Diabetes
Oral Effects
Diabetes can affect the entire body. Whether your diabetes affects your oral
health depends on how well you are able to control your blood sugar.
If your diabetes is under control, the effects on your oral health should
be minimized. However, if your diabetes is not under control, the oral
effects can be dramatic.
People with diabetes can have:
Uncontrolled diabetes
impairs white blood cells called neutrophils, which are a main defense
against bacterial infection. Because periodontal disease is a bacterial
infection, people with uncontrolled diabetes are more likely to have
it, and their conditions are likely to be more severe.
In addition, successfully treating severe periodontal disease can improve
diabetic control because any type of infection may cause blood-sugar
levels to rise. This increases the need for insulin. If the infection
is treated successfully, the need for insulin may decrease and diabetic
control likely will be easier.
Dry mouth (xerostomia) can increase your risk of tooth decay because
saliva normally washes away sugars and food particles that are fuel for
decay-causing bacteria. Recent studies have shown that uncontrolled diabetics
have decreased salivary flow. However, there's no widespread agreement
on whether diabetics as a group have more or less tooth decay than non-diabetics.
If you have dry mouth, practice regular oral hygiene to prevent decay.
You may want to talk to your dentist or physician about artificial saliva,
or other means of reducing your dry mouth. Fluoride rinses or gels should
be used to reduce the possible increase in decay rate.
If you have uncontrolled diabetes, you may have problems healing quickly
after oral surgery or other dental treatment because blood flow to the
site can be impaired.
You may also be at risk for a fungal infection called thrush, or oral
candidiasis, which thrives on the sugar in your saliva. Antifungal medication
is the treatment for this condition. Oral candidiasis can cause a burning
sensation in your mouth, sometimes called burning-mouth syndrome or stomatodynia.
The syndrome has other causes as well, but antifungal medication may
help if it is caused by oral candidiasis.
At the Dentist
No matter how well controlled your diabetes is, it's important to keep
your dentist informed about your condition. Your dentist should become
a part of your health-care team and know about any changes in medication
or the status of your condition. Anything you can tell your dentist
about your condition will help him or her decide the best treatment
for you. At the very least, your dentist should have your physician's
name and phone number so he or she can contact your physician with
any concerns or questions.
Your dentist may want to know your glycosylated hemoglobin level (the
results of your hemoglobin A1C test) to get an idea of how well controlled
your diabetes is. The test shows the percent of your hemoglobin that
is glycosylated (has sugar attached to it). Diabetics should aim for
less than 7 percent. Higher levels can indicate poor diabetic control,
meaning there's more sugar in your blood than there should be.
If your diabetes is well controlled, you probably do not need any special
dental care. However, uncontrolled diabetics — especially those
with cardiovascular and/or kidney problems — should probably receive
antibiotics before and after any dental treatment, such as surgery, that
might put them at risk for a bacterial infection.
Take your insulin and eat normally before visiting the dentist; continue
to do what's normal for you. Your dentist may have a source of glucose,
such as juice, available in case of hypoglycemia (low blood sugar; also
called an " insulin reaction" ). However, you should take a
source of glucose with you to make sure you have it if you need it. Glucose
tablets, available at pharmacies, are convenient to carry, but crackers,
cookies or any carbohydrate will work. After treatment, resume your normal
diet immediately. If this is not possible, seek advice from your doctor.
Some recent changes in the care of diabetes may affect your visit to
the dentist. The cut-off blood-sugar level for control of diabetes, which
used to be 140 g/dl, is now 126 g/dl. This increases the chance of hypoglycemic
episodes.
If you've had a hypoglycemic episode in the past, you are at increased
risk to have another one. Tell your dentist if you have had an episode,
when the last one was and how common they are. Most hypoglycemic problems
will occur when your insulin peaks, so make sure your dentist knows when
you last took insulin.
Some medications your dentist might use can interfere with some oral
medications you may take for diabetes. This makes it even more important
that your dentist know the medications you are taking and their doses.
Follow your dentist's post-treatment instructions thoroughly. People
with diabetes tend to be slower to heal and more prone to infection,
so do whatever you can to help yourself recover completely. Also, it
is especially important for diabetics who are having orthodontic work
done to contact their orthodontist immediately if a wire or bracket is
cutting into their tongue or mouth so it can be fixed before a sore forms.
People with intraoral appliances made of acrylic may also have an increased
risk for candidiasis.
If your dentist has successfully treated a major infection, you may
need to visit your physician to have your insulin dose calibrated.
Thyroid Disease
Oral Effects
High concentrations of iodine — used to treat thyroid hypertrophy, or goiter — can
cause pain in the gums, swollen salivary glands, and excessive salivation.
Children with hypothyroidism — an underactive thyroid gland — may
have upper and lower teeth that do not come together correctly (malocclusion),
as well as delayed tooth eruption, protruding tongue, swollen gums, and
an increased risk of decay and periodontal
(gum) disease.
Their teeth usually are poorly shaped. However, many children with hypothyroidism
may have none of these effects. It depends on the degree of the disease,
the age at which the child was diagnosed and the time that elapsed before
diagnosis.
Adults with hypothyroidism may have an enlarged tongue, delayed tooth
eruption, variable periodontal health, delayed wound healing and changed
taste sensitivity.
People with hyperthyroidism — an overactive thyroid gland — may
have rapid and severe periodontal disease. Their teeth come in sooner
than normal, and their oral and facial bones may be weakened.
At the Dentist
Before your dentist begins treatment, he or she may need to consult with
your physician. Make sure your dentist knows about your condition.
People with hyperthyroidism can have severe cardiac problems at the
time of a hyperthyroid episode if they are given epinephrine (contained
in many local anesthetics). People with hypothyroidism may be sensitive
to some drugs used in dental treatment, such as sedatives and opioid
analgesics. If your dentist uses these drugs, you may receive a reduced
dose.
People with hyperthyroidism have an increased sensitivity to pain and
may require higher-than-usual doses of sedatives, analgesics, and local
anesthetics. Some people with this condition are taking antithyroid agents,
which can make them predisposed to infections and poor wound healing.
Pituitary Tumors
Oral Effects
People with tumors of the pituitary gland may produce excess growth hormone,
which causes growth in facial structures containing cartilage, including
the nose, ears and jaw. Such growth may affect dentures, bridges and
orthodontic work, as well as restorations. Excess growth hormone can
also cause hypertension and type 2 diabetes.
If a pituitary problem occurs after normal growth has stopped, the jaw
will still grow, out of proportion to other facial structures. Dentists
can often help in diagnosing pituitary problems. They may notice changes
in your jaw and refer you to your physician.
At the Dentist
There are no special concerns for people with pituitary disease.
Paget's Disease Of Bone
Oral Effects
Paget's disease of bone is a disease of increased bone metabolism that
may be caused by a virus. This disease can result in deformities and
fractures in one or several bones. If the disease involves the upper
or lower jaw, considerable deformities may occur. A common first sign
of Paget's disease is an increase in the size of the head.
Bones affected by Paget's disease have more blood vessels than do normal
bones and extensive bleeding can occur after a fracture.
At the Dentist
People with Paget's disease should be followed closely by the dentist
if their jaw bones are affected. | 
