A study cited by the American Diabetes Association notes that one in five people with severe gum disease may have type 2 diabetes and not know it. Interestingly, there are times when the dentist is the first to notice symptoms of diabetes and refer patients to a primary care physician for screening. If your child has been diagnosed with diabetes, managing your child’s diabetes and keeping your child’s mouth in good condition work to help each other. Those families that are impacted by the diagnosis of diabetes in one or more of their children need to be especially attentive to their child’s oral health, and we can help keep your kiddo’s mouth as healthy as possible.
Understanding Diabetes and Its Effect on the Mouth
Diabetes mellitus type 1 is a manageable disease that is sometimes called juvenile diabetes. In type 1 diabetes, there is no insulin production; therefore, there is nothing to break down carbohydrates eaten. Those with type 1 diabetes will need insulin therapy and a maintenance plan to control their lack of insulin.
Type 2 diabetes is the most common form of diabetes and can begin at any time. In this form of the disease, the body does not properly use insulin. It produces some, but not enough to counteract the increase in blood sugar. It may need treatment of diabetic diets, oral hypoglycemics, and possibly injectable insulin, depending on the severity of the disease (1).
Children with diabetes don’t have any more bacteria in their mouths than those who don’t. The difference lies in how the body’s inflammatory response to the bacteria is affected by diabetes. Children with diabetes have a higher risk of gum diseases, gingivitis (early gum disease), and periodontitis (the advanced stages of gum disease). This inflammatory response can lead to the loss of the tissues that support the teeth (2).
When your child eats sugary substances, the sugar level increases in their blood. This increase in their blood sugar causes their saliva to be high in sugar as well. Bacteria in the mouth eat this sugar and cause a sticky substance, plaque, to accumulate on their teeth. If the plaque is not removed, it can cause decay and gum disease.
High blood sugar can also weaken your child’s immune system, the primary way your body fights infection. Therefore, you may see an increase in the time it takes for dental illness or disease to heal (3).
Oral Symptoms of Untreated Diabetes
Most of the time, these symptoms are not related to diabetes, but they can sometimes be symptoms of diabetes (4).
● Dry mouth – Less saliva causes the mouth to feel dry. Many different medications can cause it. Fight dry mouth by encouraging your child to drink more water, and eat crunchy, healthy foods to help the flow of saliva, or even chew sugarless gum.
● Cavities – Saliva washes away debris from food and cuts down on the bacteria staying in the mouth. So, dry mouth may also lead to a higher risk of cavities.
● Gum inflammation and bleeding
● Taste – Food may begin to tastedifferent, but try not to add more sugar for flavor.
● Delayed wound healing
● Infections of the mouth
● Teeth eruption – Your child’s teeth may come in faster than expected.
● Thrush
Thrush
Let’s talk a little about thrush. Thrush is a fungal infection of the mouth that comes from the yeast Candida. The symptoms may include:
● The inner cheeks, tongue, roof of the mouth, and throat may have white patches.
● There may be soreness or redness.
● Your child’s mouth may feel as if it has cotton inside.
● They may complain of loss of taste.
● Your child may be in pain while eating or when swallowing.
● There may be cracking and redness at the corners of their mouth.
● The child may complain of a burning sensation in the mouth.
Thrush is uncommon in healthy people, but those with diabetes have a higher risk of getting this fungal infection because of their diagnosis. It can also multiply or spread more easily in those with diabetes or with weak immune systems, especially if they’ve taken antibiotics and have affected the natural flora in their digestive systems.
Healthcare providers can quickly diagnose thrush simply by looking in the mouth, or they may decide to do an esophagus endoscopy. A small sample may be removed from the mouth to be examined under a microscope. Thrush is usually treated with an antifungal medication applied to the mouth for 7-14 days (5).
For Teens and Adults: Those who smoke and have diabetes are up to 20 times more likely to develop thrush and periodontal disease. Because smoking impairs blood flow to the gums, this affects wound healing in mouth tissue (6).
Prevention of Oral Health Problems When Your Child Has Diabetes
Luckily, there are many things you can do to help keep your child’s mouth healthy. Maintain your child’s blood sugar as close to normal as possible. Keep us informed of the status of your child’s diabetes, such as if your child has low blood sugar or hypoglycemia episodes. At each appointment, let us know the result of your child’s last blood sugar reading (6).
Dental hygiene is essential. Brushing with a soft-bristled toothbrush at least twice daily (preferably after every meal) with fluoride toothpaste and flossing between the teeth at least once daily is so important. (Soft-bristle brushes are important as medium or hard bristles are more likely to cause tiny scrapes in the gums.) Cleaning any appliance your child has in his mouth that is removable each time they brush is also crucial. Plaque can build up on retainers or bridges, as it does on teeth, so keeping them free from debris is important, and children with braces should brush after each meal to ensure no food remains caught in their brackets, wires, or bands (6).
It is important to visit us twice a year for a checkup, cleaning, and to care for all your child’s dental needs, whether your child has diabetes or not. Our dentists can keep on track and updated with any new findings from the child’s primary care physician, any changes in their medications, and any lab work that may affect your child’s treatment. If your child’s blood sugar is uncontrolled, it will be necessary to postpone non-emergency dental procedures, since uncontrolled diabetes may impair healing or impact the time it takes to heal from those procedures. If a bracket or wire becomes dislodged, call our orthodontists as soon as possible so it can be repaired right away – to prevent any damage to soft tissues in the mouth, or extend the time needed to complete orthodontic treatment.
Conclusion
The oral health of those with diabetes may seem to be a complex cycle. Diabetes (uncontrolled) makes blood sugars higher, which impacts the saliva in the mouth. Higher levels of sugar in the saliva cause more for bacteria to eat, allowing more plaque to be produced and adhere to the teeth. This plaque can cause tooth decay, gingivitis, and periodontal disease if not removed with brushing, flossing, and rinsing. Tooth decay and gum diseases may lead to higher blood sugars due to infection. Uncontrolled blood sugars can impact a child with diabetes in many other ways, affecting other body parts.
This may be a complex cycle, but it can be stopped with good dental hygiene. As with children without diabetes mellitus, taking care of your child’s teeth eliminates the bacteria that cause the teeth to decay and the gums to be diseased. Teaching your child the importance of brushing, flossing, and seeing the dentist for cleanings at least twice a year is the best initiative any parent can take to halt tooth decay and gum disease. Talk with our dentists at Jungle Roots Dentistry to plan your child’s dental hygiene regimen today!
References
- Understanding Diabetes. American Diabetes Association. (2022). Accessed October 3, 2022. https://diabetes.org/diabetes
- Diabetes Overview: Diabetes and Oral Health. American Diabetes Association. (2022). Accessed October 3, 2022. https://diabetes.org/diabetes/keeping-your-mouth-healthy
- Diabetes and Oral Health. Centers for Disease Control and Prevention. Last Reviewed May 7, 2021. Accessed October 3, 2022. https://www.cdc.gov/diabetes/managing/diabetes-oral-health.html
- Martin, L., Diabetes and Your Smile. (2022). Mouth Healthy. American Dental Association. https://www.mouthhealthy.org/en/az-topics/d/diabetes
- Candida Infections of the Mouth, Throat, and Esophagus. Centers for Disease Control and Prevention. Last reviewed February 25, 2021. Accessed October 3, 2022. https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.html
- Oral Health Problems and Diabetes. Cleveland Clinic. Last Reviewed August 29, 2019. Accessed October 3, 2022. https://my.clevelandclinic.org/health/diseases/11263-oral-health-problems-and-diabetes
