Dental problems in diabetes

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Dental problems in diabetes
Patrick J Phillips
Reprinted from Australian Family Physician Vol. 37, No. 7, July 2008
MBBS, MA(Oxon), FRACP, MRACMA, GradDipHealth Econ(UNE), is Senior Director, Department of Endocrinology, The Queen Elizabeth Hospital, South Australia. patrick.phillips@nwahs.sa.gov.au

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Add a dentist to the diabetes team

This article uses a case based approach to review the two most common causes of dental problems in people with diabetes – caries and periodontal disease – and highlights the importance of adding a dentist to the diabetes team.

A healthy tooth in a healthy gum and healthy mouth is fairly secure. The roots are firmly embedded in bone and the gum firmly encases the tooth, leaving only the resistant enamel exposed to any debris and bacteria that saliva has not flushed away. Dental problems are more common in people with diabetes and can affect diabetes management.1,2 Diabetes is associated with poor dental health for a number of reasons:
• diabetes is most common from age 40 years,3 when vascular disease is starting to affect the fine vessels supplying the tooth
• diabetes greatly accelerates vascular disease in the teeth as well as in the rest of the body
• saliva washes the teeth clear of debris and bacteria, but age and diabetes affect the autonomic nervous system and hyperglycaemia glycosuria causes dehydration.4 Both reduce salivary flow. The resulting dry mouth and teeth are uncomfortable (particularly for people with dentures), but also predispose patients to caries and periodontal disease
• hyperglycaemia affects immune function and the inflammatory
response, setting the scene for caries, periodontal disease and
the problems associated with progressive dental and periodontal
destruction and infection.5

Caries
We tend to think of caries as a nuisance rather than a problem. Patients may not seek attention until they experience the pain associated with advanced caries, as bacteria break through the enamel into the easily eroded dentine and through to the pulp and the alveolar bone surrounding the roots. From there, bacteria can access the tissues of the mouth and pharynx causing dental abscesses, sinusitis or deep tissue infection. These problems don’t respond to medical treatment and require root canal treatment, tooth extraction and sometimes urgent surgical drainage of pus.

Major factors that cause caries include:
• anatomy
– maligned teeth may make it difficult to keep the exposed tooth surface clean
• fluoride exposure
– older people and immigrants may not have had exposure to enamel strengthening fluoride during their youth
A healthy tooth in a healthy gum and healthy mouth is fairly

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