Patients with diabetes are at increased risk for cavities, gingivitis, periodontal disease, xerostomia, salivary gland problems, and infections.  Pharmacists can help patients develop good oral care habits to lower their risk.

Good oral hygiene is important for everyone, but it is very important for individuals with diabetes. Diabetes can increase a person’s risk of developing oral health problems. According to the American Dental Association, the most common oral health problems for patients with diabetes include:
• Cavities
• Gingivitis (inflammation of the gums)
• Periodontal disease (gum disease)
• Xerostomia (dry mouth)
• Salivary gland problems
• Increased chance of bacterial, viral, and fungal (oral candidiasis) infections

Patients with diabetes may also experience taste impairment, loss of teeth, and the inability to wear dentures due to salivary gland problems. Uncontrolled diabetes can decrease saliva flow, resulting in dry mouth. Untreated dry mouth can lead to mouth soreness, ulcers, infections, and tooth decay.

Periodontal Disease and Diabetes
Periodontal disease is often called the 6th complication of diabetes. It is the most common oral health problem among people with diabetes. Research suggests that people with diabetes are at greater risk for gingivitis (an early stage of gum disease) and periodontitis (serious gum disease).

People with diabetes are at an increased risk for serious gum disease because they are generally more susceptible to bacterial infection. They also have a decreased ability to fight bacteria that invade the gums. People with diabetes are 3 to 4 times more likely to develop periodontal disease compared with people without diabetes. This is especially true when the diabetes is uncontrolled. Smoking also increases a diabetic person’s risk of developing periodontal disease.

When diabetes is not controlled properly, high glucose levels in saliva may help bacteria thrive. This increases the risk of developing periodontal disease. Research studies also suggest that the relationship between gum disease and diabetes works both ways. Not only are patients with diabetes more susceptible to gum disease, but gum disease may negatively affect blood glucose control and contribute to the progression of diabetes.

Because periodontal disease and cardiovascular disease are both inflammatory conditions, studies report that there appears to be a relationship between them. It is not clear if having one condition increases the risk of developing the other. This relationship is particularly important for people with diabetes, because uncontrolled diabetes increases a person’s risk of developing cardiovascular disease. A statement published in the American Journal of Cardiology in 2009 recommended that:

• Patients who have periodontal disease and at least one risk factor for heart disease should have a medical evaluation for heart problems.

• Patients who have heart disease should have regular exams to check for signs of periodontal disease.

Periodontal disease can cause painful chewing and eventually tooth loss if left untreated. If you experience any of the signs and symptoms associated with gum disease, it is important to seek care from your dentist to prevent any further complications.

To prevent oral health problems, your best defense is to brush and floss twice a day to keep your gums and teeth healthy. You should also visit a dentist for routine checkups at least every 6 months, adhere to your medication and diet plan, and keep your blood glucose levels under control

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.