Teeth and gums in diabetes

Standing quietly on an English riverbank, I watched a beaver emerge from the reeds surrounding her lodge and swim slowly upstream. A very rare sight in Britain. She stopped to eat at fallen willow tree. could hear big orange teeth scraping wood as she stripped bark. Beavers can fell large trees with their teeth, well bark, leaves, other plants. Their incisors grow continuously, strengthened by iron deposits. Our don't continuously. We must look after them. The hard white enamel covers dentine (the main support of tooth). Inside, pulp contains blood vessels nerves, extending tooth roots which are protected cementum. Ligaments cementum attach its socket jaw bone. gums cover these attachments. Together all structures form periodontium. Tooth loss causes difficulty chewing speaking, inhibits smiling have major social consequences. It may make healthy eating difficult. Having type 2 diabetes increases risk compared people without diabetes. meta-analysis including 22 studies found that odds ratio (OR) for was 1.87 (1.62–2.13), adjusted OR 1.20 (1.10–1.30).1 In ADVANCE study, 10,958 counted start five years. After controlling confounders, edentulous were more likely die cardiovascular non-vascular those ≥22 teeth.2 systematic review 67% children young 1 had dental caries; both severity prevalence greater than among general population.3 An Indian study decayed, missing, filled HbA1c ≥7.0 7.9% (53–63mmol/mol) ≥8.0% (64mmol/mol). latter 2.65 times decayed carbohydrate consumption, oral hygiene, brushing habit.4 Among US adults aged over 30 years, 47% evidence periodontal disease.5 Gum inflammation (gingivitis) is potentially reversible, while periodontitis destruction structures, not. Periodontitis estimated affect 30–50% worldwide. 2010, severe (affecting 9–11% people) considered sixth most prevalent disease worldwide.6 Features include sensitive painful chewing, red tender, bleeding or swollen pulled away loose persistent bad breath unpleasant taste, changes bite partial denture fit. Diabetes key factor disease; risks poor smoking, stress, crooked dry mouth, damaged fillings, ill-fitting bridges, pregnancy, contraceptives, heredity.7 2013 consensus statement stated: ‘Over last 20 consistent robust has emerged adversely affects glycaemic control glycaemia non-diabetes subjects. patients, there direct dose-dependent relationship between complications. Emerging supports increased onset patients periodontitis,’ ‘Randomized controlled trials (RCTs) consistently demonstrate mechanical therapy associates approximately 0.4% reduction three months.’8 ‘In uncontrolled diabetes, developing higher well-controlled Also, progresses faster severely diabetes.’9 longitudinal 628 Pima ≥35 years 11 204 died. Death rates per 100 person age sex, 3.7 no mild periodontitis, 19.6 moderate 28.4 periodontitis.10 One 10 complications implants marginal bone loss, probing depth, around implant.11 As operations, should ensure good glucose before implants. Other measures advocated use prophylactic antibiotics treatment chlorhexidine.12 59-year-old man alcoholic chronic pancreatitis presented confusion week root canal treatment. He diabetic ketoacidosis, abscess, 14x7.5cm perihepatic abscess. recovered vigorous treatment.13 Periodontal abscess indicate undiagnosed 1352 known who 58.7% ≥6.5% (48mmol/mol 7.8mmol/L) 41.4% normal HbA1c.14 USA, 2016–17 Medical Expenditure Panel Survey 46,633 mean annual diabetes-associated expenditure $77 person, $1.9 billion nation (2017 cost).15 California, preventive dentistry 2005–7 reduced 2008.16 UK, NHS care provides free help some circumstances; otherwise pay.17 Over recent many UK dentists providing care, focusing solely private patients. 2022 BBC worked British Dental Association contact nearly 7000 8533 practices believed hold contracts. England, 91% not accepting new adult 37% local authorities be Across 79% child patients.18 For six practice closed Danielle Watts couldn't find dentist. ‘While issues begin with, experienced serious problems past two half They made simple things like unbearable painkillers confidence even smile.’ desperation, out own teeth.19 This situation national disgrace. cause harm, especially vulnerable such See Box • Brush your fluoride toothpaste twice day about minutes. bed one time daily Clean every surface Use manual electric toothbrush right concentration fluoride: adults, least 1350 parts million (ppm) fluoride. – see website20 brushing, spit any excess Don't rinse mouth mouthwash immediately floss and/or interdental brushes remove food lodged plaque Avoid toothpicks they damage Follow personal advice dentist hygienist elsewhere, medical health organised separately. Oral hygiene important part we non-dentists forget our enthusiasm scrutinise results discuss medication. Patients mention team. Dentists usually problems; ask issues. People disease. lose Edentulous complete dentition. Children caries peers increasing associated caries. common; increase glycaemia. Treating reduces need further Problems explain puzzling hyperglycaemia; during reviews. implant. access limited. Many can't afford care. unacceptable improved. Look you