Are you a diabetic? You might be wondering, what does diabetes have to do with my oral health? Well, there is a direct relationship between diabetes and oral health. Let’s dive in and take a closer look.
What is Diabetes?
Diabetes is when your body is unable to regulate the glucose levels in your blood stream. In a non-diabetic patient, the glucose levels are lowered by the insulin that the pancreas produces. If you consume too much glucose or your your pancreas does not produce insulin, you can become a diabetic. There are two types of diabetics: Type 1 and Type 2.
Type 1 diabetics have a pancreas that naturally does not produce insulin as a result of either being born with the condition or an autoimmune response that occurs early in life.
Type 2 diabetic is someone who becomes diabetic as a result of high glucose diet or low production of insulin by the pancreas.
Blood Glucose Levels
So what exactly does it mean to have high blood glucose levels?
When you see you primary care provider, they will typically check your glucose levels once a year to screen you for diabetes. What they are looking for is your HbA1c levels as this will let your doctor know how well your body has managed glucose for the past 3 months. If this number is above a 6, you may be considered a pre-diabetic. If the number is higher than 7, you may be considered to have diabetes and your provider will work with you on how you can manage your glucose levels and get this number back down to a normal range.
HbA1c
This test plays a big role in your dental care. If you have uncontrolled blood sugar, this can cause many issues in the body as the glucose takes up the space in the blood where nutrients would normally.
In uncontrolled diabetic patents dentist are concerned with delayed wound healing. When you are having tooth extractions, your mouth has an open wound that needs to heal. If your HbA1c number is over 7, some dentist will not extract your tooth because of the risks of delayed wound healing. They will refer you to an oral surgeon to extract the teeth.
Periodontal disease
The bacteria from periodontal disease is very harmful to your gums and bone. With periodontal disease and poor oral hygiene. Diabetic patients can see worsening conditions for both.
In order to treat periodontal disease, your dentist must also consider your diabetes management. Same goes for your primary care provider when they manage your diabetes, they need me also manage your periodontal disease.
This is why inter-professional collaborations are so important. Your dentist and primary care provider need to work together to treat your conditions as the mouth is vital part of the body.
With periodontal disease, you can expect to see tooth mobility, inflamed soft tissues, delayed healing, require tooth removal, and may require surgery to clean the bacteria under the gums.
Blood Sugar Level
With proper care and proper treatment, you can control diabetes. When you body has inflammation, such as that seen with periodontal disease, your immune system kicks in to address it. If the problem is not resolved, then you will continue to have this immune response.
This drawn our immune response causes adverse reactions in your body that can affect your blood vessels. The effect of your blood vessels means that healing elements to aid the healing process are slowed down and you can experience delayed wound healing.
Blood sugar levels are important because the more glucose you have in your blood, the less room there is for nutrients to help your body heal.
This plays a huge role when it comes to dental extractions and may cause your dentist to be extremely cautious when performing certain dental procedures.
Management of Diabetes
Your primary care provider will give you specific medications to take and possible diet and exercise modifications that you will need to make. Prior to any dental extraction, your dentist will review your medical history and confirm if you are diabetic and will also check your HbA1c number.
If you require an emergency tooth extraction, your dentist may consider extracting the tooth to address the emergency and refer you to an oral surgeon to manage the wound if there are any signs of delayed healing.
High blood sugar or blood glucose level is an important factor when trying to manage complications from diabetes.
Infection management
I keep mentioning an association with diabetes and a delayed would healing process for a reason.
If you have an infection, this is also something your immune system will try to combat. However, again, if your blood is saturated with glucose, there is no room for your immune system to deliver the nutrients needed to fight off the bacteria.
For example, if you have an infected tooth that need root canal treatment, your immune system may struggle to fight off this infection if you have uncontrolled diabetes.
In controlled diabetics, you may have fewer complications with infections and your body can have an improved healing process.
Diabetes and Extractions
Your dentist may ask your provider to re-evaluate your medication if you consistently present to the clinic with uncontrolled diabetes or an elevated HbA1c.
The reason we pay such close attention to your glucose is not to help us with the extraction, but more importantly, the healing process after the extraction.
When you have a tooth extraction procedure completed, there is an open wound in the mouth that your body needs to heal. This wound can trap food and bacteria. Patients who are diagnosed with diabetes are always asked about their HbA1c prior to any extraction.
Some symptoms of a delayed healing extraction site are:
- Prolonged bleeding or oozing of blood
- Tender gingival tissues
- Increased need for antibiotics
- Healing process in excess of two weeks
Prevention
How can you prevent all of this from possibly happening to you?
Well, it starts out with routine dental and medical care. You must see your dentist and primary care providers on an annual basis to help you monitor your health.
Also, it is up to you to make certain lifestyle changes to improve your health. I always tell my patients that we are a team in the sense that 50% of the work is what I do in the dental chair and the other 50% is done by the patient at home.
Summary
Periodontal disease and diabetes are directly linked and this is backed by many research articles and studies. So therefore, you cannot treat diabetes without treating periodontal disease and vice versa.
High blood glucose levels means you have high blood sugar and this is what we see in uncontrolled or undiagnosed diabetic patients. The glucose in the blood takes up the space needed for your body’s immune response. So, if the body cannot get the nutrients it needs to heal a bacterial infection or an open wound, you can experience delayed healing.
Diabetes is caused by a specific bacteria in the mouth. It can develop as a result of poor oral hygiene and poor follow-up with a dental provider. This bacteria caused your gums to get inflamed and when the gums are irritated and inflamed, the blood vessels dilate and open up. This give the bacteria direct access to your blood stream .
Where the blood goes, the bacteria can now go too. This is bad! Like Really bad!
It can cause issues with infections in the body, plaque accumulation in the blood vessels that can lead to heart attacks, stroke, or pulmonary embolisms. Prolonged infections, such as untreated periodontal disease, can also play a role in how insulin helps to reduce blood glucose levels.
Lastly, your primary care provider might place you on certain medication to help manage your blood glucose level but you have to help your doctor by also reducing the amount of glucose you consume as part of your diet.
Delayed healing is a possibility with elevated glucose or elevated HbA1c. Your dentist may consult with your primary care provider to manage your glucose levels before an extraction to prevent issues with healing. If your HbA1c is too high, like over 7.5, some dentists will refer you to an oral surgeon to extract the tooth and manage the extraction sight for proper healing.
Please, see your dentist and primary care provider annually and take control of our overall health.
- Dr. Gibbz (Public Health Dentist)
