Author: Adam R. Pershing, DMD

Maintaining excellent oral hygiene is important for diabetics, as they have an increased risk of developing oral infection and periodontal disease.

Diabetes is a health condition that makes it difficult to manage blood sugar levels, and as a result, can lead to high levels of sugar in the blood and saliva. Extreme blood sugar levels can weaken white blood cells, making it harder for the immune system to fight infection. In addition, sugar in saliva feeds bacteria, amplifying any existing infection in your mouth.

It’s also shown that periodontal disease makes it more difficult to manage blood sugar levels in diabetic patients, though the reason is not known. When present in diabetic patients, periodontal disease can increase chances of other serious conditions, including kidney disease and heart attack.

Common symptoms of gum disease include:

• Red and swollen gums
• Bleeding from brushing or flossing
• Receding gums
• Chronic bad breath
• Pain when chewing

Treatments for Periodontal Disease

• Antibiotics

Antibiotics for periodontal disease can be oral or topical. Topical antibiotics are put underneath the gum line to fight infection.

• Scaling and root planing

Scaling and root planing is a deep dental cleaning, where plaque is removed from below the gum line. This process often involves local anesthesia and sometimes is split into two office visits to complete.

Please let your healthcare provider know if you have or at risk for developing diabetes.

What is Halitosis?

Halitosis, also known as chronic bad breath, is often the result of improper care of your oral health. When you eat, food particles gather throughout your mouth, sticking to the surfaces of your tongue, in between your teeth, and on your gum tissue. Your oral bacteria break down these substances and release certain odors from the mouth. If left unmanaged, these odors eventually develop into halitosis. By learning what causes halitosis and what you can do to avoid it, you can maintain fresh breath.

What causes halitosis?

There are a few factors that cause halitosis, including:

• Poor dental hygiene: Poor brushing and flossing habits, or lack thereof, are common causes of bad breath. The bacteria in plaque feed on food particles left in the mouth and create odor-causing waste products. Basic oral hygiene should include brushing and flossing your teeth at least twice a day and seeing your dentist twice a year for checkups and professional cleanings.
• Gum disease: Halitosis is a frequent symptom of gum disease. When plaque and tartar build up, toxins from bacteria irritate gum tissue. This irritation can cause red, swollen, or bleeding gums, as well as persistent bad breath.
• Dry mouth: Saliva plays an essential part in your oral health. It not only helps you speak and eat, but it also disposes of any food debris. Dry mouth creates a shortage of saliva. Without the proper amount, your mouth can’t clean away dangerous pathogens. This creates unpleasant breath and results in other dental conditions.
• Oral infections: When you have an infection in the throat, mouth, or nose, bacteria spreads to your mouth through a post-nasal drip. The bacteria feed off your mucus while your body fights off the infection. These biological processes create bad breath.
• Tobacco use: Tobacco products leave a bad taste in your mouth, which creates halitosis. Smoking also dries out the mouth, leading to further complications that result in bad breath.

Treating Halitosis

Improving your dental hygiene is the best way to treat your halitosis. Take a step back and evaluate your daily routines. It’s important that you always brush your teeth at least twice a day for two minutes. Make sure that your toothpaste contains minerals such as fluoride, which helps to naturally eliminate bacteria. Another important activity is flossing, at least once a day. It’s even better to floss after every meal.

There are a few other lifestyle changes that can help, such as cutting back on caffeinated beverages, drinking more water, seeing your dentist twice a year, and chewing sugarless gum to help your bad breath while stimulating saliva production.

Our bodies are home to bacteria which are common in our mouths, but which can be dangerous elsewhere. For some people, especially those who have chronic medical conditions, specific cardiac conditions, or whose immune systems are compromised, bacteria that spreads throughout the bloodstream and into the heart can lead to a serious bacterial infection called infective endocarditis.

Generally, premedication is advised if you have one of these risk factors:

• A history of infective endocarditis
• Certain congenital heart conditions (heart conditions present since birth)
• An artificial heart valve
• A heart transplant

The American Association of Endodontists extends recommendations to patients who have undergone joint replacement surgery within the past two years, suffer from Type I diabetes, or have immune deficiencies from diseases such as lupus, rheumatoid arthritis, or HIV; cancer patients whose immune systems are suppressed because of radiation or chemotherapy; people who have had organ transplants; and people with hemophilia.

For these patients, any dental procedure may cause bleeding, and prophylactic antibiotic administration is recommended as a preventive measure.

Nutrition goes hand in hand with oral health. It can affect the speed at which oral diseases may progress. Such diseases include caries, periodontal disease, erosion, cancer, ulcers, and dry mouth. For some people, good nutrition may not be a possibility due to age, specific medical conditions, or socioeconomic status. For example, senior patients who experience tooth loss, reduced chewing ability, and decreased appetite may find that their nutritional choices are limited.

Nutritional Choices for Good Oral Health

One of the best ways we can maintain good oral health is by taking a step back and reflecting on what types of food and beverages go into our mouths every day. Take a look at the tips below and adjust your lifestyle accordingly to maintain your own oral health.

