People with diabetes are often instructed to eat small, frequent meals and to space their carbohydrate intake over the course of the day. People who frequently need to treat low blood glucose (hypoglycemia) may also suck on hard candies to raise blood glucose. While frequent and prolonged exposure to carbohydrate increases the risk for cavities, it is only thought to be a problem when carbohydrate (simple sugars, in particular) is eaten alone, without protein or fat. Meals in a balanced diabetes meal plan typically contain protein, fat, and carbohydrate, so eating small, frequent meals for diabetes control should contribute to, not detract from, oral health. However sucking on candy or mints can lead to increased cavities, so it is wise to use glucose tablets or beverages to treat or prevent hypoglycemia, since they clear the mouth more quickly than hard candies.
Fluoride is a mineral that is known to prevent cavities but is not found readily in most foods. However, it is available in toothpaste, mouth rinses, and fluoridated water. Check with your dentist on the amount of fluoride in your local water supply (some communities do not have fluoridated water) to see if you should consider taking supplemental fluoride.
Eating protein with meals is anticariogenic because it serves as a pH buffer, preventing acidic conditions in the mouth. Again, choose proteins that are low in fat and cholesterol, and emphasize fibrous plant proteins. Fiber, a type of carbohydrate, is not metabolized by the oral bacteria, so it cannot produce cavities. Fibrous foods also require more chewing than nonfibrous foods, and chewing stimulates saliva secretion. (Low salivary flow is also linked to increased dental cavities.)
Dairy products contain the anticariogenic nutrients casein, calcium, and phosphorous; in addition, milk sugar, or lactose, is the only simple sugar that is not considered to be cariogenic. Low-fat and nonfat dairy products provide the same anticariogenic nutrients without the harmful fat and cholesterol found in full-fat products. Dark-green vegetables are good plant sources of anticariogenic calcium, and they also provide beta-carotene and fiber.
Both xylitol and tea are emerging as strongly anticariogenic foods. Xylitol, a sugar alcohol, is not widely used in foods but is found in some brands of sugarless gum. Xylitol has a minimal effect on blood glucose level, so chewing gum containing it should not disrupt blood glucose control. Chewing gum that contains xylitol after meals and snacks provides the mouth with xylitol, helps clear the mouth of cariogenic foods, and stimulates saliva flow. If gum chewing is not possible, drinking a cup of green or black tea may produce similar benefits. The tea plant, Camellia sinensis, may have antimicrobial and other preventative effects on cavity formation. To help prevent cavities, at the very least, rinse your mouth after meals with our most vital nutrient, water.
(Click here to learn more about nutrients that promote oral health.)
Other oral health problems
Oral candidiasis, also known as a yeast infection, or thrush, and other fungal infections are common among people with diabetes, and denture wearers may be at particularly high risk. Elevated levels of glucose in the saliva, abnormal immune system functioning, and xerostomia (dry mouth) are thought to be predisposing factors. Salivary glucose can be reduced by exercising tight blood glucose control.
Xerostomia may affect up to 80% of people with diabetes. There may be several underlying causes of this condition, including certain medicines, chronic high blood glucose levels, and dehydration, which can be a consequence of high blood glucose. Xerostomia is thought to be related to taste dysfunction in some people. Burning mouth syndrome (also known as glossodynia) may be a result of candidiasis, xerostomia, or peripheral neuropathy. If you have xerostomia, you should discuss your medicines with your doctor and consult your dentist regarding the use of products such as artificial saliva.