A Nurse's Guide: How Does Diabetes Impact Your Oral Health?

The mouth is the gateway to your entire body. Anything you ingest can affect your overall health. Taking good care of oral health is vital to all, but even more to those with diabetes. Attention to what you put in your mouth and how you care for it is essential. Managing your diabetes well and keeping your oral cavity in good condition helps keep everything running smoothly!

Diabetes and Its Effect on the Mouth

If you have diabetes, you have no more bacteria in your mouth than those who do not have the disease. It is the inflammatory response to the bacteria of the diabetic patient that is the issue. This response is riskier for the diabetic as it promotes gum disease, which can lead to the loss of tissues supporting the teeth (1). 

When you eat sugary substances, your blood sugar level increases and your saliva has a higher sugar content. The oral bacteria eat this sugar and cause plaque to accumulate on your teeth and tartar to build up. Not removing plaque and tartar regularly can cause tooth decay and gum disease.  

These issues and the lack of good oral hygiene can cause infection, increasing blood sugar even more. High blood sugar can weaken the white blood cells. These cells are the primary way your body fights infection. Poorly managed blood sugars can delay infection and wound healing (2). 

It’s a vicious cycle!

Oral Symptoms of Untreated or Uncontrolled Diabetes

What symptoms may indicate that you need to consider your oral health more closely (3)?

• Dry mouth – less saliva production from medications, lack of water consumption, and lack of proper food intake. 
  Suggestions - Drink more water, chew sugarless gum, and eat healthy but crunchy foods to help increase saliva flow.

• Cavities – less saliva provides a higher risk of decay. 

  Suggestions – Hydrating the mouth more often washes away food debris and bacteria.

• Gum inflammation and bleeding – early signs of gum disease.

  Suggestions – Regular mouth care

• Taste – there may be changes due to bacteria and inflamed gums.

  Suggestions – Regular mouth care

• Infection and delayed wound healing in the mouth – less saliva, more bacteria, and cavities all play a part.

  Suggestions – Again, regular mouth care

Thrush

Thrush is a fungal infection from a yeast called Candida. Candidiasis is an infection from this yeast in the mouth and throat (3).

Some of the symptoms of thrush include:

• White patches in the mouth

• Soreness or redness

• The feeling of cotton in the mouth

• Loss of taste

• Pain with swallowing

• Cracking or redness at the corners of the mouth. 

• A burning sensation in the mouth

Those with a diabetes diagnosis have a higher risk of this fungal infection. It can spread and cause problems with the immune system if antibiotics have been taken and have changed the function of the normal flora in the digestive tract.

Healthcare providers can most easily diagnose thrush by looking in the mouth but may need an endoscopy to determine the cause of the ensuing symptoms. Antifungal meds can effectively treat it and usually are prescribed for 7-14 days (4).

Those who smoke and have diabetes are up to 20 times more likely to develop thrush and periodontal disease. Because smoking impairs blood flow to the gums, this affects wound healing in mouth tissue (5).

Prevention

These steps are simple but essential for a healthy mouth:

1. Keep your blood sugar under control. Discuss your target blood sugar readings with your primary care provider (5). 

2. Be aware of your hemoglobin A1C level – reasonable control will show a level under 7% (5). 

3. Dental hygiene is vital (5):

   -Brush twice daily with a soft-bristled toothbrush and fluoride toothpaste.

   -Floss at least once daily.

   -Rinse with a fluoride rinse if indicated by your dentist.

   -If you have an appliance such as a retainer or dentures, clean or remove them every time you brush. Make sure you keep braces or retainers free from debris.

   -See your dentist at least twice a year. Please make sure they are aware of your diabetes management and in touch with your primary care provider. 

Be a Part of the Solution

There are a lot of ongoing diabetes research studies currently ongoing.

Would you like to contribute to this? Your insights matter. 

By taking a few minutes to complete this short questionnaire, you can help researchers understand your needs and experiences better and create the best solution for you and others like you.

Remember:

• Your answers are confidential and anonymous.

• The questionnaire takes just a few minutes to complete.

• Every voice counts – yours included!

References

1. Understanding Diabetes. American Diabetes Association. (2022). Accessed October 3, 2022. https://diabetes.org/diabetes

2. Diabetes and Oral Health. Centers for Disease Control and Prevention. Last Reviewed May 7, 2021. Accessed October 3, 2022. https://www.cdc.gov/diabetes/managing/diabetes-oral-health.html

3. Martin, L., Diabetes and Your Smile. (2022). Mouth Healthy. American Dental Association. https://www.mouthhealthy.org/en/az-topics/d/diabetes

4. Candida Infections of the Mouth, Throat, and Esophagus. Centers for Disease Control and Prevention. Last reviewed February 25, 2021. Accessed October 3, 2022. https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.html

5. Oral Health Problems and Diabetes. Cleveland Clinic. Last Reviewed August 29, 2019. Accessed October 3, 2022. https://my.clevelandclinic.org/health/diseases/11263-oral-health-problems-and-diabetes