Toothbrush: Toothbrush bristles should be soft or extra soft (never medium or hard). The cost of a manual toothbrush does not seem to make a difference to how well it works. Electric toothbrushes are a good choice for people who have problems with hand movements. Generally, the more expensive electric toothbrushes will provide better results.
Toothpaste: Using a toothpaste with fluoride is recommended. If you have sensitive teeth, choose a toothpaste that is specially made for this problem. Also, try to avoid whitening or tartar control toothpastes since these may make your teeth even more sensitive.
Flossing: Daily flossing is very important. Flossing your teeth ensures that you are cleaning areas that are not cleaned by brushing alone. It is important to floss each contact area: bring the floss down to the base of the gums while maintaining firm but gentle pressure along the side of each tooth (the floss should form a ‘C’ shape around the side of the tooth). Use an up and down motion until you hear a squeak as the floss passes along the tooth surface (this tells you that the tooth is clean).
Rinses: A mouth rinse containing fluoride is recommended for people who are prone to tooth decay along the gumline. Remember to avoid rinses that have a high alcohol content, since they tend to leave the mouth dry.
Your mouth may have already given you some of the first signs that you are developing diabetes. Some of these signs include:
Xerostomia (dry mouth due to decreased saliva flow) is a common complaint from people whose diabetes may not be under the best possible control. This may result from dehydration or from medications taken for cardiovascular (heart) disease (a complication of diabetes), or both. Having a dry mouth all the time increases the risk of candidiasis, ulcers, sores and tooth decay. Candidiasis, or thrush, is an infection of the mouth characterized by white plaques or patches that form on the inside of the cheeks or on the tongue. It can sometimes be painful. Thrush should be diagnosed by your doctor or dentist. A number of prescription medicines can treat it.
One complication of diabetes is neuropathy. We most commonly hear about neuropathy as pain, tingling or numbness in the limbs, most often the legs. Diabetic neuropathy can also be felt orally as a burning mouth or tongue, loss of or changes in taste. The best way to prevent neuropathy is to keep blood glucose levels tightly controlled in the target goal ranges you set with your diabetes team.
Periodontal diseases are divided into two groups. In early stages of gum disease, plaque (composed of bacteria and food debris) collects around the teeth and gums. If plaque is not brushed and flossed away regularly, gums can become red, swollen, and inflamed. This is called gingivitis. Most noticeably, the gums will bleed easily. Gingivitis responds very well to proper oral hygiene care, and is completely reversible.
When plaque is left for long periods of time, it will harden into calculus (calcified plaque). Once this has occurred your dental professional must remove calculus with a scaling instrument. If plaque is not removed, gingivitis can progress to periodontitis, the loss or destruction of gums and bone that support the teeth. Once bone has been lost, it can only be replaced by various gum surgery techniques. Good control of blood glucose levels helps gums and supporting tissue around the teeth to heal properly.
Periodontal disease is among the most common chronic diseases in humans. It is caused by a bacterial infection. Severe chronic periodontal disease can also result in serious infections. For instance, an abscess can cause pain, discomfort, and even tooth loss in adults. The effects of periodontal disease are not only seen in the mouth. Recent studies suggest a connection between periodontal disease and certain medical conditions.
New research is showing that gum disease can put you at higher risk of heart disease, having a stroke, or (if you are pregnant) bearing a low birth-weight baby. Gum disease can also pose a serious problem for people with diabetes, osteoporosis or respiratory diseases like COPD. Serious dental infections, such as abscesses, can make it more difficult to control blood glucose levels. Talk to your doctor or diabetes educator if you think dental problems may be making it hard for you to manage your blood glucose levels.
One of the things that you can to do to prevent gum disease is keep control of your blood glucose levels. People with diabetes who manage their blood glucose levels within target ranges have no greater risk for developing gum disease than those without diabetes. Having high blood glucose levels does increase your chances of developing severe gum disease. Periodontitis is more common and more severe when combined with high blood glucose levels.
Excellent oral hygiene habits are the foundation for prevention and treatment of gum disease. Brush your teeth at least twice a day with a soft or ultra soft bristled toothbrush, floss at least once a day, and make regular dental visits for cleaning and check-ups. The condition of your gums will indicate how often professional cleaning is needed. Generally, a person with healthy gums and teeth should have a check-up and cleaning every six to nine months.
If you have gum disease or poor oral hygiene habits, schedule a cleaning every three to six months. The usual cleaning therapy consists of scaling and root planing (removing calculus and smoothing the root surface) to remove any irritants from the gum pocket. In advanced forms of periodontal disease, gum surgery and antibiotic therapy may be required. Treatment of periodontal disease is always an ongoing process. Even if gum disease has halted, continuous maintenance is necessary to keep it from coming back.
It is very important to tell your dentist about your diabetes. Morning appointments are usually recommended, as your body is best able to handle stress at this time. Before dental appointments, make sure you follow your regular diabetes schedule, taking your insulin and eating breakfast. Never skip breakfast! Be sure to tell your dentist or dental hygienist if you feel faint or weak during the treatment. Short appointments are easiest. Dramatic changes in your dental health may prompt your dentist to recommend that your family doctor meet with you to discuss your diabetes management.
Delayed wound healing is another common complication of diabetes. People with diabetes must be watched closely after any dental surgery. Extractions (tooth removal), scaling, implant placement, and gum surgery may also require extra care such as antibiotics.
Remember, if you keep your diabetes under good control and maintain good oral hygiene, you will have no greater risk of periodontal disease than anyone else.