There are many different disabilities that can negatively affect oral healthcare outcomes. Diabetes, in particular, is one of the most prevalent chronic diseases in America and is known to be associated with a variety of serious oral health issues.
Both type 1 and type 2 diabetes can weaken enamel and promote tooth decay, contributing to increased rates of cavity formation and tooth loss among diabetics. Additionally, individuals with diabetes are three times more likely to develop periodontal (gum) disease than those without.
If you’re living with diabetes, you may already be fully or partially aware of this risk. However, there’s a lot to unpack when discussing the relationship between oral health and diabetes, and a lot to learn about mitigating the threats it poses.
Understanding diabetes
Diabetes is a chronic health condition that affects how the body processes sugar in the blood. When you eat, your body converts the food into sugar and releases it into the bloodstream, causing your blood glucose levels to increase.
Normally, your body responds to this increase in blood sugar by releasing insulin from the pancreas, which helps you process the sugar into energy for your cells. However, when you have diabetes, your body isn’t able to make and/or process insulin correctly, and the excess sugar from food will remain in your bloodstream.
Over time, this can lead to several serious health issues if blood sugar levels aren’t properly managed, including heart disease, kidney disease and vision loss. There is currently no cure for diabetes, but the condition can be controlled with medication, exercise and a healthy diet.
According to the Centers for disease control (CDC), over 37 million American adults in the United States have diabetes. Unfortunately, diabetes also has a morbidity rate, as it is the seventh most common cause of death in the U.S., and the leading cause of kidney failure. Lower limb amputations and adult blindness are also fairly common among adults with untreated diabetes.
As time passes, diabetes becomes more common as well, as the number of diagnoses has more than doubled over the past 20 years.
Types of diabetes
There are three types of diabetes; type 1, type 2 and gestational diabetes. Type 1 diabetes, a condition in which the pancreas produces little or no insulin, most commonly appears during adolescence and is usually caused by genetic factors.
In cases of type 2 diabetes, the pancreas begins producing less insulin, or the body develops a resistance to insulin over time. It can occur in children, but type 2 diabetes is most common in adults over the age of 45, and is caused by a combination of genetic, environmental and lifestyle-related factors. It is by far the most common type, as 90-95% of all diabetics have type 2.
Gestational diabetes is a less common type of diabetes that can develop during pregnancy in women who aren’t already diabetic. The exact cause of gestational diabetes is unknown, but it may be related to hormones that cause the mother to build up insulin resistance. Approximately 2%-10% of pregnancies in the U.S. are affected by gestational diabetes every year.
The connection between diabetes and oral health
Diabetes can impact many different areas of the body, and oral health is not immune. Diabetics are more prone to oral health conditions like gingivitis and periodontitis, and may also have greater difficulty recovering from these issues because of their illness. There are several specific ways in which the effects of diabetes on the body can contribute to poor oral health outcomes:
Increased blood sugar
High blood glucose from diabetes can impact oral health in several ways. Over time, high sugar levels in the blood can also lead to glucose building up in saliva, which can substantially contribute to plaque formation and tooth decay.
In addition to changing the composition of saliva, high blood sugar from diabetes can also cause dry mouth, or xerostomia, which is a general lack of moisture in the mouth. Along with causing discomfort and bad breath, chronic dry mouth can accelerate plaque buildup, leading to issues like mouth sores and infections.
Blood vessel thickening
Poor circulation is a common diabetes-related problem that can also impact oral health. For diabetics, high glucose levels in the blood can cause fatty deposits to build up inside the blood vessels. This makes the vessels harder and narrower, which can limit blood flow throughout the body, leading to Peripheral Artery Disease (PAD).
In addition to reduced sensation in the arms and legs, circulatory issues caused by PAD can lead to slower wound healing throughout the body. This lack of blood flow can deprive the gums of important nutrients and reduce the body’s ability to fight off oral infections. For some patients, this can cause mild conditions like gingivitis to quickly develop into more severe issues like periodontal disease and bone loss.
Periodontal disease
Due to factors like high blood sugar and poor circulation, people with diabetes have a higher risk of periodontal disease, an advanced form of gingivitis caused by an infection of the gums and bones that hold the teeth in place. Also known as gum disease, periodontal disease can cause symptoms such as gum recession, bleeding, swelling and tenderness.
Eventually, periodontal disease can cause teeth to become loose and even fall out if it isn’t properly treated. Slow wound healing caused by diabetes can also complicate the treatment of periodontal disease and lengthen recovery times.
