Diabetics need to take care of their mouth 

By Dr Aaqib Hussain
The term diabetes mellitus describes a group of disorders characterised by elevated levels of glucose in the blood and abnormalities of carbohydrate, fat and protein metabolism.  It is emerging as a major health problem in Kashmir with a high number of people being affected by it. According to a survey one third of adult Kashmiris have either diabetes or pre-diabetes.
A number of oral diseases and disorders have been associated with diabetes mellitus. The human oral cavity is often called the mirror of the human body. Diabetes can lead to changes in the oral cavity. Unfortunately, caring for the oral cavity is often overlooked when trying to control other problems associated with diabetes which may contribute to hidden morbidity and undue suffering from oral health problems.
Some oral manifestations of diabetes
The prevalence of dental caries is often low in the diabetics when compared to non-diabetics. The reason may be the diet of diabetics, which consists of high protein content and limited fermentable carbohydrates as compared to the diet of non-diabetics, making the diabetics less prone to dental caries.  However, the prevalence of periodontal diseases is more in diabetics.
Salivary dysfunction: Dry mouth, or xerostomia, has been reported in people with diabetes mellitus.  Salivary flow may be affected by a variety of conditions, including the use of prescribed medications and increasing age, and it appears to be affected by the degree of neuropathy and subjective feelings of mouth dryness that may accompany thirst.
Fungal infections: Bacteria, viruses and fungi occur naturally in the mouth. The body’s natural defences and regular oral hygiene generally keep them in check. However, under some situations like diabetes, they may proliferate and impede or defeat the body’s defences. Oral candidiasis, a fungal infection in the mouth, appears to occur more frequently among people with diabetes, including those who wear dentures. If you smoke, have high blood glucose levels or are often required to take antibiotics, you are more likely to have a problem with fungal infections in your mouth. Diminished salivary flow and an increase in salivary glucose levels create an attractive environment for fungal infections such as thrush. Thrush produces white (or sometimes red) patches in the mouth that may be sore or may become ulcers. It may attack the tongue, causing a painful, burning sensation.
Gingivitis, periodontitis, and other periodontal disease: In contrast to other reported oral manifestations of diabetes mellitus, periodontal disease is a recognised and well-documented complication of diabetes. Because diabetes reduces the body’s resistance to infection, the gums are among the tissues likely to be affected. Periodontal diseases are infections of the gum and bone that hold our teeth in place. Diabetes is believed to promote periodontitis through an exaggerated inflammatory response to the periodontal micro flora. Periodontal disease often is linked to the control of diabetes. For example, patients with inadequate blood sugar control appear to develop periodontal disease more often and more severely, and they lose more teeth than people who have good control of their diabetes.
Taste and other neurosensory disorders: Taste disturbances have been reported in patients with diabetes mellitus.  It is a complex symptom, and it may be related to salivary flow and changes in food intake associated with disease management. Other neurosensory disorders of the oral and perioral tissues, including burning mouth syndrome and dysphagia (difficulty in swallowing), have been reported in patients with diabetes. Retinopathy and peripheral neuropathy that affects patients’ hands may severely limit a patient’s ability to perform oral hygiene procedures
Caring for your mouth
Preventive oral health care, including professional cleanings at the dental clinic, is important if you want to control the progression of periodontal disease and other oral health problems. Regular dental check-ups and periodontal screenings are important for evaluating overall dental health and for treating dental problems in their initial stages. Dentists may recommend more frequent evaluations and preventive procedures, such as teeth cleaning, to maintain good oral health. Choose oral care products that display the American Dental Association’s seal of acceptance, an important symbol of a dental product’s safety and effectiveness when the products are used as directed. In addition to brushing twice a day and flossing or using an interdental cleaner once a day, your dentist may suggest using an antimicrobial mouth rinse or toothpaste to control gingivitis and other periodontal diseases. Watch for signs and symptoms of oral disease and contact your dentist immediately when a problem arises. Practice good oral hygiene at home; follow your physician’s instructions regarding diet and medications, and schedule regular dental check-ups to maintain a healthy smile.
—The author is a dental surgeon. Feedback: [email protected]

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