Living with Diabetes

Yes, during pre-diabetes there is already important metabolic abnormalities, and some of them have manifestations in the oral cavity.  You should visit your dentist more frequently and discuss with him/her the changes you are observing in your mouth.  Your primary doctor should also be informed of any changes in your general and/or oral health as this will help monitor more closely your pre-diabetes status.

Indeed the relation between diabetes and gum disease is two-way. That is, diabetes predisposes to gum disease, gum disease makes diabetes control more difficult and diabetes more severe. However, you need to break the vicious cycle. You should see a periodontist (gum specialist) gum treatment can and should be initiated to begin to reduce the gum infection and inflammation so it would be easier to get your diabetes under control. More extensive periodontal therapy can then proceed as you diabetes control improves.

Research studies demonstrate that reduced levels of Vitamin C are associated with greater periodontal (gum) disease, that insufficient calcium levels are also associated with more periodontal disease even in young individuals and more so in postmenopausal women.  Vitamin D is important in calcium absorption and therefore in maintaining adequate calcium levels.  Vitamin E and CQ10 are important too, but there is less research supporting a benefit in oral health.

Diabetes is associated with low saliva production and dry mouth, which are conditions that increase the risk for enamel demineralization and make enamel more prone to decay. Very good daily oral hygiene with a soft brush and a fluoride containing and plaque fighting dentifrice will reduce this risk greatly. Use of fluoride containing mouthwashes also reduces enamel demineralization.

Individuals with diabetes are at higher risk of developing thrush and if not treated completely thrush can become chronic in diabetic patients.  A number of conditions increase the risk for thrush in addition to diabetes, such as wearing dentures, dry mouth, antibiotic use, and smoking.  You should always consult with your mother’s diabetes doctor to make sure diabetes is well controlled and the medication regime is adequate.  Visits to the dentists at least every 6 months are indicated as well. Reducing the other risk factors, such as very good daily oral hygiene, including brushing of the tongue, daily cleaning of dentures, removable partials, as well as disinfection since these can become reservoirs for yeast organisms is important to reduce the risk of reinfection. Drink adequate fluid daily to maintain oral tissues well lubricated, avoid foods or products that can dry the mouth, eating daily yogurt.

Diabetes is not a medical condition requiring antibiotic premedication.  However, your son’s dentist is better qualified to determine whether he needs to take an antibiotic prior to the dental treatment. He knows your son’s dental status and is better prepared to make that recommendation.  The practice of rinsing well after the dental cleaning to remove any small lose particles of tartar and plaque that could remain trapped between the teeth reduces the risk of swelling and inflammation after professional cleanings.

First of all check with his dentist to make sure the mucosal tissues in his mouth are healthy, moist and well lubricated. It is possible that he has dry mouth, and does not know it.  Dry mouth, which is very common in diabetes, could make his mouth feel on fire when eating hot, spicy food.

Loss of taste and taste impairment are associated with diabetes. A number of factors can be responsible for the decreased or altered taste sensation in people with diabetes.  You should inform your mother’s diabetes doctor of this. He or she will rule out diabetes control and medications use that could affect taste sensation. Your mother should also consult the dentist and have a thorough intraoral examination to rule out oral/dental causes for the loss of taste.

Consult with your diabetes doctor that diabetes is well controlled and with the primary care doctor that you have no stomach conditions (like reflux), post-nasal drip, nasal allergies, sinus problems, inflamed tonsils or adenoids that could cause bad breath.  See your dentist to rule out gingivitis, periodontal disease or cavities. Receive regular professional cleanings, brush twice/day with a fluoride and anti-gingivitis toothpaste, floss daily, avoid alcohol-containing mouthwash or maintain your mouth moist.

Sometimes mouth odor can be from sources other than the oral cavity such as post-nasal drip, sinusitis, nasal congestion and allergies.  Nasal inhalers, decongestants and other medications to treat allergies cause dry mouth and mouth odor as well. You should consult with your son’s pediatrician or ENT to rule out that his nose and tonsils are not the cause of the mouth odor.