Diabetes Self-Management Articles

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Disease, Treatment, and Oral Health

by Shirley Gutkowski, RDH, BSDH

Treatment of an oral yeast infection generally requires antifungal medicine and correction of the underlying cause, if possible. In the case of diabetes, that means taking steps to bring blood glucose levels into target range. (Lowering blood glucose should also lower the amount of glucose in the saliva and effectively cut off the yeast’s food supply.) Antifungal medicine may be taken in the form of lozenges that are sucked or a liquid that is swished in the mouth then swallowed. Denture wearers may be instructed to remove their dentures at night and soak them in a cleansing solution overnight.

Because antifungal medicines have a bitter taste, most oral preparations contain large amounts of sugar, which can contribute to both cavities and high blood glucose. There is, however, at least one preparation of the antifungal drug nystatin available in an artificially sweetened version (and there may be others) that may be a better choice for people who have diabetes or recurrent oral yeast infections.

There is some evidence that regularly chewing gum sweetened with xylitol may help to prevent oral yeast infections. Xylitol appears to interfere with the ability of yeast organisms to adhere to the soft tissues of the mouth.

Tissue overgrowth
Another potential oral side effect of some drug therapy is overgrowth of the gum tissue, called gingival hyperplasia. The class of antihypertensive drugs known as calcium channel blockers, the immunosuppressant drug cyclosporine, and the antiseizure drug phenytoin are all known to cause this overgrowth of tissue. However, hyperplasia may be prevented or at least minimized while taking these drugs by practicing careful oral hygiene that includes both attentive home care and regular professional cleanings.

When hyperplasia occurs, it can be painful and disfiguring and can interfere with speaking and eating. In some cases, switching to a different drug therapy is a possible solution. If gum overgrowth is severe, surgical removal of the tissue may be necessary. However, the tissue can regrow after surgery if the drug therapy is continued.

People with gum hyperplasia require frequent dentist visits to prevent periodontal disease. As the gums grow, a pocket is created between the tooth and the gum, creating an ideal environment for anaerobic bacteria (bacteria that flourish in the absence of oxygen). A bacterial infection will cause bad breath and will likely raise blood glucose levels as the body tries to fight off the infection.

Proper management of these pockets includes quarterly professional cleaning with an ultrasonic scaler and possibly periodic surgical removal of the overgrowth. Using a sonic toothbrush or a water jet device at home may help to keep teeth and gums as clean as possible between professional cleanings. Water jet devices can remove bacteria up to 6 millimeters under the gum — about 3 millimeters further than a manual toothbrush or floss can reach. However, home care alone is not enough to control bacterial growth when there is gum hyperplasia.

Increased bleeding
Bleeding upon brushing or flossing is a symptom of gingivitis (inflamed gums) and periodontal disease (infected gums). If you have either of these conditions and also take a drug that thins the blood or prevents clotting, such as aspirin or warfarin, you may notice quite a bit of bleeding during your teeth-cleaning sessions. Some herbal supplements, including garlic and ginkgo biloba, can also have this effect or can magnify the effect of blood thinners and anticoagulants.

Bleeding is usually not a sign that you should brush or floss less; it’s a sign to take your oral home-care routine up a notch and keep regular cleaning appointments with your dental hygienist. In addition, consult your doctor before mixing any drugs with herbal supplements. Increased bleeding is only one of many possible drug-herb interactions.

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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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