By: Frank Varon
We often take our teeth for granted, but the mouth is the first part of the digestive process. It’s amazing how what we put into it and what comes out of it can get us in so much trouble.
Most of us don’t realize that the health of our mouths affects our diabetes control, and that our diabetes control affects our oral health.
We should avoid saying “dental health” and say instead “oral health,” since there is a two-way street between systemic health and oral health.
One of the most common oral health problems for diabetics is dry mouth or altered salivary flow (or xerostomia, if you like medical terms). The teeth and muscles in the mouth, face and jaw chew the food into smaller pieces to facilitate digestion in the stomach and intestine. The saliva has several functions. It prevents infection by controlling bacteria in the mouth. It moistens and cleanses the mouth by neutralizing acids produced by dental plaque, and it washes away the dead skin cells that accumulate on the gums, tongue and cheeks. It helps with the digestion, making it possible to chew, taste and swallow food. Dry mouth occurs when there is not enough saliva (real or perceived) to keep your mouth moist, which is important for health, comfort and for speaking. Diagnosis of dry mouth is difficult due to the subjective nature of this condition.
In most cases, dry mouth is due to side effects of medications. There are over 500 prescription and nonprescription medications that have been found to cause dry mouth. Medications that treat high blood pressure or other heart problems are used by many patients to manage complications of diabetes. Other drug groups that cause dry mouth are those used for depression, anxiety and allergies, as well as diuretics, anti-psychotics, muscle relaxants, sedatives and anti-inflammatory medications. Caffeinated beverages also cause dry mouth, and these should be limited.
Ask your pharmacist about side effects of your medications in order to avoid any possible problems. It is important that diabetes patients drink water frequently while on these medications, as well as for their general health. Also, be sure to see your dentist and dental hygienist for an oral examination and dental prophylaxis at least every six months to minimize or prevent the development of oral health problems. Optimal oral health will improve your diabetes control and your quality of life.
Editor’s Note: If a patient has dry mouth, then it is not recommended to use mouthwash with alcohol. However, if dry mouth is NOT a problem—and not all diabetes patients have this problem—then the most efficacious mouthwash is one with alcohol, per dental research on controlling oral diseases.
Dental Care for Dry Mouth Patients
The diabetes patient with dry mouth along with his or her oral health team will have to develop a routine for optimal oral health. Here are some simple ways to accomplish that goal:
- Perform oral hygiene at least four times daily, after each meal and before bedtime
- Rinse and wipe the mouth immediately after meals.
- Brush and rinse removable dental appliances after meals.
- Use only toothpaste with fluoride. Some toothpastes (such as Biotene) are formulated for dry mouth.
- Keep water handy to moisten the mouth at all times.
- Apply prescription-strength fluoride at bedtime as prescribed.
- Avoid liquids and foods with high sugar content.
- Avoid overly salty foods.
- Limit citrus juices (orange, grapefruit, tomato), as well as diet sodas.
- Avoid rinses containing alcohol. Several nonalcoholic mouthwashes are now available on the market.
- Use a lip balm or moisturizer regularly.
- Try salivary substitutes, gels or artificial saliva preparations. These may relieve discomfort by temporarily wetting the mouth and replacing some of the saliva constituents.
- In severe cases, use of pilocarpine might be used under a physician’s care.
The most common reasons for a dry mouth in a diabetes patient are
- Side effects of medication
- Neuropathy (autonomic)
- Lack of hydration
- Kidney dialysis
- Mouth breathing
Some clinical signs of dry mouth
- Loss of moisture, glistening of the oral mucosa
- Dryness of the oral membranes
- Irritated corners of the mouth (cheilitis)
- Difficulty wearing dentures
- Mouth sores
- Yeast infection (Candidiasis), especially on the tongue and palate
- Dental cavities: increased prevalence and located in sites generally not susceptible to decay