Diabetes and dental care:

What do brushing and flossing have to do with diabetes? Plenty. If you have diabetes, here's why dental care matters — and how to take care of your teeth and gums.

By Mayo Clinic staff

When you have diabetes, high blood sugar can take a toll on your entire body — including your teeth and gums. The good news? Prevention is in your hands. Learn what you're up against, and then take charge of your dental health.

Cavities and gum disease

Whether you have type 1 diabetes or type 2 diabetes, managing your blood sugar level is key. The higher your blood sugar level, the higher your risk of:

• Tooth decay (cavities). Your mouth naturally contains many types of bacteria. When starches and sugars in food and beverages interact with these bacteria, a sticky film known as plaque forms on your teeth. The acids in plaque attack the hard, outer surface of your teeth (enamel). This can lead to cavities. The higher your blood sugar level, the greater the supply of sugars and starches — and the more acid wearing away at your teeth.
• Early gum disease (gingivitis). Diabetes reduces your ability to fight bacteria, which can cause more plaque to build up on your teeth. If you don't remove plaque with regular brushing and flossing, it'll harden under your gumline into a substance called tartar (calculus). The longer plaque and tartar remain on your teeth, the more they irritate the gingiva — the part of your gum around the base of your teeth. In time, your gums become swollen and bleed easily. This is gingivitis.
• Advanced gum disease (periodontitis). Left untreated, gingivitis can lead to a more serious infection called periodontitis, which destroys the soft tissue and bone that support your teeth. Eventually, periodontitis causes your gums to pull away from your teeth and your teeth to loosen and even fall out. Periodontitis tends to be more severe among people who have diabetes because diabetes lowers the ability to resist infection and slows healing. An infection such as periodontitis may also cause your blood sugar level to rise, which makes your diabetes more difficult to control. Preventing and treating periodontitis can help improve blood sugar control.

• Proper dental care

• To help prevent damage to your teeth and gums, take diabetes and dental care seriously:
• Make a commitment to managing your diabetes. Monitor your blood sugar level, and follow your doctor's instructions for keeping your blood sugar level within your target range. The better you control your blood sugar level, the less likely you are to develop gingivitis and other dental problems.
• Brush your teeth at least twice a day. Brush in the morning, at night and, ideally, after meals and snacks. Use a soft-bristled toothbrush and toothpaste that contains fluoride. Avoid vigorous or harsh scrubbing, which can irritate your gums. Consider using an electric toothbrush, especially if you have arthritis or other problems that make it difficult to brush well.
• Floss your teeth at least once a day. Flossing helps remove plaque between your teeth and under your gumline. If you have trouble getting floss through your teeth, use the waxed variety. If it's hard to manipulate the floss, use a floss holder.
• Schedule regular dental cleanings. Visit your dentist at least twice a year for professional cleanings. Remind your dentist that you have diabetes. To prevent low blood sugar during dental work, you might want to eat before your dental visits.
• Take special precautions with dental surgery. If you're having dental surgery, make sure that your dentist consults with your doctor ahead of time. You may need to adjust your diabetes medications or take an antibiotic to prevent infection.
• Look for early signs of gum disease. Report any signs of gum disease — including redness, swelling and bleeding gums — to your dentist. Also mention any other signs and symptoms such as dry mouth, loose teeth or mouth pain.
• Don't smoke. Smoking increases the risk of serious diabetes complications, including gum disease. If you smoke, ask your doctor about options to help you quit.

Managing diabetes is a lifelong commitment, and that includes proper dental care. Your efforts will be rewarded with a lifetime of healthy teeth and gums.

Can poor oral health cause heart disease?

Will taking care of my teeth help prevent heart disease?

Answer

from Martha Grogan, M.D.

Poor oral health — not regularly brushing or flossing — is unlikely to be the primary cause of heart disease. But poor oral health combined with other risk factors may contribute to heart disease.

Bacteria on your teeth and gums could travel through your bloodstream and attach to fatty plaques in your arteries (atherosclerosis), making the plaques become more swollen (inflamed). If one of the plaques bursts and causes a blood clot to form, you can have a heart attack or stroke.

It's possible that swelling in gums leads to swelling in other parts of your body, including your arteries. This swelling can also contribute to heart disease.

