People with diabetes have a higher than. normal risk of periodontal diseases, diabetes is well controlled have no more. periodontal disease than persons without …
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Diabetes
Periodontal Disease
Guide for Patients
NATIONAL INSTITUTES OF HEALTH
National Institute of Dental Research
Diabetes and Periodontal Disease
A Guide for Patients
I
s The Link between Diabetes and Periodontal Disease s How It Develops s How It is Treated
f you have diabetes, you know the disease can harm your eyes, nerves,
kidneys, heart and other important systems in the body Did you know it can also cause problems in your mouth? People with diabetes have a higher than normal risk of periodontal diseases,
Periodontal diseases are infections of the gum and hone that hold the teeth in place In advanced stages, they lead to painful chewing problems and even tooth loss Like any infection, gum disease can make it hard to keep your blood sugar under control
s Other Oral Problems Linked to Diabetes s How You Can Protect Your Teeth and Gums
What is the Link Between Diabetes and Periodontal Disease?
Diabetic Control Like other
Blood Vessel Changes Thickening
of blood vessels is a complication of diabetes that may increase risk for gum disease Blood vessels deliver oxygen and nourishment to body tissues, including the mouth, and carry away the tissues
waste products Diabetes causes blood vessels to thicken, which slows the flow of nutrients and the removal of harmful wastes This can weaken the resistance of gum and bone tissue to infection
Bacteria Many kinds of bacteria
complications of diabetes, gum disease is linked to diabetic control People with poor blood sugar control get gum disease more often and more severely, and they lose more teeth than do persons with good control In fact, people whose diabetes is well controlled have no more periodontal disease than persons without diabetes Children with IDDM insulindependent diabetes mellitus are also at risk for gum problems Good diabetic control is the best protection against periodontal disease
germs thrive on sugars, including glucose — the sugar linked to diabetes
When diabetes is poorly controlled, high glucose levels in mouth fluids may help germs grow and set the stage for gum
disease
St
udies show that controlling Smoking The harmful effects of
blood sugar levels lowers the risk of some complications of diabetes, such as eye and heart disease and nerve damage Scientists believe many complications, including gum disease, can be prevented with good diabetic
control
smoking, particularly heart disease and cancer, are well known Studies show that smoking also increases the chances of developing gum disease In fact, smokers are five times more likely than nonsmokers to have gum disease For smokers with diabetes, the risk is even greater If you are a smoker with
diabetes, age 45 or older, you are 20 times more likely than a person without these risk factors to get severe gum disease
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How Does Periodontal Disease Develop?
Gingivitis Poor brushing and flossing
There are often no warning signs of
early periodontitis Pain, abscess, and loosening of the teeth do not occur until the disease is advanced Since periodontitis affects more than just the gums, it cannot be controlled with regular brushing and flossing Periodontitis should be treated by a periodontist a gum disease specialist or by a general dentist who has special training in treating gum diseases
habits allow dental plaque– a sticky film of germs– to build up on teeth Some of these germs cause gum disease The gums can become red and swollen and may bleed during toothbrushing or flossing This is called gingivitis, the first stage of periodontal disease Gingivitis can usually
be reversed with daily brushing and flossing and regular cleanings by the dentist If it is not stopped, gingivitis could lead to a more serious type of gum disease called periodontitis
Periodontitis Periodontitis is an
How Is Periodontal Disease Treated?
Plaque Removal Treatment of
periodontitis depends on how much damage the disease has caused In the early stages, the dentist or periodontist will use deep cleaning to remove hardened plaque and infected tissue under the gum and smooth the damaged root surfaces of teeth This allows the gum to re-attach to the teeth A special mouthrinse or an antibiotic might also be prescribed to help control the infection
infection of the tissues that hold the teeth in place In periodontitis, plaque builds and hardens under the gums The gums pull away from the teeth, forming pockets of infection The infection leads to loss of the bone that holds the tooth in its socket and might lead to tooth loss
Deep cleaning is successful only if the patient regularly brushes and
As plaque builds up, the gums become inflamed and, in time, affected teeth may loosen and could be lost
flosses to keep the plaque from building up again
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Periodontal Surgery
Gum surgery is
For the person with controlled diabetes, periodontal or oral surgery can usually be done in the dentists office Because of diabetes, healing may take more time But with good medical and dental care, problems after surgery are no more likely than for someone without diabetes
needed when periodontitis is very advanced and tissues that 
hold a tooth in place are destroyed The dentist or periodontist will clean out the infected area under the gum, then reshape or replace the damaged tooth-supporting tissues These treatments increase the chances of saving the tooth
Once the periodontal infection is successfully treated, it is often easier to control blood sugar levels
If You Have Diabetes,
s
Its important for you to know how well
Are Other Oral Problems Linked To Diabetes?