Diabetic-friendly foods for oral health
Diet is a major consideration for managing diabetes and maintaining good oral health. Poor dietary practices such as excessive sugar consumption are common in America, and likely contribute to the prevalence of diabetes among the general population. Eating too much sugar can also lead to a variety of serious oral health issues, which can be further exacerbated by the symptoms of diabetes.
Working around the dietary limitations of diabetes can be challenging, especially for people with busy schedules, so it’s important to find healthy alternatives to sugar that are still satisfying. Fortunately, there are a variety of enjoyable foods that are diabetes-friendly and can support oral health:
- Low-fat dairy products such as yogurt and skim milk;
- Plant-based proteins such as beans, nuts and seeds;
- Fiber-rich fruits and vegetables like carrots, broccoli, raspberries and mangoes;
- Fluoride-rich foods such as spinach and potatoes;
- Coffee or healthier alternatives like green and herbal teas;
- Vitamin A-rich foods such as tomatoes, bell peppers and leafy greens;
- Vitamin C-rich foods such as green peppers, Brussels sprouts and citrus fruits;
- Water and other sugar-free beverages.
Sticking to a consistent, balanced diet that incorporates these items can help you improve oral health outcomes and reduce your risk of other complications and health issues associated with diabetes.
Dental concerns for diabetics
There are a variety of specific oral health problems that can be caused and/or exacerbated by diabetes. Understanding the differences between these conditions can help you identify and properly address them before they can progress.
Gingivitis
Gingivitis is the earliest stage of gum disease. It occurs when the gums become inflamed due to excessive plaque and tartar buildup. Symptoms of gingivitis include bad breath, swollen and tender gums, dark red color around the gums, bleeding from the gums when brushing or flossing and eventually receding gums.
While it is a very common condition, people with diabetes are at even greater risk of developing gingivitis due to the high levels of glucose in their saliva. Treatment for gingivitis usually involves improving oral hygiene practices, although professional cleaning or dental repair work may be necessary in some cases.
Periodontitis
Periodontitis, also known as gum disease, is a serious bacterial infection that occurs in the soft tissues around the teeth. It is primarily caused by poor oral hygiene, but diabetes is a major risk factor for periodontitis.
The symptoms of periodontitis include bleeding gums, tender gums, swollen gums, receding gum lines, pus around the gum line, loose teeth, pain when chewing, and new gaps forming between teeth. Tooth and bone loss can also occur if the condition is allowed to progress.
Treatment for periodontitis can vary depending on the severity of the case. In milder cases, doctors may prescribe antibiotics to fight the infection and employ deep cleaning procedures like tooth scaling and root planing. In more severe cases, surgical treatments such as gum and bone grafts may be needed to repair existing damage.
Dry mouth
Dry mouth, also known as xerostomia, is a lack of moisture in the mouth caused by insufficient saliva. Often related to high blood sugar, dry mouth is a common symptom in people with diabetes. Signs of dry mouth can include sore throat, hoarse voice, thickening of saliva, changes in taste, and difficulty chewing, speaking or swallowing.
While it can seem harmless initially, chronic dry mouth can lead to issues like bad breath, cracked lips, mouth sores, and even loose teeth. If it’s not addressed, chronic dry mouth can also increase your risk of plaque buildup, tooth decay, gum disease and mouth infections. Treatments for dry mouth may involve increasing your fluid intake or eating foods that stimulate your saliva production, such as sugar-free sweets.
Thrush
Thrush is an infection caused by the accumulation of candida fungus in the mouth. A form of yeast, the candida fungus can cause serious illness in people with weakened immune systems. Thrush is more common in people with diabetes, as higher blood glucose levels can create better conditions for the fungus to develop.
The most distinct sign of thrush is the appearance of raised white patches on the tongue, inner cheeks, the roof of the mouth, gums, tonsils or throat. Other symptoms include cotton mouth, loss of taste, and cracks and redness at the corners of the mouth. If thrush isn’t properly treated, it can spread to the esophagus in severe cases, causing fever and difficulty swallowing.
Treatment for thrush will usually involve antifungal medications and more intensive oral hygiene practices. Incorporating probiotics like yogurt into your diet can also help promote recovery. For diabetics, carefully managing blood sugar levels can help reduce the frequency and severity of outbreaks.
Burning mouth syndrome
Burning mouth syndrome is a medical term for a persistent burning sensation in the mouth that occurs without an immediately apparent cause. This burning can present on your tongue, gums, lips, inside of your cheeks, or the roof of your mouth, and can be severe in some cases.
Burning mouth syndrome can occur in diabetics as a result of peripheral neuropathy, or damage to the nerves outside of the brain and spinal cord. Common treatments for burning mouth syndrome include increasing your fluid intake, using saliva replacement products or taking medications like lidocaine to manage pain.
