Oral care is a must!

Dr Gauri Mohile talks about the importance of oral health and Diabetes.

Glucose is present in your saliva. When Diabetes is uncontrolled, high glucose levels in your saliva aid bacterial growth. These bacteria combine with food to form a soft, sticky film called plaque. Plaque also comes from eating foods that contain sugars or starches. Some types of plaque cause tooth decay or cavities. Other types of plaque are responsible for gum disease and bad breath. In addition, excess glucose

can cause pain, infection and other problems in your mouth. Gum disease can be more severe and take longer to heal if you have Diabetes. In turn, having gum diseases can make your blood glucose hard to control.

Building up of plaque

Plaque that is not removed hardens over time into tartar and collects above and below your gum line. Tartar makes it more difficult to brush and clean between your teeth. As a result, your gums become red and swollen, and they bleed easily. Signs of unhealthy or inflamed gums is called gingivitis.

When gingivitis is left untreated, it can advance to gum disease called periodontitis. In periodontitis, the gums pull away from the teeth and form spaces, called pockets, which slowly become infected. This infection can last a long time. Your body fights the bacteria as the plaque spreads and grows below the gum line.

Both the bacteria and your body’s response to this infection start to break down the bone and the tissue that hold the teeth in place. If periodontitis is not treated, the gums, bones and tissue that support the teeth are destroyed. As a result, the teeth may become loose and require extraction.

Mouth problems from Diabetes

One of the first signs of gum disease are bleeding gums which may be swollen or tender or both. Sometimes you won’t have any symptoms of gum disease and will not realise till serious damage is done. Hence, your best defence is to see your dentist twice a year for a clean-up as well as check- up.

The chart (see below) shows the most common mouth problems from Diabetes and their symptoms.

Preparing for a dental visit

Plan ahead. Talk with your doctor and dentist before the visit about the best way to take care of your blood glucose during dental work. Discuss with your dentist if you are taking Diabetes medications that can cause low blood glucose (hypoglycaemia). Also if you are taking insulin or any other Diabetes medication, it is advised that you carry them with you and eat before visiting the dentist. You can also carry a snack with you to the dentist’s office.

Note: You may need to postpone any non- emergency dental work if your blood glucose is not under control.

If you feel nervous about visiting the dentist, discuss your concerns with staff or the attending dentist. Your dentist will accordingly devise a treatment plan keeping your needs in mind. Don’t let nervousness stop you from undergoing regular check- ups. As delaying underlying tooth problems may worsen your complications.

Sore mouth after dental work

A sore mouth is common after dental work. If this happens you won’t be able to eat or chew foods for several hours after the procedure. For guidance on how to adjust your usual routine while your mouth is healing, ask your doctor the following:

• what foods and drinks you should have
• if you should change the timing of your Diabetes medication
• if you should change the dose of your Diabetes medicines

• how often you should check your blood glucose

Smoking and oral health

Cigarettes consist of tobacco that is directly responsible for gum disease, oral and throat cancers and oral fungal infections.

Smoking is not only responsible for discolouration of your teeth but also bad breath.

If you quit smoking,

• you will lower your risk for heart attack, stroke, nerve disease, kidney disease and amputation
• your cholesterol and blood pressure levels may improve
• your blood circulation will improve

Maintaining oral hygiene

You can keep your mouth healthy by taking these steps:

• Keep your blood glucose numbers as close to your target as possible. Your doctor will help you set your target blood glucose numbers and teach you what to do if your numbers are too high or too
• Eat healthy meals and follow the meal plan that you and your doctor or dietician have worked out.
• Keep your teeth and gums clean by:

1. Brushing your teeth at least twice a day with fluoride Fluoride protects against tooth decay.
2. Using a soft
3. Gently brushing your teeth with the toothbrush angled towards the gum line. Use small, circular motions.
4. Brushing the front, back and top of each tooth. Brush your tongue, too.
5. Changing your toothbrush every three months or sooner if the toothbrush looks worn or the bristles spread out. A new toothbrush removes more
6. Aiming to brush your teeth first thing in the morning, before going to bed, and after each meal and sugary or starchy
   • Drink water that contains added fluoride or ask your dentist about using a fluoride mouth rinse to prevent tooth
   • Ask your dentist about using an anti- plaque or anti-gingivitis mouth rinse to control plaque or prevent gum
   • Cleaning in between your teeth is as

important as brushing your teeth and tongue. This is because the food we eat gets stuck in between your teeth leading to tooth decay and gum disease. To prevent this you can do the following as part of your dental care routine.

1. Use dental floss to clean between your teeth at least once a day. Flossing helps prevent plaque from building up on your teeth. When flossing, slide the floss up and down and then curve it around the base of each tooth under the gums. Use clean sections of floss as you move from tooth to tooth.
2. Another way of removing plaque between teeth is to use an interdental brush or a water pik flosser (thin tools designed to clean between the teeth). You can ask your dentist about
   • If you wear dentures, keep them clean and take them out at night. Have them adjusted if they become loose or uncomfortable. Call your dentist right away if you have any symptoms of mouth problems.

• See your dentist twice a year for a complete mouth check-up, which should include examination of your teeth, gums, tongue, palate, floor of the mouth and tonsil. Your dentist may suggest more visits if you need them. If your dentist tells you about a problem, take care of it right away. Follow any steps or treatments from your dentist to keep your mouth healthy.
• Inform your dentist if you have Diabetes and about any changes in your health or medicines. Share the results of some of your Diabetes blood tests, such as the fasting blood glucose test. Ask if you need antibiotics before and after dental treatment if your Diabetes is
• If you smoke, stop

Dr Gauri Mohile is currently working as Dentist in London. She has been also been working with National Centre for Smoking cessation which trains and works especially with young pregnant mothers to give up the habit.