Oral health and type 1 diabetes: what do you need to know?

If you’re living with Type 1 diabetes, you’re probably well aware of how it can impact various aspects of your health. One aspect that is often overlooked, but is equally important, is oral health. Studies have shown that diabetes is a risk factor for multiple oral health complications. Namely, periodontitis (severe inflammation of the gums) occurs three times more often, more frequent caries, and tooth loss.

Hypoglycemia and hyperglycemia alter oral health 

Keeping blood sugar levels within the target range is an ongoing and challenging task when living with T1D. Consequently, encountering episodes of both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) is common and can have an impact on oral health.

The current recommendation for treating hypoglycemia is to take 15 g of fast sugars (e.g. Dex 4, juice, Rockets candy) and repeat every 15 minutes as needed. Frequent episodes of hypoglycemia or situations where the episode takes more than one try to treat can increase mouth acidity. This is especially true during times when oral hygiene is not immediately possible or challenging (e.g., during the night).  For example, according to data from the BETTER registry (population 14 years old and older), hypoglycemia less than 3.0 mmol/L occurs on average about 5 times per month and two-thirds of the respondents had at least one night-time hypoglycemia in the past month. Frequent hypoglycemia and its treatment can then promote an acidic environment where cavity-causing bacteria can damage the teeth and weaken the enamel.

On the other hand, hyperglycemia can result in dry mouth: the lack of saliva favors plaque deposition, which can increase risk of gingivitis, tooth decay and thrush (white, raised, cottage cheese-like lesions caused by a fungal infection). With high blood sugar levels, there are often high levels of sugar in the mouth too, which can also create an environment for fungal infections to develop and cause thrush. Additionally, consistently high blood sugars can also weaken the body’s ability to fight off bacteria, including the ones in our mouth, which can increase the risk of gum inflammation and disease such as gingivitis and periodontitis. Hyperglycemia can, on the other hand, slow down the healing process, making it harder for your mouth to recover from oral surgeries or injuries.  

Steps to take to support oral health

We know diabetes management can be challenging, so here we propose a few simple actions that can help keep your mouth and teeth healthy. 

1. Promote stable blood sugar levels: As explained above, both high and low blood sugar can affect your teeth so keeping your blood sugar levels within the target range is not only great for your overall health but will also help support good oral health. 
2. Adopt good oral hygiene habits: Brush your teeth after meals or at least twice a day with fluoride toothpaste and floss daily. Fluoride is indicated for people living with diabetes to help remove plaque and bacteria, reducing the likelihood of gum disease and cavities. Your dentist may also recommend a fluoride mouthwash or an in-clinic fluoride treatment.
3. Have adequate tools to ensure complete hygiene:

• • Electric brushes for those with reduced mobility or dexterity (children for example). 
  • Sugar free gum when you are not able to brush your teeth after a meal. It promotes saliva production which helps to resolve the dry mouth problem related to hyperglycemia. 
  • A piece of cheese to eat after a carbohydrate treatment or snack, to increase saliva production and wash away some of the mouth acids, but also to provide calcium and phosphorus (important minerals for your teeth). Cheese lipids (fats) also form a protective film on teeth.
  • A glass of water next to your bed to rinse your mouth when you are woken up after a nocturnal hypo and don’t feel like leaving your bed. 
  • You could also have a few mini disposable toothbrushes (waterless, no rising) on your night stand, or in your luggage.

4. Stay hydrated: If you experience dry mouth (for example due to hyperglycemia), drink plenty of water throughout the day and at night to keep your mouth moist and wash away harmful bacteria.
5. Quit smoking if you can: Smoking impacts oral health negatively. If you smoke, it is advised to seek support to quit, as this will have significant positive effects on your mouth health and overall well-being.
6. Visit your dentist regularly: Regular dental check-ups are vital for anyone, but they become even more crucial when living with T1D. Schedule dental visits every six months, or as recommended by your team, to monitor your mouth health and address any concerns promptly.

Keep  in mind that it is important to be aware of how diabetes can affect oral health. With a higher risk of cavities and gum inflammation, it is advised to take proactive steps to keep your mouth and teeth healthy. 

References:

Taleb, N. et al. (2023). Non-severe hypoglycemia in type 1 diabetes: a randomized cross-over trial comparing two quantities of oral carbohydrates at different insulin-induced hypoglycemia ranges. Frontiers endocrinol., 14, 1186680. Doi: 10.3389/fendo.2023.1186680

Gupta, S. (2017). Correlation of salivary glucose level with blood glucose level in diabetes mellitus. J. Oral Maxillofac Pathol., 21(3): 334-339. Doi: 10.4103/jomfp.JOMFP_222_15

Matthews, D. C. (2002). The relationship between diabetes and periodontal disease. J. Can. Dent. Asso., 68(3): 161-164. https://www.cda-adc.ca/jadc/vol-68/issue-3/161.pdf

Brazeau, AS, Messier, V., Talbo, M.K., et al. (2022). Self-reported Severe and Nonsevere Hypoglycemia in Type 1 Diabetes: Population Surveillance Through the BETTER Patient Engagement Registry: Development and Baseline Characteristics. Can. J. Diabetes, 46(8):813-821. doi:10.1016/j.jcjd.2022.05.010

Newton, J.T., et al. (2020). A Systematic Review and Meta-Analysis of the Role of Sugar-Free Chewing Gum in Dental Caries. JDR Clin. Trans. Res., 5(3):214-223. doi:10.1177/2380084419887178

McCammon, E. (2021). Diabetes and your teeth. Diabetes Canada. Retrieved August 27, 2023, from https://diabetes.ca/about-diabetes/stories/diabetes-and-your-teeth

Lalla, E. and Papapanou, P. N. (2011). Diabetes mellitus and periodontitis: a tale of two common interrelated diseases. Nature Reviews Endocrinology, 7: 738-748. https://www.nature.com/articles/nrendo.2011.106

Banyai, D. et al. (2021). Oral Health Knowledge and Habits of People With Type 1 and Type 2 Diabetes. Int. Dent. J., 72(3): 407-413. Doi: 10.1016/j.identj.2021.07.003

Davidopoulou, S. et al. (2022). Oral Health Implications and Dental Management of Diabetic Children. Int. J. Clin. Pediatr. Dent., 15(5): 631-635. Doi: 10.5005/jp-journals-10005-2426

Steigmann, L. et al. (2022). Type 1 diabetes and oral health: Findings from the Epidemiology of Diabetes Interventions and Complications (EDIC) study. J. Diabetes Complications, 36(4): 108120. Doi: 10.1016/j.jdiacomp.2021.108120

Diabète et soins de votre bouche. Michel Malboeuf Centre dentaire. Page consultée le 31 août 2023. https://michelmalboeuf.com/conseil-adulte/diabete-et-le-soin-de-votre-bouche