This blog post is written in the spirit of “the more information, the better.” I have nothing to gain by scaring young or newly diagnosed diabetics. Sharing my knowledge and experience is, however, a great gain to me, one of the few things I can offer the diabetic community. That said, you don’t need another source of anxiety or resentment: this disease is riddled with them. If I wasn’t so vain this may not be an issue at all, come to think of it. Anyway…
Let me start by saying, I have bad teeth. I’ll refrain from speaking of diabetics as a whole having poor dental health and just stick to what I know: I know the bad teeth of which I speak are in my head. (Some are no longer in my head, true, but we’ll take that into account when it comes up.) I’m going to briefly run through issues that can be identified as contributing factors of poor dental health in people with diabetes.
oHypoglycemia at nighttime. When you’re a child – or have a child – who wakes up hours after bedtime in a panic of sweat and tremors, instinctually we reach for sugar. My go-to candy was Lifesavers and a roll of those things was never more than a few feet away. I would mash my teeth together, breaking the candy pieces into shards with jaws like an ice-breaking ship, impacting my teeth with a sugar coating that I could still taste in the morning. At another point in my diabetes history I would keep one of the beloved plastic honey bear bottles on my nightstand, intentionally within arms reach. More than once I’ve woken up with sweet, crystallized drool hardened to my face. Believe me, brushing my teeth after a nighttime low was never a priority during childhood and, quite frankly, isn’t even now. When you feel that your very grip on existence and hope of survival are shaky, dental hygiene takes a rear seat.
oMedication. Medication affects ones teeth in more than one way. Probably more than twoways actually but these are the two I know have impacted my choppers: (1) they can cause discoloration and (2) they often cause dryness that promotes decay. Neither of these side effects are limited to diabetics but, as a population, we really take a lot of meds. Dryness – the lack of saliva – is basically like a carwash without water; having a dry mouth, or xerostomia, prevents the body from naturally cleaning itself. This leads to gum disease and, you guessed it, tooth decay. More than one dentist has recommended I chew gum, which is why I have jaw muscles like a pitbull (and quite excellent breath).
oHigh blood sugars. High sugars lead to dry mouth and, as I stated above, dry mouth can have it’s own headaches. First of all, high blood sugars make mouths dry by simple dehydration of the body. But worse, saliva in our mouths has glucose in it! Diabetics without good control are like plaque farmers: plaque is a basically undesirable germ that causes cavities and tooth decay. High levels of glucose in saliva also creates the perfect environment for candida (a.k.a. oral thrush, a.k.a. yeast) infections. Yes, more good news.
oCirculation. Yeah, you’ve heard this before: diabetics can have poor blood circulation. You heard me right: it’s not limited to your fingers and toes. Nerve damage (diabetic neuropathy) associated with diabetes can weaken the function of the salivary glands causing a decrease in production of saliva. Yes, here we are at Dry Mouth Syndrome again.
oSelf-care becomes jeopardized. Now Ireeeeeally am just speaking for myself (I’m hoping this topic will ring familiar with one or two of you). How many studies confirm depression is endemic in chronically diseased individuals? The answer lies somewhere between 8 and 8,000. Depression is the WORST complication because it can affect every area of your self-management. Self-care means you have to care for yourself (see how I did that?) and when you’re battling depress=ion (or completely flattened by it) sometimes brushing your teeth is too much to ask. Again speaking for myself, I’ve been there.
oFinances. I know, I know! I’m a broken record when it comes to complaining about the expense of diabetes (and wanting the same things other people want – like, specifically, Kate Spade bags). Here’s my beef: when you have conditions in your mouth that are known to be a result of diabetes AND these conditions bring on serious oral problems, why can’t you find a dentist who knows anything about this? Hygienists are the worst! I can’t tell you the number of times I’ve suggested my hygienist go back to school for a year, educate herself/himself on diabetes and oral health, and open their own specialty clinic. Seriously, the amount of money diabetics spend on eye care is but a fraction of the expense of dental work and yet we hear so much more about our vision.
Anyhoo, that’s what inspired this week’s cartoon (on my website it’s the previous post). Who wouldn’t laugh at the Tooth Fairy being hit up for more money because the diabetic owes so much to the dentist! (I might need to explain that breaking someone’s knees is a stereotypical punishment – and threat of worse to come – that mafia hitmen used to use when people were slow paying their debts.) That’s what we call ironic humor