Diabetes and Dental Care

Whether you have type 1 diabetes or type 2 diabetes, managing your blood sugar level is key. The higher your blood sugar level, the higher your risk of: 

• Tooth decay (cavities). Your mouth naturally contains many types of bacteria. When starches and sugars in food and beverages interact with these bacteria, a sticky film known as plaque forms on your teeth. The acids in plaque attack the hard, outer surface of your teeth (enamel). This can lead to cavities. The higher your blood sugar level, the greater the supply of sugars and starches — and the more acid wearing away at your teeth.
• Early gum disease (gingivitis). Diabetes reduces your ability to fight bacteria. If you don't remove plaque with regular brushing and flossing, it hardens under your gumline into a substance called tartar (calculus). The longer plaque and tartar remain on your teeth, the more they irritate the gum tissue. In time, your gums become swollen and bleed easily. This is gingivitis.
• Advanced gum disease (periodontitis). Left untreated, gingivitis can lead to a more serious infection called periodontitis, which destroys the gum tissue and bone that support your teeth. Eventually, periodontitis causes your gums to pull away from your teeth and your teeth to loosen and even fall out. Periodontitis tends to be more severe among people who have diabetes because diabetes lowers the ability to resist infection and slows healing. An infection such as periodontitis may also cause your blood sugar level to rise, which makes your diabetes more difficult to control. Preventing and treating periodontitis can help improve blood sugar control.

To help prevent damage to your teeth and gums, take diabetes and dental care seriously: 

• Make a commitment to managing your diabetes. Monitor your blood sugar level, and follow your doctor's instructions for keeping your blood sugar level within your target range.
• Brush your teeth at least twice a day. Brush in the morning, at night and, ideally, after meals and snacks. Use a soft-bristled toothbrush and toothpaste that contains fluoride. Avoid vigorous or harsh scrubbing, which can irritate your gums. Consider using an electric toothbrush.
• Floss your teeth at least once a day. Flossing helps remove plaque between your teeth and under your gumline.
• Schedule regular dental cleanings. Visit your dentist at least twice a year for professional cleanings.
• Make sure your dentist knows you have diabetes. Every time you visit your dentist, remind him or her that you have diabetes. Make sure your dentist has contact information for your doctor who helps you manage your diabetes.
• Look for early signs of gum disease. Report any signs of gum disease including redness, swelling and bleeding gums to your dentist. Also mention any other signs and symptoms, such as dry mouth, loose teeth or mouth pain.
• Don't smoke. Smoking increases the risk of serious diabetes complications, including gum disease. If you smoke, ask your doctor about options to help you quit.

Managing diabetes is a lifelong commitment, and that includes proper dental care. Your efforts will be rewarded with a lifetime of healthy teeth and gums.

Toothpaste History

Toothpaste dates back as far as 5000 BC. Ancient Egyptians were using a tooth powder to maintain a clean mouth. They didn’t use a toothbrush; just their fingers. The Greeks and Romans improved upon the process, but it wasn’t until 1873 that toothpaste was first mass-produced.

• The toothpaste of the Egyptians was made of mashed salt, crushed pepper, wet mint leaves, and dried iris flower. 

• The Greeks and Romans used a more abrasive formulation containing bones and oyster shells. In Rome toothpaste also included flavoring to help improve breath, in addition to powdered charcoal and bark.

• The Chinese culture used a combination of herbs, water, salt, and flower petals.

• In India twigs containing sweet nectar were used.

• In the 1800s a powder  containing soap and chalk was developed, followed by paste formula  developed in the 1850s.

• By the turn of the century toothpaste packaged in the tube was invented and more than a century later remains the delivery method of choice.

What is a dental implant?

A dental implant is a surgical device, most commonly used to replace one or more missing teeth by fusing to the bone and acting as an artificial tooth root. The term, dental implant, technically refers only to the portion of the structure that is in the bone. To become functional, however, other parts are attached including an abutment, that comes through the gums, an abutment screw that joins the abutment to the implant and the crown which attaches to the abutment.
    

Single Tooth Replacement

To replace a single tooth, an implant is placed into the bone, where the previous root existed and is allowed to heal for a period of time. The time allowed for the implant to heal varies with the location, load, bone type and surgeon preference. Once the healing is complete a second piece, called an abutment, is secured to the implant with a screw. The crown is then cemented to the abutment.

Multiple Tooth Replacement

In multiple tooth replacement, the same concepts used in single tooth replacement apply. However, two or more implants may replace many teeth. In this case, the teeth that are directly over an implant are called the abutment teeth and the teeth without implants under them are called pontic teeth. Collectively, the fixture is referred to as an implant supported bridge or implant supported fixed partial denture.

