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.
Dental Procedure, Pocket Depth Reduction
As the bacteria that cause periodontal disease release toxic substances, they trigger the breakdown of gum and bone. The gum then separates from the teeth, forming gaps that are called periodontal pockets. Bacteria settle in these pockets and because they cannot be removed by the patient's daily oral hygiene, they continue to accumulate and reproduce. Without proper treatment, the bacteria will continue to populate these pockets, creating further gum and bone destruction.
The first step in the treatment of periodontal disease involves the removal of the bacteria that inhabit the periodontal pockets in the form of plaque and tartar. The removal of the pocket irritants, scaling and root planing is combined with oral hygiene instructions that are aimed at improving the patient's ability to control plaque and avoid bacteria from re-infecting the periodontal pockets. Several weeks after completion of scaling and root planing, a periodontal re-evaluation should be completed to assess the healing response. If the periodontal pockets do not reduce to below 4 mm and the gums are still unhealthy, surgical treatment may be indicated.
Pocket depth reduction is a term used for a series of different surgical procedures (gingivectomy, flap surgery, osseous surgery). The purpose of these procedures is to gain access to the root surface to effectively remove calculus and to reduce the size of the pockets to help prevent bacteria from settling in.
What to Expect
Pocket depth reduction is done in the dentist's office with local anesthesia (lidocaine). After lifting the gum back, the bacterial plaque and tartar are removed from the root surfaces. It also may be necessary to remove the infected gum tissue and to smooth the bone surface. Stitches (sutures) are placed to aid in healing. The stitches are usually removed five to ten days after the surgery. Follow-up appointments are scheduled as necessary to evaluate healing and plaque control.
Post-surgical discomfort may last a few days and is usually minimal. It can be easily managed with commonly available over-the-counter medications such as aspirin, acetaminophen, or ibuprofen. Patients can expect to follow their normal routine the day after surgery. A dentist will provide special instructions related to diet, exercise, and medications.
After pocket depth reduction, patients may experience heightened tooth sensitivity. This is temporary and usually resolves within a few weeks. There are chemical aids available that help reduce sensitivity.
Some people also may experience looser teeth after periodontal surgery. This also is a transient finding that occurs as part of the normal healing process. With proper plaque control and bite adjustment, the teeth usually tighten up in a few weeks.
Another concern after pocket depth reduction is that the teeth may appear longer and that there are spaces in between the teeth. Actually, longer teeth are the result of periodontal disease, not of periodontal surgery. As periodontal disease infects and destroys the bone that encases the roots, the root surfaces become exposed. They do not appear exposed because they are covered by the inflamed, swollen gums that form the periodontal pocket. Without proper treatment, the periodontal pockets continue to deepen, giving way to more infection, bone loss, and eventually tooth loss and systemic complications.
There are treatments that can help improve esthetics after periodontal treatment. In addition to periodontal plastic surgery procedures, orthodontic tooth movement (braces) or restorative treatment (crown and bridges) can help create a more pleasing smile line.
Benefits
If periodontal pockets do not resolve after scaling and root planing, a dentist may recommend pocket depth reduction. Whether a dentist performs a gingivectomy, periodontal flap surgery, or osseous surgery, the patient will benefit from the reduction in pocket depth and the reattachment of the gums to the root surface. Pocket depth reduction, when followed by supportive periodontal treatment, is a predictable procedure that can help keep teeth healthy and reduce the risk of serious health problems related to periodontal disease. If a general dentist does not frequently do surgeries, he or she may refer the individual to a periodontist that specializes in this technique.
By Laura Minsk, DMD
+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.