[Oral Health #10] Diabetes and Your Oral Health.

Hello Steemers!!!
Diabetes is one of the most common diseases of the world. It is also called as Royal Disease as it has not spared even the Developed Countries.

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Diabetes is an endocrine disease related to the body sugar level. Diabetes affects your body’s ability to process sugar. The Diabetes are of different types: Type I, Type II, Gestational Diabetics.
In Type I diabetes, the body doesn’t make enough insulin, a hormone that carries sugar from your blood to the cells that need it for energy.
In Type II diabetes, the body stops responding to insulin.
Type II diabetes is generally related to most if the Oral Problems.
Both cases result in high blood sugar levels, which can cause problems with your eyes, nerves, kidneys, heart, mouth and other parts of your body.
Approximately 29.1 million people of US are Diabetics which amounts around 9.3% of total US population. Among them around 8 million people don't even know that they are diabetic.
So, How exactly does Diabetes affect Mouth?
What are different Gum Problems associated with Diabetes?
How can we prevent them?
To answer all these, lets take up today's Voyage on Diabetes.

What are the different oral problems associated with Diabetes?

Diabetes tends to increase the blood sugar levels in the body which has a direct as well as indirect effect on the oral hygiene of a person. High sugar levels increases the healing time of the body, gums too. The infections are easy to occur. The Gums are the most important to show the signs of Diabetes.
The most common oral health problems affecting people with diabetes are:

• Gum disease
• gum abscesses
• tooth decay
• fungal infections such as thrush
• lichen planus (an inflammatory, autoimmune skin condition)
• mouth ulcers
• taste disturbances
• a dry, burning mouth (low saliva levels) known as Xerostomia.
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Gum Disease

Gum disease is more common and more severe in people with suboptimal blood glucose levels. This is because they generally have lower resistance to infection and reduced healing capacity.

Smoking is the Highest Risk Factor for Gum Problems.

• Early gum disease (gingivitis): Diabetes reduces your ability to fight bacteria. If you don't remove plaque with regular brushing and flossing, it'll harden under your gumline into a substance called tartar (calculus). The longer plaque and tartar remain on your teeth, the more they irritate the gingiva — the part of your gums around the base of your teeth. In time, your gums become swollen and bleed easily. This is gingivitis.
• Advanced gum disease (periodontitis). Left untreated, gingivitis can lead to a more serious infection called periodontitis, which destroys the soft tissue and bone that support your teeth. Eventually, periodontitis causes your gums and jawbone to pull away from your teeth, which in turn causes your teeth to loosen and possibly fall out. If you are smoking, you are at higher risk of developing periodontitis.

Diabetics who Smoke have much higher tendency to develop Gums Complication than the Diabetics who don't Smoke.

Periodontitis tends to be more severe among people who have diabetes because diabetes lowers the ability to resist infection and slows healing. An infection such as periodontitis may also cause your blood sugar level to rise, which in turn makes your diabetes more difficult to control. Preventing and treating periodontitis can help improve blood sugar control.
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Symptoms of gum disease

Please see your dentist immediately if you notice any signs and symptoms of gum disease, including:

• red, swollen, tender, bleeding gums
• a persistent discharge (pus) coming from the gums
• gums that are loose and pull away from the teeth
• a bad taste or bad breath
• loose teeth – this can change the ‘feel’ of your bite when your teeth are placed together or may make dentures fit differently
• spaces opening up between your teeth.

Oral Thrush

Oral thrush (candidiasis) is a fungal infection. It is caused by an overgrowth of the yeast, Candida albicans, which occurs naturally in the mouth. Some conditions caused by diabetes such as high glucose in saliva, poor resistance to infection and dry mouth (low saliva levels) can contribute to oral thrush.
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Oral thrush causes white or red patches on the skin of the mouth, which can result in discomfort and ulcers. Good mouth hygiene and optimal blood glucose levels are critical to successfully treating oral thrush. Your dentist can treat this condition by prescribing antifungal medications.

Periodontitis as a complication of Diabetes

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Diabetes is believed to promote periodontitis through an exaggerated inflammatory response to the periodontal microflora.
The formation of Advanced Glycation End Product (AGE) occurs when excess available glucose is in contact with proteins. The AGE once formed bind to a receptor known as Receptor for AGE (RAGE). RAGE is found on endothelial cells and monocytes which are proinflammatory cells. AGE-RAGE binding on the surface of endothelial cells induce cell adhesion molecule-1 expression which attracts monocytes to its side thus perpetuates inflammatory response which is important for the periodontitis. Along with this, apoptosis is also advocated to contribute to periodontitis. Several other theories are also presented and much research is still going on the periodontitis as complication of diabetes.

Influence of Periodontitis on Diabetes

Periodontitis is believed to affect the glucose levels in the body. It is believed to increase the Body Glucose Levels of body, Thus Worsen the Diabetes.

Periodontitis may result in Uncontrolled Diabetes in already Diabetic Patients.

Periodontitis being associated with inflammatory reaction, a number of proinflammatory cytokines like tumor necrosis factor, interleukin 6 and interleukin 1 antagonize insulin (controls body sugar levels) and affect the tissues and organ at distant sites via circulation. Thus worsening the already bad condition.

How can i prevent the Oral Problems?

Make sure to take extra good care of your oral health with regular dental check ups. Routine monitoring of blood glucose levels and maintaining a good insulin control generally have lesser chances of developing Oral complications.

These tips and facts will help you to maintain good dental health:

• Brush your teeth last thing at night and at one other time in the day; the most important brush is the one at the end of the day

• You should use small brushes or floss once a day to remove the plaque from in-between your teeth, preferably before toothbrushing.

• Fluoride in toothpaste keeps the teeth strong and prevents dental decay

• AVOID SMOKING

• To prevent dental decay you should reduce the frequency of sugary snacks and carbonated drinks.

• After brushing spit out don’t rinse the excess toothpaste away – this will keep fluoride on your teeth.

• The mechanics of brushing your teeth makes it better at removing dental plaque and maintaining healthy gums than using mouthwash.

• Water is the only drink that you should take to bed at night.

• A timer can be useful to make sure you brush for a full 2 minutes.

• If you are diagnosed with gum (periodontal) disease, your blood sugar control may be more difficult to manage, but effective gum treatment can help to improve it.

• Your teeth and gums should be checked by a dentist at least once a year; the dentist will advise how often you should attend the dentist or hygienist for treatment.

• If you use dentures clean them properly and regularly before use and after meals.

Best time for Dental Check-Up

If your blood sugar is not under control, talk with both your dentist and physician about receiving elective dental care. Dental procedures should be as short and as stress free as possible. Also make morning appointments because blood glucose levels tend to be under better control at this time of day. If you have a scheduled appointment, eat and take your medications as directed. See your dentist on a regular basis, keep him or her informed of your health status and keep your mouth in good health.

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