Changes in the Oral Cavity
Diabetes can lead to changes in the oral cavity. Of particular concern to dentists and dental hygienists are the effects of diabetes on the health of the gingiva (gums) and periodontal tissues. Diabetes can cause gingival hyperplasia and gingivitis. Other diabetes-related conditions affecting the mouth include burning sensations (known as burning mouth syndrome), abnormal wound healing, fungal infections, and dental decay. Some individuals with diabetes may notice a fruity (acetone) breath, and others may report frequent xerostomia (dry mouth) or a change in saliva thickness. These findings are associated with excessive loss of fluids through frequent urination, altered response to infection, altered connective tissue metabolism, microvascular changes, medications for dry mouth, and possible increased glucose concentration in saliva.
Unfortunately, caring for the mouth is often overlooked when trying to control other problems associated with diabetes.
Periodontal Disease
People with diabetes are two to three times more likely than persons without diabetes to have destructive periodontal disease, such as periodontitis.23 Periodontal disease progresses more rapidly and often is more severe in individuals with both type 1 and type 2 diabetes.24
Periodontal disease is a bacterially induced chronic inflammatory disease that destroys noncalcified connective tissue and bone supporting the teeth and can lead to tooth loss. Recent research suggests a two-way connection between diabetes and periodontal disease. Not only are people with diabetes more susceptible to periodontal disease, but the presence of periodontal disease can worsen glycemic control.25,26,27,28,29 Proper care of the mouth can help people with diabetes achieve better glycemic control.
Some studies have suggested a relationship between insulin resistance and inflammatory mediators.30,31 The inflamed periodontal tissue, which can affect an area as large as an adult palm, is highly vascular and may become ulcerated. This can allow the entry of inflammatory mediators, as well as bacteria, lipopolysaccharides, and other toxins, into the systemic circulation.
Signs and symptoms of periodontal disease include bleeding gums; red, swollen, or tender gums; gums that have pulled away from the teeth; pus between the gums when they are compressed; persistent bad breath or bad taste in the mouth; permanent teeth that are loose or moving apart; any change in the way the teeth fit together when the patient bites; and any change in the fit of dentures. Most people with diabetes do not experience pain with periodontal disease, however, and some can have periodontal disease and be asymptomatic.
