Clinicians' Guide to Diabetes and Oral Health
Diabetes, Oral Health, Hygiene and Prevention

Regular Dental Care Not Optional for People with Diabetes

It is vital that people at any age with any type of diabetes be proactive about oral hygiene and care. Clinicians can help educate their patients about the facts—the potential risks for oral disease, asking their patients with diabetes five simple questions during each appointment, and providing guidance on “how to” step up their oral care health regime.

Patients Need You to Explain the Simple Facts

People with diabetes are more prone to tooth decay and periodontal disease. The bacterium that causes tooth decay has an increased risk of reaching disproportionately high levels, as compared to the other oral bacteria species, when blood glucose levels are chronically high. Dry mouth and lack of saliva facilitates buildup of plaque and bacteria. Physicians should take into consideration when prescribing medications with side effects of dry mouth.

dental x-ray shows tooth decay

Over time, communities of bacteria, referred to as plaque, may spread and grow under the gum line. Toxins released by plaque cause gums to become inflamed; tissues that support the teeth break down; gums separate from teeth and pockets form between teeth and gums and may become infected. Untreated teeth may loosen, become painful and/or need to be pulled. Periodontal disease may increase insulin resistance and risk for long-term complications.

5 Easy Questions to Ask

  1. Do your teeth hurt?
  2. Do your gums bleed after brushing or flossing your teeth?
  3. Tell me about your oral hygiene habits.
  4. When did you last see your dentist?
  5. Does your dentist know you have diabetes?

Oral Health and Hygiene “How To” Tips

The tooth brush head should be small enough to fit around all sides of teeth in all areas of the mouth. Based on patient’s preference and dexterity, either manual or electric tooth brush may be used, as long as patient uses proper brushing technique.

how to brush teeth properly

  • The proper way to brush is using small vertical or circular strokes. Avoid rough horizontal strokes and pressing hard, as this can lead to gum recession. Brush for at least two minutes.
  • Brush twice a day
  • It is time to buy a new toothbrush when wear is visible; bending or fraying of the bristles

Tongue Care
Brush or scrape the tongue daily to keep bacteria levels under control.

tongue scraping

If your teeth are tight, overlapped, crowded or difficult to floss in between, select a flat waxed floss that has some elasticity to it.

  • Floss at least once a day
  • Floss either before or after brushing

how to floss teeth

Purpose of mouthwash is to reduce microbial load, provide moisture and lubrications, neutralize pH, and provide a pleasant flavor and scent.

Types of mouthwash include formulas with and without alcohol, moisture-promoting rinses, as well as prescription rinses, such as chlorhexidine. Patients who have irritated oral tissues, such as those with gum disease, should avoid mouth washes containing alcohol. A dentist may prescribe a mouth rinse following certain dental treatments to be used for a set period of time, but chronic use should be avoided.

  • Mouthwash is not necessary for everyone, and it does not take the place of brushing and flossing.
  • Patients with dry mouth should use mouth rinse that provides moisture and lubrication to oral tissues.
  • Patients with acid reflux or an acidic diet should use a mouthwash that neutralizes the oral pH.
  • Patients who have had a mouthwash prescribed by their dentist should use this to reduce the microbial load in the mouth.

Braces and Oral Hygiene
Metal braces or clear braces (Invisalign) both act to improve alignment of the teeth. Straighter teeth are easier to clean around and in between, and allow the gums to adapt better around the teeth. This decreases plaque accumulation and subsequent gum disease.

dental pick helps to keep teeth and braces clean

During the course of orthodontic treatment, a patient is more prone to plaque build-up due to having appliances in the mouth. Extra consideration should be given to oral hygiene during this time.

Continue Reading:
Chapter 1: Overview of the Interrelationship of Diabetes and Dental Care
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