Diabetes & Oral Health: How to Protect Your Teeth

Diabetes and your teeth may not seem to be linked, but they are.

Having uncontrolled diabetes can boost your risk for oral health problems such as gum disease.

But the link goes the other way, too, most experts believe. If you have gum disease, it may make it harder to keep blood sugar under control. So the diabetes and oral health link is a two-way street.

The good news: taking care of your oral health will help not only your teeth and gums, but perhaps help your diabetes control.

Other oral health problems, although not as common, are also associated with having diabetes.

Among them:

* Slower healing time after dental surgery
* Fungal infections
* Dry mouth
* Cavities

Even so, you can take steps to protect your teeth and oral health. Here's how to minimize the risks.


Diabetes & Oral Health Risks Explained
Having diabetes can make you less able to fight off infection, including gum infections that can lead to serious gum disease.

In early stages, gum disease is known as gingivitis. The gums are swollen, soft, and may bleed, particularly during brushing or flossing.

If gum disease progresses, however, the gums may begin to separate from the teeth, forming pockets that can trap bacteria and boost the risk of infections. Untreated, the infections can destroy the underlying bones that holds the teeth in place.

Surgery may be needed. In one technique, called pocket depth reduction, the periodontist folds back the gum tissue, removes the bacteria, and secures the tissue into place so that it fits more tightly around the teeth.

With diabetes, you may heal more slowly after oral surgery. Your health care provider may prescribe antibiotics to keep post-operative infection at bay. Pay close attention to your blood sugar levels and control before and after oral surgery.

If you have diabetes, you are also at risk for fungal infections in the mouth, called oral candidiasis or thrush. This is true even if you wear dentures.

Dry mouth, called xerostomia, is another common problem among people with diabetes. Saliva is important to oral health -- it helps wash away food particles and keep the mouth moist. When you don't have enough saliva, bacteria thrive, tissues can get irritated and inflamed, and your teeth can be more prone to decay.

Diabetes & Your Teeth: How to Minimize Risk

Taking care of your oral hygiene at home every day is crucial. Make sure you brush twice a day and floss once a day. Using an antibacterial mouthwash or toothpaste can help reduce bacteria in the mouth that can cause gingivitis.

Examine your mouth for an inflammation or signs of bleeding gums. If you notice either, let your dentist know as soon as possible.

Experts recommend having your teeth professionally cleaned every six months, or even every three or four months. Step up the professional cleaning schedule if you know you tend to be lax about home care.

Be sure to tell your dentist that you have been diagnosed with diabetes. It will also help your dentist to know the names of all prescription and over-the-counter drugs you take.

You may want to see a periodontist -- a dentist who specializes in gum disease -- if your gum problems persist or seem to get worse.

Diabetic Nephropathy

Kidney disease in diabetes as we all knows ‘diabetic nephropathy’ is a major microvascular complication occurring in around 20-40 % diabetic patients with prolonged diabetes. It’s a leading cause of end stage renal disease, dialysis and transplant.

Diabetic nephropathy is characterised by persistent proteinuria of >500mg/day with concomitant diabetic retinopathy, hypertension and absence of other kidney or renal tract disease.



Years of diabetes
GFR-Glomerular filtration rate
ESRD-End Stage Renal Disease




Symptoms:-

* Ankle and leg swelling. (Pedal oedema) and/ facial puffiness.
* Reduced urination (<400ml/day-oliguria). * Episodes of hypoglycaemia.
* Less requirement of insulin or antidiabetic medication.
* Reduced appetite (anorexia) and weakness.
* Nausea and vomiting.
* Itching.
* Breathlessness.
* Palpitation.

Diagnosis of diabetic nephropathy
Evidence of diabetic retinopathy ( retina changes in diabetes)
Presence of proteins in urine- presence of urine microalbumin or urine spot protein creatinine ratio of >0.2.
High levels of blood urea and creatinine
Enlarged renal size on ultrasonography.
Associated findings of- high blood pressure, anaemia and increased serum potassium levels.

