Oral care for people with diabetes

Periodontal disease can be life threatening for diabetic patients. The disease can affect one tooth or many teeth. It begins when the bacteria in plaque—the sticky, colorless film that constantly forms on teeth— cause the gums to become inflamed. In the mildest form of the disease, gingivitis, the gums redden, swell and bleed easily. Contrary to popular belief, bleeding gums are never normal. There is usually little or no discomfort. Gingivitis often is caused by inadequate oral hygiene and is reversible with professional treatment and good oral home care.
Long-term studies have proven the value of consistent and regular oral hygiene care routines. Regular and timely dental visits are imperative to reinforce those habits and to minimize oral health problems.

The basics of oral care for all people include brushing, flossing, mouth rinsing and tongue cleaning. Special care in many of those areas is important for people with diabetes.

Tooth brushing

Teeth should be brushed at least twice daily with a soft brush. If possible, teeth also should be brushed after meals. The use of a brush with soft bristles is very important. Stiff bristles or too rigorous brushing can damage the gums and in-crease the potential for problems.

The variety of brushes available in-creases on an almost daily basis. Choices exist with regard to the size of the brush head, shape of the brush, and shape and flexibility of the handle. Patients should be encouraged to try different brushes so they can identify the one they find most comfortable. Consideration also may be given to electric brushes. A good-quality electric brush may make it easier for many people to brush more effectively without exerting unnecessary pressure that is potentially damaging...

Flossing

Patients also should be encouraged to floss. Ideally, teeth should be flossed at least once daily. Again, a wide array of flossing products is available in most pharmacies. And, again, patients should be encouraged to try various flossing products so that they find one they like and will use. Several types of flossing tools designed to make flossing easier are also available.

Mouth rinsing

Mouth rinsing also can be part of good oral health, but care should be taken to select a mouth rinse that meets the patient’s specific needs. Some mouth rinses have fluoride and are intended to decrease cavities. Those mouth rinses typically have little effect with regard to gum disease and bad breath. Other products are
intended to be used before brushing and are for the purpose of increasing the effectiveness of brushing. For people with diabetes the greatest areas of concern tend to be with gum disease and bad breath. Those people need a mouth rinse that addresses bacteria and the by-products of bacteria that contribute to gum
disease and bad breath.

A key area of concern for people with diabetes is the amount of alcohol in a mouth rinse. Of particular concern is the drying effect of alcohol. As indicated above, saliva plays an important role in oral health. Anything that has a drying effect on oral tissues is likely to increase oral health problems, including the potential for bacterial growth. Increasingly, attention is being given to the role of bacteria with anaerobic activity and their output of volatile sulfur compounds. Mouth rinses containing oxidizing agents are recommended in that regard. It also is recommended that mouth rinses be sugar free and alcohol free.

Tongue brushing

While attention has long been given to the importance of the gums in oral health, the tongue largely has been overlooked. Recently, there has been greater recognition of the role of tongue cleaning in maintaining good oral health. There are a variety of approaches to tongue cleaning. The simplest is to clean the tongue
using a toothbrush. However, for many people, the use of a regular toothbrush to clean the tongue will be limited by the size of the toothbrush and its potential to produce a gag reflex when it is used on the back of the tongue. Increasingly tongue scrapers and cleaners are coming into common usage. Tongue brushes also
have been well received by many patients.