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Uncontrolled diabetics face a much greater risk of dental complications because of high glucose
By Cheryl Powell
Beacon Journal medical writer
Published on Tuesday, Dec 11, 2007
Just about everyone knows that snacking on too many sweet treats is bad for your teeth.
But it may come as a surprise to discover that uncontrolled blood sugar levels can play havoc on oral health, too.
The problem isn't so much the sugar itself but the consequences of uncontrolled blood glucose levels on the rest of the body — the immune system, circulation, the nervous system and even saliva production.
In Akron, the Summa Health System Center for Dental Health is working with doctors who specialize in diabetes care to raise awareness about the link between the disease and dental problems.
Dentists who are completing one-year, optional residencies at Summa's new dental program on the Akron City Hospital campus get lessons from endocrinologists about caring for diabetics.
And diabetic patients at the dental center get extra attention, including blood glucose tests, particularly before undergoing invasive dental procedures.
The overall goal is to create a ''team effort'' among dentists and doctors when it comes to providing better health care, said Marvin D. Cohen, an Akron-area dentist and director of Summa's dental residency program.
''There is definitely a relationship between the medical health of a patient and the dental component of medical care,'' Cohen said.
Diabetes is a group of diseases that causes patients to have high levels of glucose — or sugar — in their blood because of defects in insulin production or activity.
Thanks to the expanding waistlines of Americans, the number of cases of diabetes continues to climb each year.
An estimated 20.8 million people in the United States — or about 7 percent of the population — have diabetes, according to the American Diabetes Association. Of those individuals, more than 6 million are not aware they have the disease.
Another 54 million Americans have pre-diabetes, meaning their blood glucose levels are elevated but not high enough for them to be classified as diabetic.
If left unchecked, the consequences of diabetes can be grave.
Serious or life-threatening complications can include heart disease and stroke, high blood pressure, blindness, kidney disease, nervous system damage, amputations, pregnancy complications, sexual dysfunction and dental disease.
Though eye screenings and
foot exams routinely are recommended for patients with diabetes, routine dental care too often gets overlooked, said Dr. James Salem, an endocrinologist and chief of Summa's endocrine division. (Endocrinologists specialize in treating patients with hormonal disorders, including diabetes.)
Mounting risks
Without proper monitoring and treatment, Salem said, diabetic patients are at increased risk for gum disease, as well as periodontitis, which spreads to the supporting structures of the tooth.
Impaired immune system function from diabetes also puts patients at risk for fungal infections of the mouth, he said.
''There's a variety of mechanisms, and they're not all completely understood,'' Salem said. ''Some of it has to do with the way that immune function is affected in diabetes. You don't tend to fight off infection quite as well. Some of it probably is due to vascular changes that are secondary to the diabetes.''
Diabetics don't heal as well from invasive procedures, such as tooth extractions, Cohen said. ''It's incumbent upon the practicing dentist to be aware of that.''
Invasive procedures that cause stress in patients also can raise their epinepherine (stress hormone) levels, which then can raise their blood-sugar level.
For that reason, diabetic patients at the Summa Center for Dental Health get their blood pressure checked and their blood glucose levels tested with a finger-prick test before any invasive procedures.
''If the level is beyond normal limits or is not controlled, we will not do the procedure,'' Cohen said.
Nerve problems
Patients with diabetes are prone to nervous system problems that cause ''burning mouth syndrome,'' or abnormal, hot sensations in the mouth, Salem said.
In addition, Salem said, many diabetics have severely dry mouths because of salivary gland dysfunction.
The lack of saliva is not only bothersome to patients but dangerous for their teeth.
''Without an adequate amount of saliva, the teeth . . . are prone to dental decay,'' Cohen said.
To cut down risks, he said, dentists can give diabetic patients antibiotics before dental procedures and intense fluoride treatments at home and in the office.
Patricia Adkins, 64, of New Franklin has been living for years with extreme dry mouth caused by her diabetes.
She couldn't find any relief until she went to the Summa Center for Dental Health.
Eduardo Rodriguez, a dentist in Summa's residency program, recommended a special sugar-free gum to help with her dry mouth and then tested her glucose level right in the dental center.
''They were very thorough, very nice,'' Adkins said of the center. ''I've never had a dentist ask me about my blood sugar.''
As the number of people with diabetes continues to increase, it's becoming increasingly important for dentists to understand the disease and talk to patients about the risks, Cohen said.
''Preventive maintenance is key to someone with dental problems,'' he said.
Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.
Just about everyone knows that snacking on too many sweet treats is bad for your teeth.
Get the full article here.
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