No one enjoys going to the dentist, but for people with diabetes, getting cleaning andcheck-ups are especially important. While everyone is prone to periodontitis, or diseases of the tissues surrounding the teeth and gums, people with diabetes often have more severe cases of these conditions which can lead to additional diabetic complications.

Periodontitis or periodontal diseases involve inflammation and destruction of the tissues supporting and surrounding the teeth, including the gums and supporting bone. Periodontitis destroys the periodontal ligaments or connective tissue fibersthat attach the tooth to the bone causing resorption of the alveolar bone (tooth socket). Consequently, the gums swell, redden, change shape, bleed, teeth loosenand pus forms.

If an infection enters the gums it is referred to as gingivitis, the first stage of periodontitis. Bacteria that collect and breed at the gum line and the groove between the gum and the tooth cause the gums to redden, swell and bleed. Other signs include loose teeth, a bad taste in the mouth and persistent bad breath.

Blood glucose (BG) control and good oral hygiene seems to be the key to avoiding most dental complications in the diabetics. People with diabetes, regardless of age or type of diabetes, are more susceptible to periodontal diseases. There are several reasons for this.

First of all, people with diabetes have more sugar in the mouth which provides a more hospitable environment for hostile bacteria. High and fluctuating BGs are also a big factor in the increased risk of periodontal disease. Poor BG control means higher degrees of periodontitis and more vulnerability to complications.

It also makes healing more difficult once an infection sets in. At the same time, on-going infections may make BG control more difficult. Inflammation and infection affect BG control no matter where they occur.

Patients with diabetes may also experience dry mouth as a result of reduced saliva.Neuropathy and some medications may be the cause of reduced salivary flow.

In case of diabetics prevention is a key. By far the most important step that can be taken is to brush and floss regularly. It is advisable to discuss proper brushing and flossing techniques with your dental team. Prevention also includes making and keeping the dental appointment. Seeing the dentist at least twice a year, or as often as necessary is crucial.

If an infection is already present, it must be treated before any procedures can beattempted. Once diabetes is under good control, oral surgery can be performed without complication.

Many patients are fitted for dentures when teeth loss is occurs. They need to be removed and cleaned daily. Wearing dentures continuously and not taking the proper precautions can promote the growth of mouth fungus leading to thrush.

Dentures may also be ill-fitting and uncomfortable. This is because the gums of people with diabetes may be especially sensitive. This makes eating and proper BG control more difficult.

The dental team needs to know if their patients take oral agents or insulin because that means special precautions must be taken. They should also be familiar with the common signs of hypoglycemia and hyperglycemia.

GLOSSARY
alveolar bone – kość wyrostka zębodołowego 
attach – przyczepić, przymocować 
attempt – próbować, usiłować 
avoid – unikać 
beed – zagnieździć 
blood glucose – poziom glukozy/cukru we krwi 
case – przypadek 
check-up – badanie, wizyta kontrolna 
crucial – istotny 
destroy – niszczyć 
experience – doświadczyć 
fibre – włókno 
fit for dentures – dopasować protezy 
fluctuating – wahający, zmienny 
gingivitis – zapalenie dziąseł 
groove – rowek, bruzda 
healing – gojenie 
hospitable – (tutaj) przyjazny
hostile – wrogi, nieprzyjazny 
hyperglycemia – hiperglikemia
hypoglycemia – hipoglikemia 
ill-fitting – źle dopasowane 
key – klucz, kluczowy
lead – prowadzić do
loosen – obluzować
neuropathy – neuropatia
no matter – bez względu na
occur – pojawić się, wystąpić
on-going infection – trwająca infekcja
persistent – uporczywy
precautions – środki ostrożności
prevention – zapobieganie, profilaktyka
pus – ropa
redden – zaczerwienić się
regardless – bez względu na
salivary flow – ilość wytwarzanej śliny
susceptible – podatny na 
supporting bone – kość wspierająca zęby

Are these sentences true (T) or false(F)?

1. Some of the dental problems may lead to serious complications in the diabetic patients. ___
2. Periodontitis affects mostly the teeth supporting bone. ___
3. Gingivitis is the final and the most serious stage of periodontitis. ____
4. Blood glucose management is crucial in treatment and prevention of diabetic dental problems. ____
5. People with Type 2 diabetes are at higher risk for periodontal diseases. ____
6. High concentration of sugar in one’s mouth increases bacteria’s growth. ____
7. Dental infections may influence the BG level and may make it difficult to control. ___
8. Diabetic patients should schedule regular yearly check-ups. ____
9. Oral surgery is contra-indicated in the diabetics. ___
10. Oral thrush is common in people suffering from diabetes because many of them use ill-fitted dentures. ____

Complete the sentences with a proper form (noun, adjective, gerund, adverb, verb) of word in the bold print.

1. Please remember about your regular dental ___________ . CHECK
2. Different ____________ influence on glucose blood level. INFECT
3. The damage to alveolar bone causes teeth to ____________. LOOSE
4. ______________ - fitting dentures are extremely uncomfortable. BAD
5. Brushing and flossing are the most common _____________ measures.PREVENT
6. While the inflammation progresses the gums swell and __________. RED
7. The diabetics have decreased ____________ flow. SALIVA
8. _____________ of the type of diabetes, these patients have problems with healing process after various dental procedures. REGARD

Complete this lifestyle advice for your diabetic patients with words from the table.

If you are a diabetic, follow these 1)…………….:
• 2)…………….. your blood glucose regularly. Remember, good blood glucose control can help prevent mouth problems.
• Brush and 3)…………… every day.
• 4)……………. regular dental check-ups.
• Be sure to 5) ……………. your dentist that you have diabetes.
• Tell your dentist if your 6)……………..do not fit right, or if your gums are sore.
• 7)……………. smoking. Smoking makes gum disease worse. 
• Take time to 8)…………….. your mouth regularly for any problems. Sometimes people notice that their gums bleed when they brush and floss. Others notice dryness, soreness, white patches, or a bad taste in the mouth. All of these are reasons to visit your dentist.

Match terms with definitions

a) hyperglycemia          1. the jawbone that supports the teeth 
b) hypoglycemia            2. fungal infection in one’s mouth
c) gingivitis                    3. an abnormally high level of glucose in the blood
d) alveolar bone             4. damage to nerves in the body that occurs due to high blood sugar levels
e) periodontal disease   5. an abnormally low level of glucose in blood 
f) oral thrush                  6. gums’ inflammation
g) diabetic neuropathy   7. a bacterial infection that destroys the attachment fibers and 
supporting bone that hold the teeth in the mouth


Lesson 21 answers