Regardless of whether you have heart disease, it's important to take care of your teeth and gums. Steps to good oral hygiene include:

• Brushing your teeth at least twice daily
• Flossing your teeth daily
• Replacing your toothbrush at least every three months
• Getting regular dental checkups, as recommended by your dentist

Gillam is a small community with a population of approximately 1200, located 600 miles north of Winnipeg on the Nelson River between Thompson and Churchill. This is where the hydro electric power for Manitoba, Winnipeg and the Midwestern USA is generated.

A chance meeting at a 1969 cocktail party between Dr. Walker Shortill, a founding partner of ADG, and John Knight, the chief administrator of the local government district (LGD) of Gillam, led to the establishment of a health service delivery program of which we are very proud. It was agreed that the citizens of Gillam would provide office space and bare bones dental equipment, and ADG would provide the dentists and staff to this northern isolated community three or four times each year. John Knight organized a dedicated group of Gillam citizens into the Gillam Dental Committee. The foundation of the continuing relationship between Gillam and ADG has been provided by this organization.Through the 30 years, well over 100 citizens of Gillam have volunteered their time to this committee to ensure that complete dental treatment can be provided in their community. Gillam was initially a railroad town on the line to Churchill. In the late sixties the provincial government decided to develop the generation of hydro electric power through the construction of the Kettle Dam and hydro electric generation plant. Through the 70's and 80's two more project (Longspruce and Limestone) on the Nelson River were completed.

Manitoba Hydro employees make up a significant portion of the population of Gillam. Hydro is committed to supplying the citizens a broad spectrum of services and has been very supportive of ADG's involvement in Gillam. The 32 years has seen the evolution of the Gillam Dental Clinic from its Spartan beginnings to a modern dental office. Initially the dental team consisted of one dentist, one dental assistant, and one dental hygienist. This crew transported not only consumable supplies and dental instruments but also compressors and vacuum equipment to Gillam and back. Through the efforts of the dental committee, Manitoba Hydro, and the citizens of Gillam, the office has evolved into a modern five-chair dental clinic with all the conveniences of our home office. We now travel to Gillam in the spring and fall. Teams of two dentists, two dental assistants, and two dental hygienists arrive for eight day stays, one to two weeks apart. This allows the delivery of all restorative and preventive dental services to the community. Working extended hours, the four visits provide approximately the equivalent of 80-100 days of dental service to Gillam annually. For a remote northern community to receive comprehensive dental treatment from the same dental office for 32 years is a rare achievement. We would like to express our appreciation to our staff who disengage from the comforts of home to contribute to our efforts in Gillam. Hats off as well to all the Gillam residents who have helped us over these very rewarding 32 years.

For a look at our northern practice and some photos of the community of Gillam visit our facebook gallery page here

Emergency visits increase dramatically when teenagers, children, and even adults have damaged their metal braces or suffered a dental injury due to eating treats such as candy.

The fact is that many of the treats that we and our kids so richly enjoy during Halloween may be harmful to our teeth.

If you have good overall dental health and practice proper oral hygiene you can probably safely eat some Halloween treats in moderation. If you wear metal braces, have a lot of crowns or fillings, or have a history of weak teeth that break easily you might want to be careful when you are eating your treats.

Here are some ways to be careful:

- Avoid treats that are crunchy such as nuts, chewy such as caramel, extremely hard such as peanut brittle, or sticky such as taffy. These kinds of treats can compromise crowns, pull out fillings, break teeth, and cause damage to other types of dental work. Be careful with treats that say they are 'naturally sweetened' as they can have a lot of sugar in them. Look at food labels on products and make smart choices.

- Only let your kids eat soft, non-sticky treats like chocolate kisses, peanut butter cups, or thinly sliced fruit. Sticky treats are not easily brushed from the grooves of teeth and can cause cavities even after you try to brush.

- Don’t chew on the ice when you finish with your soft drink. It may damage metal braces and tooth enamel. Have sugar free drinks as often as you can as even fruit juices contain a lot of sugar. Choose water or an unsweetened beverage.

- Make sure that after you eat the Halloween treats, you thoroughly brush and floss. Remember that prevention is your best medicine.

Have a great Halloween, and be safe!