What to eat?

Patient should take low sodium and protein diet. Recommended dietary protein intake is 0.6 to 0.8 gm/kg body weight/day and salt of 2 to 3 gm/day.

Lifestyle modification

Patient is required to exercise daily and loss weight to maintain ideal body weight. To avoid tobacco and alcohol.

Medications supposed to be avoided in renal diseases.

Avoid nephrotoxic drugs like NSAIDS, aminoglycosides etc, over the counter medications (medicines brought directly from the pharmacy without prescription), alternate and native medication and painkillers unless very necessary, use nephrosafe painkillers like paracetamol and tramadol. Avoid intravenous contrast agents for imaging like CT scan and angiography. Avoid metformin in renal diseases, insulin is the best choice.

Management
Good glycaemic control of HbA1c<7% Good Blood pressure control of <130/80mm hg with ACE inhibitors/ARB (angiotensin receptor blocker) as first line followed by beta blockers and calcium channel blockers. Lipids levels to remain under control

Can we cure diabetic nephropathy?
Once onset complete reversibility is not possible but we can slow the progression of diabetic nephropathy and delay onset of end stage renal disease with good glycaemia and blood pressure control and use of ACE inhibitors/ARB in early stages.

Pregnancy and diabetic nephropathy?
ACE inhibitors/ARB should be avoided as they cause foetal malformations. Best is to maintain a strict glycaemic control of HbA1C <7.0% and blood pressure control of <130/80mm of hg. Benefits of early diagnosis of kidney disease.

Kidney being an innocent organ, in diabetes, it’s prone to microvascular insult. Any further damage due to infections drugs, etc can further compromise the renal function, recovery from which may not be possible through conservative means.

Hence early diagnosed kidney diseases can have a better and prolonged survival if certain precautions are attained at the beginning itself, for example, avoiding use of painkillers, alternate medicines, intravenous contrast agents during imaging studies and nephrotoxic drugs. Taking plenty of fluids and consulting your physician each time you need to take medicines. Regular checkup for renal functions and urine for proteinuria.

Consult your physician if you have, reduced urine, burning micturition, swelling in feet, loin pain, any urinary discoloration.

Nephrology evaluation is must for patients having skin or joint problems (ex- SLE, psoriasis, leprosy, etc), cyst or stones in kidney, family history of renal diseases and patients with prolonged pain killer intake.

Complications of Diabetes

Definition
Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood. Those with diabetes are at high risk for a number of complications.

Causes, Incidence, And Risk Factors
Insulin is a hormone made by the pancreas, an organ located behind the stomach. Insulin is needed to move glucose (blood sugar) into cells, where it is stored and later used for energy.

Diabetes is caused by a problem in the way your body makes or uses insulin. There are several types of diabetes. This article discusses the possible complications related to diabetes.

Signs And Tests
If you have diabetes, you should see your health care provider every 3 months. At these visits you can expect the health care provider to:
• Check your blood pressure
• Check the sensation (feeling) on your feet
• Check the skin and bones of your feet and legs
• Examine the back part of your eyes with a lighted instrument called an ophthalmoscope

Complications
After many years, diabetes can lead to serious problems throughout your body, including your eyes, kidneys, and nerves.

EYE PROBLEMS
Diabetes can also damage blood vessels in the eyes, causing vision problems or blindness. Conditions may include:
• Cataracts
• Diabetic retinopathy
• Glaucoma
• Macular edema

FOOT AND SKIN PROBLEMS
People with diabetes are more likely to have foot problems because of nerve and blood vessel damage. Small sores or breaks in the skin may turn into deep skin ulcers if not treated properly. If these skin ulcers do not improve, or become larger or go deeper, amputation of the affected limb may be needed. (Diabetes foot care.)