Fruits & Vegetables

All fruits have sugar, but did you know that some are better for you than others? While still better for you than other sugary treats, fruits like pineapples, oranges, and grapes are high in sugar and can affect the health of your teeth if eaten regularly enough. Apples are a great source of fiber and even act as “nature’s toothbrush” while you eat one. A great nutritional choice for your teeth is vegetables, especially ones high in fiber, like carrots, broccoli, and cauliflower. These vegetables can also act as “nature’s toothbrush.” Fruits and vegetables also contain many antioxidant vitamins, such as vitamin C, that help protect the gums from infection.

Acidic Beverages and Processed Sugar

Sugar attracts harmful bacteria. The bacteria consume the sugar and produce excess amounts of acid, which attacks your tooth enamel. Left unchecked, this can then lead to cavities and tooth decay. It’s recommended that you limit your intake of processed sugars such as candy and other sweet treats, as well as acidic beverages like coffee, juice concentrate, and soda. Acidic beverages not only create a breeding ground for bacteria and ultimately tooth decay and gum disease, but they are also the culprits behind unsightly staining on your teeth. Water is the healthiest option for your oral health. For example, hydration aids in saliva production, which is extremely important to help reduce infections in the mouth and throat. Saliva also helps protect your teeth and gums.

Brushing and Flossing

It is vital that you brush and floss your teeth at least twice a day to remove extra food particles and debris caught in between your teeth. If these particles and debris are left where they are, the conditions are perfectly set up for tooth decay to develop. However, after consuming something sugary or acidic, it is recommended that you wait 30 to 60 minutes before you brush. This is because the sugar and acid have softened the enamel on the surface of your teeth. You would actually be helping your teeth erode by brushing right after.

Visit Your Dentist

It’s important to visit your dentist twice a year. With special tools, your dentist is able to take a look at those hard to reach areas in your mouth that you might have missed with your toothbrush. Because of this, your dentist is able to see if there are any signs of an issue forming in your mouth. Early detection is the best way to treat a problem. At each of your visits, you will also get a professional cleaning done. Your dental technician will thoroughly clean and polish your teeth, even those hard to reach areas.

Nutrition and oral health are directly connected. Consider some of these tips and see where you can improve or change your nutritional habits to maintain your own good oral health.

It’s important to take good care of your teeth as you age. Elderly patients often need more frequent visits to stay healthy, as they are at a higher risk of oral complications, including extraction, tooth decay, and periodontal (gum) disease.

Electric Toothbrush

One of the best things you can do for your oral health, especially during your golden years, is to invest in an electric toothbrush. Whereas a traditional toothbrush takes a bit more elbow grease, electric toothbrushes clean your teeth while requiring minimal physical effort. This is perfect if you struggle with mobility. It cleans your mouth without jeopardizing your physical wellbeing.

Modify Your Traditional Toothbrush

If you are unable to invest in an electric toothbrush, there is a way to modify your traditional toothbrush. Try elongating the handle of your toothbrush. This way you can easily reach your back molars and other harder to reach areas. Look around your home for a few simple materials. Specifically, foam, rubber, or even tongue depressors can assist you. Wrap these around your toothbrush handle closer to its end. You should now have a longer toothbrush and brushing your teeth should be much easier.

Caretakers Can Help Too

If you live with or take care of an older individual, your help is important too. Gently remind them to brush twice a day and floss as well. If they have problems with physical tasks, assist them. You can also offer to give them rides to their dental appointments or even schedule the appointments for them. As dental care can be expensive, many communities offer public health programs for older patients, offering discounted or even free services. Reach out to your local social services or public health office to learn more.

Routine Checkups

Dental hygiene is extremely important for anyone, but even more so for senior citizens. It’s vital that senior citizens come in for routine checkups so that we can monitor their dental health. Sometimes poor dental health can be an indicator that something else is going on inside the body. Gently remind your senior of this and help them set up their next appointment.

Geographic tongue, also called benign migratory glossitis, is an inflammatory condition in which red patches appear on your tongue resembling continents on a globe.

The patches can appear on the top and sides of your tongue and sometimes other parts of your mouth. The shape and location of the patches can change day to day, but in general, these patches can last up to a year.

Geographic tongue is harmless, poses no health risk, and heals on its own. It isn’t contagious either, so it cannot be passed from one person to another.

The red patches come from the absence of the tiny bumps on your tongue called “papillae” that normally cover the entire surface of the tongue. These patches may:

• Change in size, shape, color, and location
• Appear and disappear over the course of up to a year
• Have a border that is often white or light-colored

Though most cases are symptom-free, some symptoms may include a burning sensation or pain in your mouth, in which case it might be best to:

• Avoid spicy or acidic foods, or dry, salted nuts
• Avoid cigarette smoke and alcohol
• Use a toothpaste for sensitive teeth, without intense flavors or whitening additives

Though the cause is unknown, geographic tongue is thought to be associated with a vitamin B deficiency.

If you are experiencing persistent and severe discomfort, your doctor may recommend:

• Over-the-counter pain relievers
• Zinc supplement
• Mouthwash with anesthetic
• Corticosteroids for the tongue