabetes affects your mouth

High blood sugar levels can cause a variety of changes leading to oral health problems such as:

  • Narrowing of the blood vessels, including those that supply the gums, which reduces blood flow and therefore increases infection.
  • A decrease in saliva in the mouth, which is used to neutralise acid in the mouth and wash away flood debris and bacteria.
  • An increase in sugar in the gingival fluid, leading to an increase in cavities, especially on the root surface of teeth.

Increased risk of mouth infections, such as the fungal infection, Thrush.  These infections can lead to a burning, painful mouth and turn into ulcers.

 

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  • Burning mouth Syndrome
  • Fungal infections (oral Thrush)
  • Dental caries
  • Gum disease
  • Lichen Planus (lesions on the gums and cheek)
  • Neurosensory dysaesthesias (Sensory loss and changes)
  • Salivary gland dysfunction and enlargement
  • Taste disturbance
  • Delayed and abnormal wound healing
  • Xerostomia (dry mouth)

Patients who maintain good blood sugar levels can undertake dental treatment with minimal restrictions. Prevention of oral health complications requires education and health promotion.  Dental treatment for patients with diabetes is individualised to meet patient needs and may include more frequent recall appointments, comprehensive medical histories, dietary modifications, smoking-cessation recommendations, assessment of salivary functions, topical fluoride application and correct oral hygiene instruction.

In order to maintain good oral health, diabetic patients must maintain normal and controlled blood sugar levels through the course of treatment, reducing the risk of complications from diabetes and to promote optimal healing.

Other treatment considerations include:

  • Scheduling appointments for the morning
  • Ensuring patients have eaten their regular meal before dental treatment, especially if using local anaesthesia
  • Taking blood sugar levels before treatment
  • Keeping appointments short and simple
  • Treating infections more aggressively than normal
  • Prescribing antibiotic prophylaxis if necessary