HEART AND BLOOD VESSELS

If you have diabetes, your risk of a heart attack is the same as someone who has already had a heart attack. Both women and men with diabetes are at risk. You may not even have the typical signs of a heart attack. Other problem with the heart and blood vessels include:

• Damage to blood vessels that supply the legs and feet (peripheral vascular disease)
• High blood pressure (hypertension)
• High cholesterol
• Stroke

NERVE PROBLEMS

Diabetes can damage nerves, which means you may not feel an injury until a large sore or infection develops. Nerve damage causes pain and numbness in the feet, as well as a number of other problems with the stomach and intestines, heart, and other organs. ( Diabetic neuropathy.)

OTHER COMPLICATIONS

• Infections of the female genital tract, the skin, or the urinary tract
• Kidney disease and kidney failure (diabetic nephropathy)
• Problems attaining or maintaining an erection (impotence)

Calling Your Health Care Provider

Call your health care provider if you have:
• Numbness, tingling, or pain in your feet or legs
• Problems with your eyesight
• Sores or infections on your feet
• Symptoms of high blood sugar (being very thirsty, having blurry vision, having dry skin, feeling weak or tired, needing to urinate a lot)
• Symptoms of low blood sugar (weakness or tiredness, trembling, sweating, feeling irritable, unclear thinking, fast heartbeat, double or blurry vfision, feeling uneasy)

Prevention

You should learn basic diabetes management skills. They will help prevent complications and the need for medical care. These skills include:
• How to handle sick days
• How to recognize and treat low and high blood sugar
• How to take medications, if needed
• How to test and record your blood sugar level
• What to eat and when
• Where to buy diabetes supplies and how to store them

It may take several months to learn the basic skills. Always continue to education yourself about the disease and its complications. Learn how to control and live with diabetes. Over time, stay current on new research and treatment.

The American Diabetes Assocation recommends keeping blood sugar levels in the range of:
• 80 - 120 mg/dL before meals
• 100 - 140 mg/dL at bedtime

EXERCISE

Regular exercise is important for everyone, but especially if you have diabetes. Regular aerobic exercise lowers blood sugar without medication and helps burn excess calories and fat so you can mange your weight.

Exercise can help your overall health by improving blood flow and blood pressure. Exercise also improves your ability to handle stress.

The following are important for preventing complications of diabetes:
• Get yearly tests to be sure your kidneys are working well (microalbuminuria and serum creatinine)
• Have your blood pressure checked at least every year (pressure should bve 130/80 mm/Hg or lower)
• Have your cholesterol and triglyceride levels checked yearly (LDL levels should be 100 mg/dL or below)
• Have your glycosulated hemoglobin (HbA1c) check every 6 months if your diabetes is well controlled or every 3 months if it's not
• See the dentist every 6 months for a thorough cleaning and exam. Make sure your dentist and hygienist know you have diabetes
• Visit your ophthalmologist at least once a year -- more often if you have signs of diabetic retinopathy

FOOT CARE

To prevent problems with your feet, you should:
• Check and care for your feet EVERY DAY, especially if you already have known nerve or blood vessel damage or current foot problems. Follow the instructions below.
• Get a foot exam by your health care provider at lesat twice a year and learn whether you have nerve damage
• Improve control of your blood sugar
• Make sure you are wearing the right kind of shoes
• Stop smoking if you smoke

MEDICATIONS TO PREVENT COMPLICATIONS

Since those with diabetes have a much higher chance of developing heart disease, kidney disease, and other medical problems, they may need to take certain medicines to treat or prevent these problems.

An ACE inhibitor (or ARB) is often recommeded:
• As the first choice medicine for treating high blood pressure
• For those who have signs of early kidney disesae (microalbuminuria)
• ACE inhibitors include captopril (Capoten), enalapril (Vasotec), quinapril (Accupril), benazaeprl (Lotensin), ramipril (Altace), perindopril (Aceon), and lisinopril (Prinivil, Zestril)

Statin drugs are usually the first choice to treat an abnormal cholesterol level. Aim for LDL cholesterol level less than 100 mg/dL.