Diabetes and Dental Care

Nearly every diabetic knows the risks associated with the disease. It’s one of the first things that your doctor or nurse talks to you about when the diagnosis is made. And there are some dental nuances that affect the diabetic as well.

I’ve talked about the book, Wheat Belly, in this column. It describes the relationship of wheat to several chronic diseases. I would encourage you, particularly if you are a diabetic, to read it. It proposes a definite negative relationship between the consumption of wheat products and Type 2 Diabetes. Reading Wheat Belly and practicing its philosophy could make a positive impact on reversing your diabetes. That’s not a small statement.

Diabetics are certainly more prone to dental diseases as well. Periodontal disease involves the loss of bone support for the teeth. New figures place periodontal disease at 50% of the adult population, one of the most prevalent chronic diseases in the United States. It is usually identified by the dentist or hygienist during your dental examination. The bone loss is identified as a “pocket,” identified by measuring the distance between the top of the gum line and the underlying attachment to the bone. The deeper the pocket, the more the disease.

In an uncontrolled diabetic, the disease can progress faster than in the normal population. And while I don’t want to bore you with immunology, there is a lesson to be learned here. Our body’s immune system is made up of white blood cells called neutrophils whose sole job is to engulf bacteria and neutralize them. But in diabetes, the neutrophil no longer can sense the bacteria, so the bacteria spread and the pocket gets deeper, leading to loosening of the tooth. This is one reason why diabetics are more prone to generalized infections as well. But if the diabetes is controlled, the neutrophil recovers and can find the bacteria.

While the blood test commonly used is the hemoglobin A1C, which averages your blood sugar control over 60-90 days, recent studies indicate that what may be more important is control of “spikes” in your blood sugar. Each spikc, which occurs after a high carbohydrate meal, can cause damage. So for those who feel that you can cheat, and then keep your blood sugar low for the next couple of days to make your A1C look better, it just isn’t so. That is one reason why your doctor wants you to test your blood sugar throughout the day to be sure that your diabetes is continually under control. That way, your neutrophils are always protecting you from infection.

The good news is that if you are a controlled Type 2 diabetic with good periodontal care, you have a good chance of minimizing your periodontal disease and retaining your teeth. And that control will reduce your chance of generalized infections as well.

Lee N. Sheldon, DMD