Diabetes and Other Endocrine Disorders

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Diabetes and Other Endocrine Disorders

Diabetes
Oral Effects
Diabetes can affect the entire body. Whether your diabetes affects your oral health depends on how well you are able to control your blood sugar. If your diabetes is under control, the effects on your oral health should be minimized. However, if your diabetes is not under control, the oral effects can be dramatic.

People with diabetes can have:

* Rapidly progressing periodontal (gum) disease
* Gum inflammation (gingivitis)
* Dry mouth (xerostomia)
* Poor healing of oral tissues
* Oral candidiasis (thrush)
* Burning mouth and/or tongue

Uncontrolled diabetes impairs white blood cells called neutrophils, which are a main defense against bacterial infection. Because periodontal disease is a bacterial infection, people with uncontrolled diabetes are more likely to have it, and their conditions are likely to be more severe.

In addition, successfully treating severe periodontal disease can improve diabetic control because any type of infection may cause blood-sugar levels to rise. This increases the need for insulin. If the infection is treated successfully, the need for insulin may decrease and diabetic control likely will be easier.

Dry mouth (xerostomia) can increase your risk of tooth decay because saliva normally washes away sugars and food particles that are fuel for decay-causing bacteria. Recent studies have shown that uncontrolled diabetics have decreased salivary flow. However, there's no widespread agreement on whether diabetics as a group have more or less tooth decay than non-diabetics. If you have dry mouth, practice regular oral hygiene to prevent decay. You may want to talk to your dentist or physician about artificial saliva, or other means of reducing your dry mouth. Fluoride rinses or gels should be used to reduce the possible increase in decay rate.

If you have uncontrolled diabetes, you may have problems healing quickly after oral surgery or other dental treatment because blood flow to the site can be impaired.

You may also be at risk for a fungal infection called thrush, or oral candidiasis, which thrives on the sugar in your saliva. Antifungal medication is the treatment for this condition. Oral candidiasis can cause a burning sensation in your mouth, sometimes called burning-mouth syndrome or stomatodynia. The syndrome has other causes as well, but antifungal medication may help if it is caused by oral candidiasis.

At the Dentist
No matter how well controlled your diabetes is, it's important to keep your dentist informed about your condition. Your dentist should become a part of your health-care team and know about any changes in medication or the status of your condition. Anything you can tell your dentist about your condition will help him or her decide the best treatment for you. At the very least, your dentist should have your physician's name and phone number so he or she can contact your physician with any concerns or questions.

Your dentist may want to know your glycosylated hemoglobin level (the results of your hemoglobin A1C test) to get an idea of how well controlled your diabetes is. The test shows the percent of your hemoglobin that is glycosylated (has sugar attached to it). Diabetics should aim for less than 7 percent. Higher levels can indicate poor diabetic control, meaning there's more sugar in your blood than there should be.

If your diabetes is well controlled, you probably do not need any special dental care. However, uncontrolled diabetics — especially those with cardiovascular and/or kidney problems — should probably receive antibiotics before and after any dental treatment, such as surgery, that might put them at risk for a bacterial infection.

Take your insulin and eat normally before visiting the dentist; continue to do what's normal for you. Your dentist may have a source of glucose, such as juice, available in case of hypoglycemia (low blood sugar; also called an " insulin reaction" ). However, you should take a source of glucose with you to make sure you have it if you need it. Glucose tablets, available at pharmacies, are convenient to carry, but crackers, cookies or any carbohydrate will work. After treatment, resume your normal diet immediately. If this is not possible, seek advice from your doctor.

Some recent changes in the care of diabetes may affect your visit to the dentist. The cut-off blood-sugar level for control of diabetes, which used to be 140 g/dl, is now 126 g/dl. This increases the chance of hypoglycemic episodes.

If you've had a hypoglycemic episode in the past, you are at increased risk to have another one. Tell your dentist if you have had an episode, when the last one was and how common they are. Most hypoglycemic problems will occur when your insulin peaks, so make sure your dentist knows when you last took insulin.

Some medications your dentist might use can interfere with some oral medications you may take for diabetes. This makes it even more important that your dentist know the medications you are taking and their doses.

Follow your dentist's post-treatment instructions thoroughly. People with diabetes tend to be slower to heal and more prone to infection, so do whatever you can to help yourself recover completely. Also, it is especially important for diabetics who are having orthodontic work done to contact their orthodontist immediately if a wire or bracket is cutting into their tongue or mouth so it can be fixed before a sore forms. People with intraoral appliances made of acrylic may also have an increased risk for candidiasis.

If your dentist has successfully treated a major infection, you may need to visit your physician to have your insulin dose calibrated.

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