World Diabetes Day 2021

How Diabetes Affects Our Oral Health and Our General Health

In the absence of a register of people who have diabetes no-one can be entirely sure how many people in Ireland live with diabetes. However, the total number of people living with diabetes in Ireland is estimated to be 225,840. There are two types of diabetes, Type 1 diabetes and Type 2 diabetes.

The International Diabetes Federation Diabetes Atlas (2013) estimate that there are 207,490 people with diabetes in Ireland in the 20 – 79 age group (prevalence of 6.5% in the population) which is in line with previous estimates that by 2030 there would be 278,850 people with the condition.

Diabetes affects your body’s ability to control sugar levels in your blood. Much of the food you eat, especially carbohydrates, is converted into sugar and used for energy. In Type 1 diabetes, the body produces no insulin, a hormone that carries sugar from your blood to the cells that need it for energy. In Type 2 diabetes, not enough insulin is produced by the pancreas or else the body’s cells fail to react to insulin. Both cases result in high circulating blood sugar levels, which cause problems throughout the body including in the major organs. Key to the damage caused is failure of tiny blood vessels to form properly throughout the body.

Uncontrolled diabetes where the level of sugar circulating in the blood is higher than normal causes damage throughout the body including the eyes, kidneys, heart, liver, nerves, blood vessels, immune system and the skin, but “how does it affect my mouth”, you ask?

Diabetes can cause Dry Mouth, Burning Mouth, Oral Thrush and contribute to Periodontal (gum) disease. Gestational diabetes occurs during pregnancy and usually resolves once your child is born.

Economic Cost of Diabetes in Ireland

The economic burden of diabetes on the Irish health care system is becoming a major challenge for the government and the HSE. Prof. J. Nolan’s seminal CODEIRE study is still the most accurate estimate of costs. The CODEIRE study was an international accredited study and examined the cost of treating type 2 diabetes in Ireland during Nov-Dec 1999, and suggested that 10% of the national health budget was being consumed treating the condition (49% on hospitalization for complications and wages; 42% on drug costs; 8-9% on ambulatory care and attending non-diabetes specialists for diabetes related complications).

The relationship between Gingivitis (early gum disease), Periodontitis (serious gum disease) and Diabetes

How does plaque start gingivitis?

A plaque biofilm, if left undisturbed around the gum margin and if not removed daily, releases poisons which cause your gums to become red, swollen and in some cases bleed excessively when brushed. Gingivitis is a reversible condition and with a good brushing technique can be cleared up in a few days.

How gingivitis progresses to periodontal disease (periodontitis) in the presence of type 2 diabetes.

If you have diabetes, it is easier for untreated gingivitis to progress into periodontitis. In fact, a dentist may be the first health professional to suspect a diagnosis of uncontrolled Type 2 Diabetes because of the presence of rapidly progressing severe periodontal disease. Signs of this are the gums beginning to fall away from the teeth and form spaces, called pockets which become infected with the plaque biofilm.

Untreated gum disease has been found to affect blood sugar levels making control and conversely patients who have comprehensive gum treatment can experience improved diabetic control (reduced HbA1c levels).

Other Health effects of Periodontal Disease

Untreated gum disease is a chronic inflammatory disease process that releases enzyme like chemicals which may send harmful signals to other parts of the body. Coronary heart disease, preterm low birth weight babies (PTLB), respiratory infections and diabetes, are examples of serious health conditions that may be affected by the presence of untreated gum disease.

How do I know if I have periodontal gum disease?

Gum disease is a silent and slowly progressive condition, so you may not notice any symptoms from the get go. You may have gum disease if you have ever noticed or have:

• Red, bleeding or swollen gums that do not respond to normal cleaning
• Pus from the gums
• Foul taste or persistent bad breath
• Longer looking teeth or receding gums
• Losing teeth
• Increasing spaces between your teeth

Living with Diabetes – Oral Health Tips

• Maintain a good blood glucose control. This is very important to preventing mouth problems.
• Quit smoking as it damages your immune system and makes gum disease worse.
• Don’t forget to brush (using a fluoride toothpaste) and floss daily and attend your dentist regularly.
• Reduce frequency of sugary snacks and carbonated drinks and eat a healthy, well balanced diet.
• Drink plenty of water to help dilute acid attacks caused by food or drinks.
• Visiting the dentist in the morning is the optimum time as blood sugar is more stable after breakfast.
• Your dentist may contact your GP to make your visits are as comfortable as possible.
• Your dentist may also refer you to a gum (periodontal) specialist if your gum disease persists and does not respond to initial care.

Access to Diabetes Care: If not now, when?

Access to Diabetes Care is the theme for World Diabetes Day 2021-23. Access campaign materials and find out how you can get involved.

• Millions of people with diabetes around the world do not have access to diabetes care.
• People with diabetes require ongoing care and support to manage their condition and avoid complications.

We cannot wait any longer for:

• Medicine, technologies, support and care to be made available to all people with diabetes that require them.
• Governments to increase investment in diabetes care and prevention.

The centenary of the discovery of insulin presents a unique opportunity to bring about meaningful change for the more than 460 million people living with diabetes and the millions more at risk.