Diabetes and Other Endocrine Disorders

Oral Effects
Diabetes can affect the entire body. Whether your diabetes affects your oral health depends on how well you are able to control your blood sugar. If your diabetes is under control, it should have little effect on your oral health. However, if your diabetes is not under control, the oral effects can be dramatic.

People with diabetes can have:

  • Periodontal (gum) disease that gets worse rapidly
  • Gum inflammation (gingivitis)
  • Dry mouth (xerostomia)
  • Poor healing in the mouth
  • Oral candidiasis (thrush)
  • Burning mouth and/or tongue

Uncontrolled diabetes hurts one of your body’s main defenses against infection, white blood cells. Because periodontal disease is a bacterial infection, people with uncontrolled diabetes are more likely to have it. Their gum disease also is likely to be more severe.

If you have severe periodontal disease, you need to get treatment. Successful treatment also can help improve diabetic control. Any type of infection may cause blood sugar levels to rise. This includes periodontal disease. If the infection is treated successfully, your blood sugar may go down, and you may need less medicine to control your diabetes.

Dry mouth (xerostomia) can increase your risk of tooth decay (cavities). Saliva normally washes away sugars and food particles that are fuel for decay-causing bacteria. These bacteria can cause more decay in a dry mouth.

People with uncontrolled diabetes may have decreased flow of saliva. However, it’s not clear whether diabetics have more or less tooth decay than non-diabetics.

If you have dry mouth, practice regular oral hygiene to prevent decay. You may want to talk to your dentist or physician about artificial saliva or other means of moistening your mouth. Fluoride rinses or gels should be used to help prevent decay.

If you have uncontrolled diabetes, you may have problems healing quickly after oral surgery or other dental treatment. There are several reasons for the slow healing, including poor blood flow to the site.

You also may also be at risk of a fungal (yeast) infection called thrush or oral candidiasis. This condition is treated with antifungal medicine. Thrush can cause a burning sensation and/or a bad metallic taste in the mouth. Other conditions related to diabetes also can cause a burning sensation in the mouth. Your dentist or a specialist can examine you and determine whether you have thrush or a different condition.

At the Dentist
No matter how well controlled your diabetes is, it’s important to keep your dentist informed about your condition. Your dentist should become a part of your health care team. He or she should know about any changes in your condition or your medicines. This information will help your dentist decide the best treatment for you.

At the very least, your dentist should have your physician’s name and phone number so he or she can call with any concerns or questions.

Your dentist may want to know the results of some of your blood tests (for example, hemoglobin A1C and fasting blood glucose). This information helps your dentist to better understand your diabetes control. In general, diabetics with a hemoglobin A1C level of less than 7% are considered to be well controlled. Levels above 8% indicate poor control.

People with poorly controlled diabetes have higher risks of infection and poor wound healing. Because diabetes can affect your blood counts, always give your dentist a copy of your most recent blood tests.

If your diabetes is well controlled, you probably do not need any special dental care. People with uncontrolled diabetes may need to take antibiotics before and after dental treatment that might put them at risk of a bacterial infection. An example would be oral surgery. This is even more important for diabetics who also have cardiovascular or kidney problems.

Take your insulin and eat normally before visiting the dentist. Your dentist may have a source of glucose, such as juice, available in case your blood sugar levels drop. But you should take a source of glucose with you to the dental office anyway. Glucose tablets are convenient to carry, but crackers, cookies or any carbohydrate will work. After treatment, resume your normal diet immediately. If this is not possible, ask your doctor for advice.

If you’ve had low blood sugar (hypoglycemic) episodes in the past, tell your dentist how often they have occurred and how severe they have been. Low blood sugar can occur when your insulin level peaks. If you take insulin, make sure your dentist knows when you last took insulin and ate food.

Some medicines your dentist might use can interfere with some pills you may take for diabetes. This makes it even more important that your dentist know the medicines you are taking and their doses.

People with diabetes tend to heal more slowly than non-diabetics. They also are more prone to infection. Follow your dentist’s instructions thoroughly after treatment. This will help you to recover as soon as possible.

If you are having orthodontic work (braces) done, contact your orthodontist immediately if a wire or bracket is cutting into your tongue or mouth. You should get this fixed before a sore forms. People with mouth appliances made of acrylic also may have an increased risk of developing thrush.

Thyroid Disease
Oral Effects
Radioactive iodine is used to assess and treat various forms of thyroid disease. This chemical can damage the salivary glands and cause them to swell. It also can cause changes in saliva production.

Hypothyroidism is an underactive thyroid gland. In children with this condition, the upper and lower teeth may not come together correctly. Their teeth may come into the mouth later than normal. They also may have a protruding tongue and thick lips. However, many children with hypothyroidism have none of these effects. It depends on the degree of the disease, the child’s age when diagnosed and how long he or she had the disease before treatment began.

Adults with hypothyroidism may have an enlarged tongue and a hoarse voice.

At the Dentist
Your dentist may need to talk to your physician before treating you. Make sure your dentist knows about your condition.

People with poorly controlled hyperthyroidism (overactive thyroid gland disease) can have heart problems if they are given epinephrine. This is an ingredient in many local anesthetics (dental injections).

People with uncontrolled hypothyroidism may be sensitive to some drugs used in dental treatment, such as sedatives and opioid pain relievers. If your dentist prescribes these drugs, you should discuss dosages first.

Pituitary Tumors
Oral Effects
People with tumors of the pituitary gland may produce an excess of growth hormone. This can lead to gradual changes in parts of the face that contain cartilage, including the nose, ears and jaw. If normal growth has stopped, the jaw may still grow. As a result, it may look out of proportion to other parts of the face. The tongue also may get larger. These changes may affect denture fit.

When this disease is undiagnosed, people may visit an orthodontist, thinking that braces can help with the tooth or jaw growth problems. Excess growth hormone can lead to heart disease (including high blood pressure) and diabetes.

At the Dentist

Dentists can help in the diagnosis of pituitary problems. They may notice changes in your jaw, tongue, face and other health signs. In this case, the dentist will suggest further evaluation by your physician. After your physician makes a diagnosis, your dentist can plan proper dental procedures or other visits for you.

Oral Effects
In Paget’s disease of bone, the body breaks down bone and builds it up again at a faster rate than normal. Some research suggests it may be caused by a virus. This disease can result in broken or deformed bones. If the disease involves the upper or lower jaw, major deformities may occur. A common first sign of Paget’s disease is pain or an increase in the size of the head.

Bones affected by Paget’s disease can have more blood vessels than normal bones. Extensive bleeding may occur after a fracture or dental surgery.

At the Dentist
A dentist should monitor people with Paget’s disease closely if their jaw bones are affected. That’s because cancerous bone changes can occur over time.

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