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Gum Disease and Early Diabetes Detection

In many cases it's the dentist - and not the physician - who has the first opportunity to detect diabetes early, because diabetics are especially prone to dental health problems.

Swollen, tender, receding and bleeding gums, loose teeth, and a sore tongue may not just be signs of poor dental hygiene. They may be danger signals for diabetes, too.

If you have any of these symptoms, you may be one of the estimated 11 million people in North America who already have diabetes, or you may be one of the 600,000 who will be diagnosed this year.

Diabetes occurs when a gland called the pancreas fails to produce sufficient amounts of the hormone, insulin, to regulate blood sugar levels. In other words: Diabetics have too little insulin and too much sugar in their blood.

When this happens, the body tissue can't convert the sugar it needs into energy. The blood stream then fills with this unused sugar and the result is diabetes - a disease medical journals often describe as the "forever" disease.

A serious illness which respects neither age, sex, race nor income level, diabetes is the leading cause of blindness in people 20 to 65 years old and can lead to kidney failure, heart attacks and even death.

But outside the dental community, few people realize that diabetics have more than their share of tooth and periodontal (gum) problems. This fact is especially true for undiagnosed diabetics or those who have failed to control their disease adequately with insulin and/or diet and exercise.

Periodontal disease among diabetics progresses rapidly, recurs frequently, and heals slowly. The resistance to treatment can lead to loosened teeth and premature tooth loss.

Your regular dental office visits provide the best chance for early detection of many health problems, including diabetes. If you have a diabetic tendency, your dentist may very well refer you to your physician - another good reason to keep your prescribed dental recall and dental cleaning appointments faithfully!

If you are diabetic, it's important that you keep your dental health history up-to-date, exercise regularly, and eat a diet that provides good nutrition:

• Have regular meals and snack times. Don't skip meals.
• Avoid sweets (cake, candy, pie, ice cream).
• Limit use of animal fats and trim fat off meats. Avoid butter, cream, egg yolks.
• Bake and broil rather than fry foods.
• Don't use alcohol, wine, or beer without your doctor's permission.
• See your dentist regularly so small dental problems can be taken care of with a local anesthetic.

Teeth don't heal themselves, so small problems turn into big ones if left untreated. Major oral surgery requires a general anesthetic which means "no food prior to surgery" - a problem for diabetics.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Smoking and Gum Disease

The systemic risks of tobacco use are well known. Tobacco use can increase the risk for cancer, lung disease, and heart disease. But whether you smoke, dip, or chew tobacco, it also affects the oral cavity in a variety of ways. It contributes to oral cancer, stains the teeth, and contributes to tartar deposits, bad breath, and a loss of taste and smell.

Tobacco use causes inflammation of the soft tissues of the mouth, ulcers, recession, and other oral lesions. Tobacco users are two times more likely to develop periodontitis, and ten times more likely to develop acute necrotizing ulcerative gingivitis (ANUG). They also are more likely to lose teeth than those who don't smoke. Smoking is the number one most significant risk factor in the development and progression of periodontal disease.

Tobacco smoking causes periodontal bone loss that is not related to the amount of gum inflammation or plaque accumulation. Although the periodontal disease may be advanced, the classical signs of gum inflammation (redness, bleeding gums, etc.) are not usually as evident in tobacco smokers. Thus, prevention and early detection are more difficult.

Tobacco smoking has a direct effect on the oral tissues and it can alter the immune response. Although smokers do benefit from periodontal treatment, the healing is often delayed and the results are less predictable. In addition, the success rates of periodontal and implant treatment are reduced in people who use tobacco products. The amount of complications is related to the amount of daily tobacco exposure, and the number of years the person has been exposed.

The use of tobacco products can increase the risk of periodontal disease:

1. It weakens the immune system: Tobacco products suppress the body's ability to fight infection. Carbon monoxide (a major byproduct of cigarette smoke) reduces oxygen concentration and inhibits the movement of white blood cells. This reduces the capacity of the white blood cells to fight bacteria (including the bacteria that cause periodontal disease), and delays healing.

2. It masks signs of infection: Tobacco reduces the ability of blood vessels to carry infection fighting cells, nutrients, and oxygen to the tissues. As a result, the typical signs of periodontal disease (redness, swelling, and bleeding of the gums) are masked. People who smoke may have periodontal disease that is harder to diagnose.

3. It increases calculus formation: Smoking can cause more calculus (tartar) accumulation that if not removed promptly can lead to more plaque build-up and periodontal disease.

4. It reduces healing: Nicotine and other chemicals can be absorbed directly by the root surfaces of the teeth and reduce the ability of cells to reattach to the root surface during healing.

Besides the obvious health benefits of discontinuing tobacco use, quitting can also reduce the risk of oral cancer and the detrimental effects of tobacco on the gums and bone that support the teeth. In addition, another incentive to stop smoking is that former smokers respond similarly to never smokers to periodontal treatment.

Because there is a physical and psychological addiction to tobacco, quitting can be very difficult. But millions of Americans quit smoking every year. There are aids available that reduce the craving for tobacco. These include the use of systemic medications, the nicotine patch, the nicotine gum, the nicotine inhaler, and the nasal spray. See your dentist or physician for aid in stopping tobacco use.

By Laura Minsk, DMD