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Diabetes and Oral Health
What’s Their Relationship?

by Ira B. Lamster, DDS, MMSc

A healthy mouth is essential for healthy living. The mouth is where digestion begins when chewing mixes food with saliva. A healthy mouth is also important for communication and social interaction, and overall personal appearance is dramatically affected by one’s smile. Everyone needs to pay attention to oral health. As emphasized by former Surgeon General C. Everett Koop, a person is not truly healthy unless he also has oral health. This is particularly true for people living with diabetes.

The potential complications of diabetes are well known to most people with the condition. These include retinopathy (diabetic eye disease), potentially leading to impaired vision and blindness; nephropathy (kidney disease), possibly leading to the need for dialysis or kidney transplantation; heart attacks and strokes; nerve and sensory disorders; and poor wound healing, often evidenced by ankle and foot ulcers.

In addition, a number of oral disorders are associated with diabetes. It is important that people with diabetes, their health-care providers, and any caregivers understand the importance of oral health and, if problems occur, arrange for appropriate care. Especially important is preventive oral health care, which involves personal oral hygiene practices and regular visits to the dentist.

Preventive care
Preventive oral health care is an essential part of maintaining a healthy mouth, including the teeth, the gums, and the mucosal surfaces in the mouth (which include the tongue, the palate, and the insides of the cheeks and lips). This begins with effective oral hygiene, including brushing the teeth twice daily. The goal of toothbrushing is removal of dental plaque and food particles that adhere to the teeth. Dental plaque is the soft material that coats the surfaces of the teeth, including the area below the gum line (the gingival margin). Plaque is a biofilm, composed of many different species of bacteria embedded in a matrix of complex sugars. The types of bacteria found in plaque in a healthy mouth differ from those found in a mouth affected by dental disease. A dental cleaning provided by a dentist or dental hygienist removes the soft plaque as well as its calcified form, known as tarter (also called calculus).

A soft-bristle, manual toothbrush is the first option for most people; using such a brush helps avoid damaging the teeth and gums. Electric or automatic toothbrushes are also available. These devices have an oscillating or rotating head and can be useful to people with limited manual dexterity (such as those who have experienced a stroke or have arthritis affecting their hands) who are unable to effectively use a manual brush.

With either type of brush, toothpaste should be used; fluoridated toothpaste is best. Fluoride has antimicrobial properties and can strengthen tooth enamel by becoming incorporated into its crystalline structure. Approximately half an inch of paste should be placed on the brush. Teeth should be brushed for about two minutes, with equal time devoted to the teeth in the upper jaw and lower jaw. Both the outer surfaces and inner surfaces of the teeth should be cleaned.

Dental floss should also be used daily to remove plaque between the teeth. Waxed floss is best to facilitate plaque removal between tight tooth contacts, areas that cannot be reached through toothbrushing.

Additional products can also be helpful, depending on conditions in the mouth. Mouth rinses can be used to reduce bad breath; some rinses also have an antiplaque effect. In addition to dental floss, several different between-the-teeth (interproximal) cleaning devices are available, which can be used to remove plaque from tooth surfaces when there is space between the teeth. These devices include small brushes, wide-diameter dental floss, and interproximal picks and wedges.

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Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.



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