Learn About - Massachusetts Cure Tooth Decay

Diabetes and Periodontal Disease

It's important for your dentist to know if you have diabetes, and how you're controlling it. Good control of your diabetes affects your oral health as well as your overall health.

Diabetics tend to be less resistant to infection than non-diabetics, have more fragile bones, and take longer to heal after an operation.

An oral infection can make diabetes worse, which makes the infection worse, which makes the diabetes worse - and so on into a major medical problem.

Diabetics develop severe gum disease more often, too, especially over the age of 40. Once gum inflammation - gingivitis - sets in, it can erupt into periodontal disease or even infection in the jaw. In undiagnosed or uncontrolled diabetics, this could mean tooth loss.

How to hang on to your teeth?

Practice preventive dentistry and follow the medication, diet, and meal schedules recommended by your physician. This, with balanced rest and exercise, will bolster your resistance to disease, including oral infections and cavities.

If you're taking insulin injections, you may want to schedule appointments around your medication times. The stress of an examination or procedure can change the way your body uses insulin. Your dentist will want to be prepared to help you in case you have a reaction. And let him or her know if you are taking any other medications. Drug interactions can be serious.

You may want to have your gums examined (and have a dental cleaning) by a dental hygienist more often than twice a year - just to make sure nothing suspicious gets started.

And on the home front, good dental hygiene - controlling plaque, the invisible bacterial film that undermines teeth - is crucial. Home care rules to live by: brush at least twice a day and floss at least once a day. The more, the better.

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Periodontal Disease: Preventing Tooth And Bone Loss

The best way to control periodontal disease and to help prevent tooth loss is with early detection and treatment. Three out of four people are afflicted by periodontal disease at some point in their lives, so everyone should be tested. After reviewing a patient's dental and medical history, the dental care provider or periodontist will conduct a thorough clinical intraoral exam called a periodontal charting.

This consists of taking a series of measurements around each tooth. Unless the gums are very inflamed and sensitive, the periodontal charting causes minimal discomfort.

The space between the gum and the tooth is measured using a periodontal probe. This space is called the probing or pocket depth. In a healthy mouth, this space should be between 0 and 3 millimeters.

The amount of recession or loss of gum around each tooth is measured. In healthy mouths, the gum tissue should be at the junction of where the crown of the tooth meets the root. The two measurements (pocket depth and recession) are then added to calculate the amount of attachment loss around each tooth. The greater the amount of attachment loss, the more advanced the periodontal disease.

While completing the periodontal charting, a dentist will evaluate the conditions of an individual's gums. Healthy gums are pale pink, firm, and immobile. The gums should not bleed during the probing exam. Bleeding gums during this exam are a sign of gum inflammation, gingivitis or periodontitis.

The dentist will also measure tooth mobility. Under normal functional conditions, teeth should not move. Tooth mobility is a sign that there has been bone loss around the teeth or that the biting forces are too strong. If so, the dentist may also assess a patient's occlusion, or bite. If the bite has changed or if the forces on the teeth are too strong, there may be an acceleration of bone loss around the teeth.

A full mouth series of X-rays (approximately 20 films) are also indispensable in a periodontal examination.

In addition to identifying areas with cavities, bone infection, tumors, or developmental abnormalities, X-rays help reveal if bone loss has resulted from periodontal disease. The crest of the teeth's supporting bone is normally 2 mm below where the crown of the tooth meets the root. A greater distance indicates a history of bone loss.

Although bacterial samples are not usually taken for diagnosis of periodontal disease , under certain circumstances, it may be necessary to take a bacterial culture from a plaque sample. This is especially valuable to help detect sites at high risk for disease progression or if conventional treatment is not working.

The culture is analyzed in a laboratory for the presence of certain bacteria that are known to contribute to gum disease. Actually, of the more than 300 different types of bacteria normally found in the mouth, there are only about 13 that are known to be associated with causing periodontal disease. After identifying the specific disease-causing bacteria, the laboratory can test to determine what antibiotics they are susceptible to.

Depending on the risk factors (see article " Risk Factors for Periodontal Disease") involved and a person's specific situation, other tests may also be required. Under certain circumstances, a dentist may require diagnostic casts (molds of one's teeth), medical laboratory tests, medical consultation, or genetic testing.

After completing the periodontal examination, the dentist will be able to discuss with the patient the diagnosis, treatment alternatives, potential complications, and expected results. The key to long-term periodontal health is early diagnosis and treatment. Because everyone is at risk of developing periodontitis, everyone should be routinely tested.

By Laura Minsk, DMD