Oral and Dental Problems in Diabetes
Unfortunately, diabetes is a disease that damages vital organs in the body, and it is also a major threat to gums and teeth. People with uncontrolled diabetes have a high chance of non-healing wounds, leading to infections after treatment. This issue is even more common in individuals who smoke and have diabetes. Oral and dental problems in diabetes include the following:
Oral Problems in Diabetes: Symptoms of oral issues in diabetic patients include:
- Cracks at the corners of the lips due to reduced saliva secretion and dry mouth
- Severe redness of the oral mucosa, burning sensation on the tongue and mucosa, and altered taste sensation
- Presence of fungal-like papillae on the tongue
- Development of grooves around the teeth near the tongue
- Enlargement of the tongue, thickening, and formation of grooves
- Tongue pain
- Change in the oral microbiome, such as an increase in Candida albicans, which causes lip corner cracks and thrush.
Dental Problems in Diabetes: Symptoms of dental issues in diabetic patients include:
- Increased sensitivity of teeth to pressure, especially in the gum-tooth junction
- Tooth pain without visible cavities
- Enamel destruction and increased tooth decay
- Sores caused by irritation from dentures in individuals with uncontrolled diabetes
Gum Problems in Diabetes: Symptoms of gum issues in diabetic patients include:
- Gum bleeding due to changes in gum blood vessels
- Gingival hypertrophy with severe redness and swelling
- Gingivitis and periodontitis, inflammatory diseases of the gum tissue. People with periodontitis eventually lose their supporting bone structure and teeth. Poor diabetes control is a very serious risk factor for periodontitis, and conversely, gingivitis and periodontitis are often the first signs of diabetes. Proper oral hygiene is crucial for diabetic patients, and regular dental check-ups can help detect oral problems early in these patients. In chronic gum inflammation, the supporting structures of the teeth (alveolar bone and periodontal fibers) are destroyed. This disease can be caused by various factors, including anaerobic bacteria and sometimes viruses, along with other risk factors such as smoking, diabetes, and depression, which make the individual more susceptible to gum inflammation. The body’s immune system’s inflammatory response to bacteria leads to tissue destruction, and this occurs in chronic gum inflammation.
Chronic Gingivitis Diagnosis in Diabetes: Chronic gingivitis is a very common inflammatory reaction that occurs in the gum tissue in response to dental plaque accumulation. If this condition persists, it can lead to periodontitis, though not necessarily. Clinical manifestations of gingivitis can change due to systemic factors, including poorly controlled diabetes, which further affects the gum tissue in response to dental plaque.
The Connection Between Diabetes and Gingivitis/Periodontitis in Dental Problems: Although periodontitis is a known complication of diabetes, individuals who effectively control their diabetes and maintain good oral hygiene are not at an increased risk of periodontitis. However, the risk of periodontitis clearly increases in people with poorly controlled diabetes, especially if they smoke. Recent epidemiological studies indicate that the prevalence of diabetes is twice as high in individuals with periodontitis compared to others.
Since diabetes can exist for years before being diagnosed, dentists are often the first professionals to detect warning clinical signs of diabetes in patients. Additionally, they can provide insight into how well a patient’s diabetes is being controlled based on oral symptoms.
These symptoms include:
- Resistant gum inflammation after standard periodontal treatment (scaling above and below the gums, oral hygiene practices)
- Severe gum inflammatory response to dental plaque and proliferation of gum tissue at the edges
- Continued alveolar bone loss despite periodontitis treatment
- Progressive and severe periodontitis in individuals aged 20 to 45 (deep periodontal pockets, increased tooth instability and movement, greater spacing between teeth, radiological evidence of advanced bone damage)
- Spontaneous formation of periodontal abscesses.
How Diabetes Increases the Risk of Periodontitis in Diabetic Patients: Glycosylation of end products and their deposition on tissues due to elevated blood glucose levels can alter the phenotype of macrophages and other cells via specific cell surface receptors. Macrophages are key cells in the development of periodontitis, as they cause the disease through the production of various cytokines. They also affect the inflammatory response, fibroblast and lymphocyte metabolism, and bone resorption via prostaglandin E2. Excessive glycosylation of end products seems to convert macrophages into destructive cells that uncontrollably produce pro-inflammatory cytokines.
The function of neutrophils, which are the first defense line in gum tissue and the bone surrounding teeth, is reduced in diabetic individuals. This may be another mechanism by which diabetes increases the risk of periodontitis.
Is There a Relationship Between Periodontitis and Diabetes Control? While periodontitis is a well-known complication of poorly controlled diabetes, it also creates metabolic disturbances that affect diabetes management. This process occurs due to the release of systemic mediators (inflammatory cytokines like TNF-α from gums affected by periodontitis) and exposure to gram-negative organisms.
What Steps Can Patients Take? People with diabetes must take special care of their oral health, including brushing and flossing. Using toothbrushes that reach between the teeth can help alleviate gingivitis. Using chlorhexidine mouthwashes or chlorhexidine gel twice daily (separately from toothpaste, as chlorhexidine is deactivated by toothpaste) can help manage many severe forms of gingivitis. Patients should consult their dentist to determine the appropriate duration for chlorhexidine use. Dental care, including checks and treatments every six months, is essential for diabetic patients to maintain gum health and prevent advanced treatments.
The diabetes care team should refer diabetic patients with gingivitis or periodontitis to a dentist for necessary treatments.