Symptoms of oral health problems in diabetics
While it can sometimes be difficult to identify oral health problems, especially when trying to manage diabetes, seeking medical attention promptly can help you prevent existing issues from progressing and ensure the best possible outcome.
If you or someone you care about is diabetic, it’s critical to watch for the following symptoms of oral health issues:
- Swollen, painful, or bleeding gums;
- Pain in your mouth or jaw that doesn’t go away;
- Loose teeth;
- Pain when you chew;
- Bad breath that doesn’t go away when you brush.
If you notice any of these symptoms, you should promptly reach out to a trusted care provider that can help you identify their root cause and determine the most effective course of treatment.
How can diabetics prevent oral health problems?
While diabetics are at greater risk for many oral health problems, they can still protect themselves by following the right dietary and oral hygiene practices. These practices can help reduce the risk of a variety of serious oral health issues.
- Brush twice a day with fluoride toothpaste;
- Floss daily;
- Limit sweets and other snacks that can cause tooth decay;
- Drink water;
- Control your blood sugar.
If possible, going for regular dental cleaning can also help reduce your risk of oral health issues, and ensure that any preexisting issues are identified and addressed before they become too severe.
Covering the cost of dental care
Even if you know that you’re dealing with a serious oral health issue, the cost of dental care may deter you from seeking professional medical attention. Paying for dental care on a budget can be a daunting proposition, especially for the 33% of adults that do not have dental benefits, as out-of-pocket costs can be quite high.
Tooth scaling and planing, a deep cleaning procedure that can help remove plaque and tartar buildup and prevent gum disease, can cost between $150-$350 without insurance. Simple extractions can range from $75-$250 per tooth, while surgical extractions can cost $180-$550 per tooth.
Root canals can cost from $620-$1,472 per tooth, with molars generally being the most expensive. While out-of-pocket costs for these procedures can vary significantly on a state-by-state basis, they are often difficult to afford for those without disposable income, especially if they are simultaneously dealing with the costs of diabetes treatment and care.
Low-cost dental care options
For many people, especially those without insurance, finding affordable dental care can be a challenge. This is particularly concerning for diabetics, who will likely experience more oral health problems than the average person.
Some people with oral health problems may even refrain from seeking treatment due to their financial concerns, which can allow their condition to worsen and necessitate more intensive treatments in the future. Fortunately, there are several different options for quality low-cost dental care.
Dental discount plans
In some cases, dental discount plans can be a worthwhile option for patients without dental insurance. These plans work like membership clubs, similar to stores like Costco, but offer members discounted prices on dental services, rather than gas and groceries.
Unlike those with dental insurance, people with discount plans pay a single annual fee instead of monthly bills. In exchange, they are given a dental discount card, which they can present to their care provider to get dental services at a reduced price.
Each plan is tied to a network of providers who have agreed to give discounted services to members. Similar to many traditional insurance plans, dental discount plans will only be accepted by providers that are in their predetermined network.
Dental discount plans do not reimburse providers as regular insurance plans do, and patients with these plans will need to pay their dentist directly upon receiving services. Additionally, many dental discount plans will not cover the same range of services as traditional insurance.
Donated dental services
Donated dental services (DDS) programs are free oral healthcare services offered to qualified patients through the Dental Lifeline Network, a charitable organization devoted to providing dental care for adults with special needs.
To be eligible for a DDS program, patients must be over 65 years of age, have a permanent disability, or be able to prove that their care is medically necessary. If they qualify, they can receive care for free, or at an extremely low cost, from one of the volunteer providers participating in their state’s program.
DDS volunteers will not provide patients with cosmetic services or emergency care. Additionally, the availability of services can vary depending on your location, so it’s important to research your state’s DDS program to determine if they are accepting applications in your area.
CareCredit
Healthcare credit cards, such as the CareCredit card, are specifically designed to provide uninsured patients with financing for medical expenses. These cards are accepted by a wide variety of enrolled providers including doctors, dentists, hospitals, pharmacies, and imaging centers.
These cards are deferred interest, meaning that they offer a promotional period where interest doesn’t accrue. However, this can be risky, as not paying back the full amount before the end of this period will cause you to owe interest on the entire original sum, even if the balance has already been partly paid-off.
United Way and Other Free dental clinics
Throughout the country, there are a variety of charitable clinics affiliated with or operated by the United Way. At these clinics, eligible patients can receive healthcare services for free or at a very low cost. You can research the locations of free and discounted dental clinics in your area by calling 211 or checking the United Way directory.
