Diabetes and Pre-mature Tooth Loss

Diabetes and Dental Extractions Due to Premature Tooth Loss
Roger Myers DMD-Oral Surgeon Hinesville and Statesboro, Ga.
Southern Georgia Oral Surgery


Diabetes is a disease that can affect the whole body, including your mouth. Dental care is particularly important for people with diabetes because they face a higher than normal risk of oral health problems due to poorly controlled blood sugars. The less well controlled the blood sugar, the more likely oral health problems will arise.  The ramifications caused by uncontrolled sugar level can result in kidney failure, loss of vision and oral/systemic issues.  The patients have a greater susceptibility to infections and delayed healing time recovering from trauma with resultant wounds.  This is because uncontrolled diabetes impairs white blood cells, which are the body's main defense against bacterial infections that can occur in the mouth.

What Dental Problems Are People With Diabetes at Higher Risk For?

People with diabetes face a higher risk of:

• Dry mouth. Uncontrolled diabetes can decrease saliva flow, resulting in dry mouth.  The technical term for dry mouth is xerostomia.   Dry mouth can further lead to soreness, ulcers, infections, and tooth decay.  A decreased salivatory state promotes stagnancy and reduces the bodies natural method of washing away tooth adhered bacteria.  This alone can significantly contribute to premature tooth loss, periodontal issues and fungal infections.
• Gum inflammation (gingivitis and periodontitis). Besides impairing white blood cells, another complication of diabetes is that it causes blood vessels to thicken, which slows the flow of nutrients to and waste products from body tissues, including the mouth.  However, when tissue is inflamed due to infection, the region can exhibit profuse bleeding during surgery. When this combination of events happens, the body's ability to fight infections is reduced. Since periodontal disease is a bacterial infection, diabetics with uncontrolled disease may experience more frequent and more severe gum disease.  Gum disease can lead to periodontal issues which affect the retention of teeth.
• Poor healing of oral tissues. People with uncontrolled diabetes do not heal quickly after oral surgery or other dental procedures because blood flow to the treatment site can be impaired.
• Thrush. People with diabetes who frequently take antibiotics to fight various infections are especially prone to developing a fungal infection of the mouth and tongue. The fungus thrives on the high levels of sugar in the saliva of people with uncontrolled diabetes.
• Burning mouth and/or tongue. This condition is caused by the presence of thrush.  This is also called glossodynia.  This can be of neuropathic etiology or form the presence of candida albicans(fungal).  If the cause derives from a fungal infection, anti-fungal agent can be taken.  But, if the cause is of neural origin the patient must be followed by a neurologist.

People with diabetes who smoke are at even a higher risk -- up to 20 times more likely than nonsmokers -- for the development of thrush and periodontal disease. Smoking also seems to impair blood flow to the gums -- which may affect wound healing in this tissue area.
Since people with diabetes are more prone to conditions that may harm their oral health, it's essential to follow good dental care practices and to pay special attention to any changes in your oral health and to seek a prompt dental consultation if such changes occur. Here are some tips to consider.

• Keep your blood sugar as close to normal as possible( 70-110)
• At each dental care visit, tell your dentist about the status of your diabetes. For instance, he or she may want to know your HgA1C level to determine how well controlled your diabetes is (good control is indicated by a level under 7%). If you've had a hypoglycemic episode in the past (low blood sugar, also called an insulin reaction), you are at increased risk to have another one. Tell your dentist when your last episode was, how frequently such episodes occur, and when you took your last dose of insulin, if you take it.  The A1C is a blood serum blood test.
• See your diabetes doctor before scheduling treatment for periodontal disease. Ask your doctor to talk to your dentist or periodontist about your overall medical condition before any dental treatment is performed. If oral surgery is planned, your doctor or dentist will tell you if you need to take any presurgical antibiotics or need to change your meal schedule or the timing and dosage of your insulin, if you take it. At Southern Georgia Oral Surgery, we premedicate all diabetic patients and ask each patient to take check their level prior to surgery.  If insulin dependent, the patient will take 1/2 their dose prior to surgery or calibrate it accordingly.
• Bring your dentist a list of all the names and dosages of all medications you are taking. Your dentist will need to know this information to prescribe medications least likely to interfere with the medications you are already taking if medications are needed. If a major infection is being treated, your insulin dose -- for those taking insulin -- may need to be adjusted. Check with your doctor.
• Postpone nonemergency dental care procedures if your blood sugar is not in good control.  Lack of sugar control can lead to an inevitable infection and potential prolonged healing after surgery.   However, acute infections, such as abscesses, should be treated right away.
• Keep in mind that healing may take longer in people with diabetes. Follow your dentist's post-treatment instructions closely.