Diabetes is a very important disease from a dental point of view. Uncontrolled Diabetes is a cause of concern as it has many detrimental effects on teeth and gums.
Effects of uncontrolled Diabetes
- Tooth decay: In case of uncontrolled Diabetes high glucose levels in saliva help bacteria to thrive resulting in greater acid attacks on the teeth thus resulting in a greater number of cavities.
- Periodontal disease: Gum disease is very commonly seen in patients with uncontrolled Diabetes. This is primarily because such patients have a lowered body resistance to infections and delayed healing. Common Signs:
i) Gums are spongy in nature and bleed very easily on brushing.
ii) There is persistent bad breath or bad taste.
iii) Presence of permanent teeth that are loose or separating.
iv) There are frequent gum boils or Periodontal Abcess.
All these demand a visit to a dental clinic as studies have shown that people with gum disease are at a greater risk of getting heart diseases and also there is greater occurrence of premature low-birth weight babies in pregnant women with gum diseases.
- Dry Mouth: Xerostomia or dry mouth is a common complaint of a Diabetic patient. Due to excessive fluid loss or Polyuria seen in Diabetics the mouth remains dry. This can lead to drying and cracking of the soft tissues of the mouth. Patients often complain of burning sensations in the mouth. This reduced flow of saliva also results in tooth decay, as saliva is known to flush away food debris from the mouth thus cutting off the food supply of the bacteria. It also helps in reduction of acidity levels of the byproducts of micro-organisms. Saliva also contains Fluorides which are essential for rebuilding of the damaged tooth structure.This condition requires a visit to a dental surgeon who may advise you sugarless gum, sugarless mints, frequents sips of water, melting ice chips and may even prescribe a salivary substitute to help alleviate dry mouth.
- Fungal Infections: Patients with uncontrolled Diabetes are more prone to fungal Infections of the mouth. This is primarily because of a lower body resistance to infections.
- Taste Impairment: Altered taste sensations in Diabetics results in craving for sweet tasting foods with highly refined carbohydrate content. This consequently spoils the Diabetic control and also damages the teeth.
Precautions to be taken for dental treatment of Diabetic patients
A majority of patients visiting a dental clinic are Diabetic and almost half of these patients have not yet been diagnosed with this disease. Many a times a routine visit to a dental clinic has led to discovery of Diabetes in a patient. This is because a detailed case history regarding diet taken by a competent dental practitioner can reveal a lot. Also examination of the mouth and family history of the patient can raise his/her suspicions to order laboratory investigations for detection of Diabetes.
At this juncture I would like to present a protocol which I follow in my practice in doing treatment for Diabetic patients:
- Diabetics have delayed wound healing and are at a greater risk of getting infections. Therefore patients are strongly advised to inform their dental surgeon about their being Diabetic.
- Consultation with the patients Physician: A counsel with the patient’s physician can help in bringing to notice any associated disease a patient may be suffering from .Any precautions during the procedure or alterations in the medication can also be discussed.
- Laboratory investigations : laboratory investigation for estimation of sugar levels in known and suspected Diabetics whenever surgical procedures like tooth removal or gum surgery are done.
- Antibiotic coverage: Diabetic patients are often advised antibiotics before and after the surgical procedures to rule out chances of infection.
- Normal dose and meals: The patients are advised to take their normal dose of medicine and meals on the day of the dental procedure.Preferably morning appointments are given to these patients as insulin levels are generally optimum at this time therefore there is a greater ability to tolerate stress.
- A-traumatic procedures: Any dental procedure is done as a-traumatically as possible.
- Recall and home care instructions: Patients are recalled after any procedure for a check up. Also adequate and accurate home care instructions are given and patients are advised to follow them religiously.
In conclusion……patients with Diabetes should keep their sugar levels in control by strictly following the dietary and medication instructions of their physician. A regular dental checkup is advised and good oral hygiene should always be maintained. A vigil for signs and symptoms of oral disease should be kept and immediate dental check-up is advised if any problem is suspected.