Dental Cavities Young people with
your diabetes is controlled and to tell your dentist this information at each visit,
s
See your doctor before scheduling
treatment for periodontal disease Ask your doctor to talk to the dentist or periodontist about your overall medical condition before treatment begins
s
IDDM have no more tooth decay than do nondiabetic children In fact, youngsters with IDDM
who are careful about their diet and take good care of their teeth often have fewer cavities than other children because they dont eat many foods that contain sugar
You may need to change your meal
schedule and the timing and dosage of your insulin if oral surgery is planned
s
Postpone non-emergency dental
procedures if your blood sugar is not in good control However, acute infections, such as abscesses, should be treated right away
Thrush Thrush is an infection caused by
One of the major causes of dry mouth is medication More than 400 over-thecounter and prescription drugs, including medicines for colds, high blood pressure or depression, can cause dry mouth If you are taking medications, tell your doctor or dentist if your mouth feels dry You may be able to try a different drug or use an artificial saliva to keep your mouth moist
a fungus that grows in the mouth People with diabetes are at risk for thrush because the fungus thrives on high glucose levels in saliva Smoking and wearing dentures especially when they are worn constantly can also lead to fungal infection Medication is available to treat this infection Good diabetic control, no smoking, and removing and cleaning
dentures daily can help prevent thrush
Dry Mouth Dry mouth is often a
Good blood glucose control can help prevent or relieve dry mouth caused by diabetes
symptom of undetected diabetes and can cause more than just an uncomfortable feeling in your mouth Dry mouth can cause soreness, ulcers, infections, and tooth decay The dryness means that you dont have enough saliva, the mouths natural protective fluid Saliva helps control the growth of germs that cause tooth decay and other oral infections Saliva washes away sticky foods that help form plaque and strengthens teeth with minerals
Keep Your Teeth
Serious periodontal disease not only can cause tooth loss, but can also cause changes in the shape of bone and gum tissue The gum becomes uneven, and dentures may not fit well People with diabetes often have sore gums from dentures If chewing with dentures is painful, you might choose foods that are easier to chew but not right for your diet Eating the wrong foods can upset blood sugar control The best way to avoid these problems is to keep your natural teeth and gums healthy
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Y
How Can You Protect Your Teeth and Gums? Harmful germs attack the teeth and gums
when plaque builds up You
can stop plaque build-up and prevent gum disease by brushing and flossing carefully every day
s
Gently brush teeth twice a day with a soft nylon brush with rounded ends on the bristles
I
I
s s
Avoid hard back-and-forth scrubbing Use small circle motions and short back-and-forth motions
s
Gently brush your tongue, which can trap germs
s
Use a piece of dental floss about 18 inches long
s
Use a fluoride toothpaste to protect teeth from decay
s
Using a sawing motion, gently bring the floss through the tight spaces between the teeth
Check Your Work Dental plaque is
hard to see unless it is stained Plaque can be stained by chewing red disclosing tablets sold at grocery stores and drug stores or by using a cotton swab to smear green food coloring on the teeth The color left on the teeth shows where there is still plaque Extra flossing and brushing will remove this plaque
s s
Do not snap the floss against the gums Curve the floss around each tooth and gently scrape from below the gum to the top of the tooth several times
s
Rinse your mouth after flossing
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Dental Check-ups People with
diabetes should have dental check-ups at least every 6 months, or more often if
recommended by their dentist Be sure to tell your dentist you have diabetes Frequent dental check-ups are needed to find problems early when treatment is most effective See your dentist as soon as possible if you have any problem with your teeth or mouth
Preventi
ng or controlling gum
disease depends on teamwork The best defense against this complication of diabetes is good blood sugar control, combined with daily brushing and flossing and regular dental check-ups
For copies of this pamphlet write to: National Oral Health Information Clearinghouse 1 NOHIC Way Bethesda, Maryland 20892-3500
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NATIONAL INSTITUTE OF DENTAL RESEARCH Bethesda, Maryland 20892 NIH Publication No 94-2946