Restoring an Entire Arch of Teeth

To restore an entire arch of teeth, the restoration can be either fixed or removable. In a fixed complete denture, a denture with a metal substructure is attached to four or more implants. Alternatively, a larger version of a dental bridge can be fabricated. A removable denture can also be created, where the implants have a small button or ball abutment and the denture houses a female adapter which grabs the abutment. In this case, the denture can be removed with finger pressure by the denture wearer. This is referred to as an implant supported overdenture.

Tooth sensitivity - causes and treatment

Tooth sensitivity is tooth discomfort in one or more teeth that is triggered by hot, cold, sweet, or sour foods and drinks, or even by breathing cold air.

What Causes Sensitive Teeth?

• Brushing too hard. Over time, brushing too hard or using a hard-bristled toothbrush can wear down enamel and cause the under layer (dentin) and nerve endings to be exposed. It can also cause recession of the gums (the gum tissue pulls away from the teeth).
• Tooth decay near the gum line.
• Recession of the gums. As gums move away from a tooth due to conditions such as periodontal disease, the root surface becomes exposed.
• Gum disease. Inflamed and sore gum tissue may cause sensitivity due to the loss of supporting ligaments, which exposes the root surface that leads directly to the nerve of the tooth.
• Cracked teeth.
• Teeth Grinding. Grinding or clenching your teeth may wear down the enamel and expose underlying dentin.
• Tooth whitening products.
• Plaque build-up. The presence of plaque on the root surfaces can cause sensitivity.
• Mouthwash use. Long-term use of some mouthwashes. Some over-the-counter mouthwashes contain acids that can worsen tooth sensitivity if you have exposed dentin (the middle layer of the tooth). The acids further damage the dentin layer of the tooth. If you have dentin sensitivity, ask your dentist about the use of a neutral fluoride solution.
• Acidic foods. Regular consumption of foods with a high acid content, such as citrus fruits, tomatoes, pickles, and tea, can cause enamel erosion.
• Recent routine dental procedures. Sensitivity can occur following teeth cleaning, root planing, crown placement, and tooth restoration. Sensitivity caused by dental procedures is temporary, usually disappearing in four to six weeks.

What Can I Do to Reduce Tooth Sensitivity?

• Maintain good oral hygiene.
• Use a soft bristled toothbrush.  Brush gently and carefully around the gum line.
• Use desensitizing toothpaste. There are several brands of toothpaste available for sensitive teeth. With regular use you should notice a decrease in sensitivity. You may need to try several different brands to find the product that works best for you. Another tip. spread a thin layer of the toothpaste on the exposed tooth roots with your finger or a Q-tip before you go to bed. 
• Watch what you eat. Frequent consumption of highly acid foods can gradually dissolve tooth enamel and lead to dentin exposure.
• Use fluoridated dental products. Daily use of a fluoridated mouth rinse can decrease sensitivity. Ask your dentist about available products for home use.
• Avoid teeth grinding. If you grind or clench your teeth, use a mouth guard at night.
• See your dentist at regular intervals. Get professional tooth cleaning, oral hygiene instructions, and fluoride treatments every six months (or sooner depending on your condition).

If you still have discomfort, talk to your dentist. There may be some dental procedures that may help reduce sensitivity, including the use of:

• White fillings to cover exposed root surfaces
• Fluoride varnishes applied to the exposed root surface
• Dentin sealers applied to the exposed root surface

Why do I need a crown?

A dental crown is a tooth-shaped "cap" that is placed over a tooth to cover the tooth to restore its shape and size, strength, and improve its appearance.

The crowns, when cemented into place, fully encase the visible portion of a tooth. 

 

A dental crown may be needed in the following situations:

     1. If your cavity or filling takes up more than one third of the tooth surface.
     2. To cover a severely worn down tooth
     3. To cover malformed and or severely discolored teeth
     4. To cover a dental implant
     5. When having cosmetic work done
     6. After a root canal
 

 For children, a crown may be used on primary (baby) teeth in order to:

• Save a tooth that has been so damaged by decay that it can't support a filling.
• Protect the teeth of a child at high risk for tooth decay, especially when a child has difficulty keeping up with daily oral hygiene.
• Decrease the frequency of sedation and general anesthesia for children unable because of age, behavior, or medical history to fully cooperate with the requirements of proper dental care.

In such cases, a pediatric dentist is likely to recommend a stainless steel crown.

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