Diabetes is a chronic disease with a high prevalence, which among other alterations can lead to significant complications in the oral health of those affected. For this reason, prevention and a specialised therapeutic approach in dental care are essential, especially for elderly people who live in nursing homes and have reduced mobility.
Diabetes Mellitus is a chronic disease, which is a major public health problem due to it being so common. According to the IDF Diabetes Atlas , published by the International Diabetes Federation, 10.5% of adults aged 20-79 years are living with diabetes, which is 537 million people. This is projected to rise to 643 million by 2030 and to 783 million by 2045.
While type 1 is genetic in origin, type 2 diabetes is influenced by lifestyle and aging, with older people being more at risk. Complications from diabetes can lead to multiple conditions, including heart attacks, kidney failure, limb amputation, blindness, neurological problems and peripheral nerve damage.
The impact of diabetes on oral health
In addition, oral manifestations occur in more than 90% of diabetic patients. Scientific evidence indicates that diabetes severely damages oral tissues causing disorders such as periodontal disease, edentulism or tooth loss, xerostomia, tooth decay, Burning Mouth Syndrome (BMS), salivary gland disorders, delayed wound healing and scarring, lichen planus, geographic tongue and oral candidiasis.
The relationship between periodontitis and diabetes is bidirectional. This implies that by treating gum disease we are directly improving the diabetic person’s glycaemia, and therefore the improvement of the symptoms derived from this disease.
Unfortunately, most diabetics are unaware of the impact of gum disease on their oral health. Only a small percentage visit the dentist regularly for check-ups, especially if they are elderly people living in nursing homes and have reduced mobility.
One of the key issues to be aware of, is the delayed healing of oral lesions and scarring in diabetic patients. This is due to, among other factors, reduced cellular response and angiogenesis, inadequate production of growth factors and insufficient blood supply.
Many of these factors are altered in patients with uncontrolled diabetes, which affects dental procedures that require healing. However, patients with controlled diabetes due to hypoglycaemic medication do not usually have an increased risk of delayed healing after tooth extraction.
Specialised therapeutic approach
For all these reasons, the dental management of diabetic patients requires special attention in the treatment plan and how it is carried out, especially post-treatment when surgery has been performed. This is because patients often have complications in the healing of oral wounds, which can lead to ulceration or even systemic infections.
We must also keep in mind that diabetes is associated with poor bone regeneration, which increases the risk of fracture and osteoporosis. For this reason, in the care of these patients it is essential to cooperate proactively with their referring physician to ensure long-term periodontal and implant treatment.
In relation to treatments, it is interesting to mention that there is evidence that 0.8% hyaluronic acid applied to the socket after extraction improved wound healing in patients with uncontrolled diabetes, especially in the first few days after the procedure.
In the care of these patients, at Lura Care we recommend antibiotic prophylaxis before invasive dental procedures in patients with type 1 diabetes, and monitoring blood glucose levels of no more than 170mg/dl to minimise the risk of complications.
The importance of prevention
We cannot forget that prevention is the most important thing. Lifestyle changes such as blood glucose control, self-care practices and regular check-ups with an emphasis on periodontal treatment, can effectively prevent oral complications from this illness.
It is important to remember the reinforcement of oral care and hygiene instructions, as well as ultrasound prophylaxis and curettage, which have been shown to be effective in improving glycaemic control among diabetic patients.
In conclusion, it is very important that our seniors with diabetes have a regular check-up with a dentist. And it would be optimal if this professional is part of a multidisciplinary team, working in a coordinated way to help diabetics improve both their general health and their oral health.