Diabetes and Periodontal Disease
Part Two–Prevention and Control
Periodontal (gum) disease has been recognized as a potential complication of diabetes. Dr. Roy A. Kaplan, an eminent endocrinologist (who just happened to have saved my life about 20 years ago, but that’s another story) told me that “The disease is not diabetes. The disease is high blood glucose”. This is the most basic truth in the control of all diabetic complications-- the better your diabetic control the lower your risk for complications. So it is with gum disease.
But even with a consistently normal A1c periodontal disease can still be problematic for the diabetic. Excellent oral hygiene and regular professional care are the two other parts of the prevention puzzle when it comes to gum disease and diabetes.
Excellent Oral Hygiene
The objective when practicing excellent oral hygiene is to remove or disrupt the biofilm layer and the bacterial plaque attached to it on the teeth at and below the crest of the gum tissue. This biofilm layer, the genesis of gum disease, is a sticky film that forms on the teeth and bacterial plaque sticks to it fairly tenaciously.
Your oral hygiene regimen should take about five minutes twice a day. A good habit to develop is to brush for two minutes, one minute to floss, and 30 seconds to rinse with an antibacterial mouth wash.
Tooth brushing technique is vital. You should use a soft (not medium or hard, we’re not scrubbing the floor) brush, holding it wth the bristles at a 45° angle between the tooth and the gums. Like this:
Concentrate on brushing each tooth, with short small circular motion. Remember, you only have to brush the teeth you want to keep.
As a dentist I strongly recommend a powered, sonic toothbrush. The preeminent one available is the Phillips Sonicare. I have no financial interest in the company and get no honorarium from them. I just think the brush does a great job, better than you could possibly do manually. Below is a good demonstration of its use:
Flossing is simply brushing between your teeth. You can’t get the brush in there, but the in between area still needs to be cleaned. Flossing takes practice. You probably won’t get it the first few times, but it gets easier if you persist. Take about an 18 inch piece of floss, wrap the ends around your index fingers so that about 8 inches of floss is stretched between your index fingers. Start placing the floss between each tooth contact and when the floss snaps between the teeth wrap the floss into a “C” against each tooth surface. Move the floss up and down a couple of times and then go to the next tooth contact. The floss should be placed like this:
If you have problems mastering flossing, don’t give up! You can get a floss aid device, that looks like a curved sling shot. It should make flossing drop dead simple:
You should finish your routine with an antibacterial mouth rinse. If nothing else it will make your mouth feel nice and clean. But it can also deliver fluoride, kill bacteria, and inhibit the reformation of the biofilm layer.
Smoking Causes Gum Disease
I should mention smoking at this point. Far be it from me as a dentist to tell you not to smoke because it can cause lung and heart disease. But as a dentist I can certainly tell you that in forty years in practice I have never seen a patient who smokes who does not have periodontal disease. Never. Smoking lowers tissue resistance and it creates a much more tenacious biofilm that is very difficult to remove. Enough said about smoking. Don’t. Do. It.
When Will My Bleeding Gums Stop Bleeding?
Everything I’ve demonstrated above is how you can maintain your dental health. But what if your gums bleed when you brush, or you have a heavy buildup of tartar on your teeth, or your gums look red and swollen? If so, you have gum disease, and it can only be brought under control by your dentist. In the next article I’ll be discussing the need for professional care.