Thursday, March 20, 2014

Tooth or Consequence? Oral health and diabetes

Dr. Jessie Albeus
by Dr. Jessie Albeus

During the last Luzon Area Conference of the Philippine Dental Association that I attended  last January 13-14  at the Philippine International Convention Center, the lectures focused on oral health in relation to medically-compromised patients such as diabetics and patients with cardio-vascular diseases, among others.

Diabetic patients are one of the risk groups among patients being handled by dentists.  MNT Knowledge Center defines  Diabetes (diabetes mellitus), as a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin, or both.  What are the symptoms of persons with diabetes? Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).

A number of oral diseases and disorders have been associated with diabetes mellitus, and periodontitis has been identified as a possible risk factor for poor metabolic control in subjects with diabetes.  Numerous studies have linked periodontitis as a complication of diabetes. Patients with long-standing, poorly controlled diabetes are at risk of developing oral candidiasis, and the evidence indicates that periodontitis is a risk factor for poor glycemic control and the development of other clinical complications of diabetes. Evidence suggests that periodontal changes are the first clinical manifestations of diabetes.

What dental problems are people with diabetes at higher risk for? One is dry mouth. Uncontrolled diabetes can decrease saliva flow, resulting in dry mouth. Another would be gum inflammation such as gingivitis and periodontitis. Third is poor healing of oral tissues as blood flow to the treatment site can be impaired. Fourth, burning mouth and/or tongue that is caused by the presence of thrush.  MNT Knowledge Center defines oral thrush (also known as oral candidiasis) as a yeast fungi infection of the genus Candida that develops on the mucous membranes of the mouth. It is most commonly caused by Candida albicans, but may also be caused by Candida glabrata or Candida tropicalis. Candidosis or Moniliasis refers to adult oral thrush, while oral thrush can refer to that which affects both adults and babies.

Oral thrush causes thick white or cream-colored deposits, most commonly on the tongue or inner cheeks. The lesions can be painful and may bleed slightly when they are scraped. The infected mucosa of the mouth may appear inflamed and red.

People with diabetes who smoke are at even a higher risk, up to 20 times more likely than nonsmokers, of developing thrush and periodontal disease. Smoking also seems to impair blood flow to the gums, which may affect wound healing in this tissue area.

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 at least every six months. Be sure to inform your dentist of your health status to prevent complications and keep your mouth in good health.

Dr. Jessie R. Albeus is the two-term president of the Philippine Dental Association in Camarines Sur (January 2012 to May 2014). He is also the President of the Ateneo de Naga University Alumni Association.

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