You may also be able to find free or reduced-cost dental services in your area by contacting your state or local health department. People in these departments may be able to connect you with free care providers nearby or tell you about financial assistance programs that may be available.
Medicare, Medicaid, and CHIP
Uninsured patients in need of dental care can also consider utilizing government programs such as Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), although the degree of dental coverage offered by these programs can be limited in many cases.
Medicare, an insurance program for people who are 65 and older, or those who have certain specific disabilities, can sometimes provide limited dental coverage. However, Medicare will usually only pay for dental services under very select circumstances, such as when they are integral to another covered procedure.
Medicaid is a state-run program that provides eligible individuals and families with health benefits, as well as some limited dental benefits. Most guidelines for Medicaid coverage are set independently by states, so you’ll need to check your state’s policies to see what types of benefits you can receive.
In many states, the dental coverage offered by Medicaid is limited to emergency services for individuals aged 21 and over, although it is more comprehensive in some places. However, children covered by Medicaid are eligible for a much wider variety of services, including those related to the maintenance and restoration of teeth.
For families that don’t qualify for Medicaid, but still struggle to pay for dental care, CHIP may be a viable option. CHIP (Children’s Health Insurance Program) provides health and dental coverage to uninsured children who are 19 or younger.
CHIP is intended to help children in families that make too much to qualify for Medicaid, so the requirements for eligibility are generally not as stringent. However, like Medicaid, CHIP’s specific eligibility requirements and the benefits it provides can vary significantly on a state-by-state basis, so it’s important to research your state’s specific CHIP rules.
Dental schools and dental hygiene schools
Many dental schools and teaching facilities operate clinics where students can gain experience treating real patients under the supervision of experienced, licensed dentists. Here, you can receive substantially discounted dental services in exchange for helping students practice.
You may also be able to receive care from hygienists in training by visiting a clinic at a dental hygiene school, although this is usually limited to low-cost preventative care such as cleanings. Contacting a dental school or dental hygiene school near you can help you determine the availability of discounted care.
Finding a dentist
If you think you should go see the dentist, there’s no reason to put it off, as the problem you’re dealing with is unlikely to go away on its own. However, it’s also important to make the right considerations when finding a dentist and coordinating your care.
Depending on the type of issue you’re dealing with, you may need to find a provider in the right dental subspecialty, such as a periodontist who’s trained to treat gum diseases. If you already have a general dentist, communicate your concerns promptly so that they can treat you or direct you to a specialized provider who can.
Preparing for your appointment
If you haven’t been to the dentist in a while, you might not know what to expect when you return. If you’re diabetic, it may be prudent to speak with your primary care provider about your concerns before your dental visit, as they will be able to provide additional information about treatments or medications your dentist may prescribe.
The best way to prepare for a dental appointment will depend on the type of care you’re receiving. Preparing for a teeth cleaning appointment or a simple extraction is a relatively easy process that involves thoroughly brushing and flossing your teeth, and avoiding whitening agents that may increase sensitivity.
More complex procedures, such as periodontal surgery, will often come with more comprehensive instructions that your doctor will likely explain. For example, your doctor may instruct you to stop taking certain medications in the weeks before surgery or to avoid smoking and/or alcohol.
Talking with your dentist about diabetes
Talking with your dentist about diabetes is often tricky, but the process can be made much easier if you know what to expect and what questions to ask. Asking questions freely and giving honest responses to your dentist can help you coordinate your care more effectively.
Questions to ask your dentist
Asking your dentist these questions can help you gain valuable insights about managing your oral health:
- What preventative steps can I take to avoid diabetes-related oral complications?
- What are the early signs of diabetes-related oral complications?
- What can I do to manage existing diabetes-related oral health issues?
Of course, it’s also critical to bring up any other questions or concerns that you may have with your dentist, including any symptoms you’ve been experiencing or apprehensions you may have about a proposed treatment strategy.
Questions your dentist may ask you
Your dentist will also likely have their own questions about your experience with diabetes. These questions can help your dentist identify any undiagnosed problems you may have and determine the best way to support your long-term oral health:
- How long have you had diabetes?
- What was your most recent A1c result?
- What medications to take to manage your diabetes?
- When did you last see a doctor about your diabetes?
- Have you been experiencing any oral health problems lately? Such as bleeding gums, mouth sores, or increased sensitivity;
- Do you have any other complications related to diabetes?; such as vision problems, numbness in extremities, etc;
When discussing diabetes with your dentist, you should always answer these questions honestly and volunteer any other pertinent information. This practice can help you coordinate your dental care with your diabetes treatment and any other health services you may be receiving, leading to improved outcomes in all areas.