By Carrie Swift, MS, RDN, BC-ADM, CDCES, FADCES
According to the American Dental Association (ADA), people with diabetes are more likely to experience periodontal issues. With approximately 22% affected by gum disease, it is the most common dental concern for those with diabetes. However, diabetes care and education specialists understand the connection between hyperglycemia and increased risk of dental problems and can offer support. It is a two-way street between hyperglycemia and infected gums – hyperglycemia worsens infection and gum infection may elevate blood glucose.
Unfortunately, the COVID-19 pandemic may have inadvertently contributed to dental neglect for our patients. With concern over going out in public, and attending appointments, many may have cancelled regularly scheduled dental checkups. Additionally, mask wearing for face-to-face appointments, or substituting telehealth visits for in-person encounters, may have been a barrier for diabetes care and education specialists to make usual oral and facial observations.
The ADA states treating gum disease can help improve blood sugar management in those living with diabetes, decreasing the progression of the disease.
Not being able to see our patients’ mouths makes it more likely that we may miss dental problems during our diabetes assessments. Stressing the importance of oral health is important. The ADA states treating gum disease can help improve blood sugar management in those living with diabetes, decreasing the progression of the disease.
What are the oral health problems and recommendations for people with diabetes? Adapted from the ADA guidelines.
Potential oral problems:
- Decreased saliva – dry mouth.
- Increased risk of cavities.
- Gum inflammation and infection (bleeding gums).
- Decreased taste of food.
- Avoid smoking – this is not only to avoid gum disease, but many other diabetes complications as well.
- If you wear dental partials or dentures, clean them daily.
- Brush twice a day with a soft brush and clean between teeth daily – e.g. floss and/or water pick.
- See your dentist for regular checkups – every 6 months is recommended.
Acidic beverages may contribute to erosion of tooth enamel. Intake of soft drinks are of particular concern in tooth enamel wear. Regular saliva production is usually enough to neutralize the acid from these beverages, so when dry mouth occurs, it may result in an increased effect of these acids on tooth erosion. Additionally, excess consumption of sugar, or starchy carbohydrates increases the risk of tooth decay and cavities.
When thinking about nutrition, diabetes, and dental concerns, it is important to understand that there is a bidirectional relationship between oral health and nutrition. Nutritional intake affects oral health, and the health of the mouth and dentition affects the types of food, and therefore, nutrients eaten. Asking our patients about foods or liquids avoided due to tooth or mouth pain may lead to important discoveries about glycemic variations as well as overall health status.
What are beneficial foods for oral health? Adapted from the University of Rochester.
- Fruits and vegetables. The ADA says fiber helps keep teeth and gums clean and gets saliva flowing. Saliva contains traces of calcium and phosphate, restoring minerals to areas of teeth that have lost these important minerals.
- Cheese, milk, plain yogurt and other dairy. Cheese helps produce saliva. The calcium and phosphates in milk and other dairy products, help redeposit tooth minerals to protect tooth enamel.
- Green and black teas. Polyphenols in these teas help control bacteria to decrease acid that attacks teeth. Tea may also be a source of fluoride.
- Sugarless chewing gum. A great saliva maker that also helps remove food particles from the mouth.
- Foods with fluoride. Fluoridated drinking water or foods made with fluoridated drinking water.
Bottom line, it is important to remind your patients about regular dental checkups. It is also critical to ask about pain in their mouth and if they are avoiding foods because of the pain. If so, encourage them to seek dental help and discuss nutritious options with foods they can eat. If you are not sure what to recommend, refer them to a registered dietitian nutritionist who is familiar with diabetes care and education to help make recommendations for adequate nutritional intake. Together we can help our patients improve their oral health. To learn more about the role of the diabetes care and education specialist in caring for diabetes complications and common comorbid conditions, visit DiabetesEducator.org/comorbidities.
ADCES Perspectives on Diabetes Care
The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.
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