Years of research by medical and dental researchers have shown a link between diabetes and oral health. In patients with diabetes many body systems and organs can be affected by complications. The complications that may occur in the mouth include:
- Gum diseases
- Dry mouth
- Root caries (tooth decay of the root of the tooth)
- Fungal infections
- Denture problems
- Poor healing
Figure: Diabetes may be associated with several complications in the mouth.
Gum diseases are a complication because diabetes results in a stronger inflammatory response to dental plaque. People with diabetes are much more likely to have gum disease than people without diabetes. The common forms are caused by the bacteria in the dental plaque leading to an inflammatory reaction from the body. The signs of inflammation are redness, bleeding, and swelling.
The milder form of gum disease (gingivitis) is generally reversible with improved removal of dental plaque and a professional cleaning. The most noticeable changes in gingivitis are gums that look red and puffy, and that bleed on gentle brushing.
Figure: Gingivitis. The right hand side of the tooth shows red, puffy and swollen gums. The left side shows health for contrast.
The more severe form of gum disease (periodontitis) leads to destruction of the bone that holds the tooth into the jaw resulting in loose teeth, a changing appearance of the gums making the teeth appear longer, gum abscesses, foul breath, and eventually loss of the teeth. Periodontitis can progress rapidly in people with diabetes.
Figure: Periodontitis. The right hand side of the tooth shows inflammation, gum recession, and destruction of the bone.
Dry mouth is a complication of diabetes due to a decrease in saliva production. Saliva is important for good oral health through cleansing the mouth of food debris that may lead to dental decay, protecting the tissues by lubrication enabling speech and swallowing, and providing a plentiful supply of minerals to nourish the teeth. Any decrease in saliva will compromise oral health and may lead to dental decay, ulcers, and infections. If removable dentures are worn, a lack of saliva as in dry mouth will result in poor retention and stability of the denture. Without this natural lubrication, the denture will rub the tissues, causing sores that may become infected.
Root caries can be a dental complication of diabetes in people who have gum recession and exposed roots. The cause is not clear, other than with dry mouth there will be reduced protection from saliva. Root caries can be challenging for a dentist to treat successfully.
Fungal infections may be a complication of diabetes. When taking any antibiotics, the bacteria in the mouth change and enable fungi to grow, forming an infection of the soft tissues and lining of the mouth. Commonly known as thrush, these white or red areas of fungal infection may lead to a burning feeling of the mouth or tongue.
Denture problems may arise as a complication of diabetes. Diabetes increases the risk of fungal infections under and around the denture, so cleaning and routine check-ups with your dentist are essential. Removable dentures should be cleaned thoroughly by brushing with a proprietary cleanser at least once per day, and removed and rinsed after meals to remove food debris. A loose fitting denture is likely to cause mouth sores and, if the blood glucose levels are not well-controlled, these will become infected and not heal. Taking your dentures out at night and soaking them in a cleaning solution will help prevent fungal infections and sores as well as give your mouth a rest from the presence of the denture.
Poor healing is a complication of diabetes after any type of oral surgery, as wounds heal more slowly and are more likely to become infected. Dental implants cannot generally be fitted in diabetic patients who have poor blood glucose control, as the implants are more prone to poor healing and infection.