Orthodontics: How increased sugar levels affect the teeth

Diabetes has consequences throughout the body, but one of the lesser-known ones is that it increases the risk of periodontal disease and other problems that manifest in the mouth.

As with all complications of diabetes, dental ones can be largely prevented with good glycemic control and careful oral hygiene, not only at home but also at the dentist’s office.

But how can uncontrolled blood sugar affect oral health? “Medical research has highlighted many factors that may contribute to oral complications of diabetes, including disturbances in collagen metabolism and the functionality of many immune cells, such as polymorphonuclear cells, neutrophils, and macrophages,” says Dr. Katerina Douma-Michelaki, DDS, PhD, a specialist in Orthodontics for Children & Adults. “These types of disturbances pave the way for many problems, such as reduced saliva production, which causes dry mouth and indirectly promotes tooth decay, as saliva has a protective effect on the teeth.”

Additionally, it may favor inflammation and bleeding that signal gingivitis and periodontal diseases, increase susceptibility to oral infections from fungi such as candidiasis and lichen planus, lead to tooth loss, disrupt taste, and naturally slow down the healing of any sores in the mouth, as it does throughout the body. Especially in young children, the consequence can be early eruption of permanent teeth.

At the core of all these problems is hyperglycemia, or increased blood sugar (glucose), which exacerbates all pathogenic processes through which infections and inflammation develop in the mouth. Practically, this means that when glucose levels rise in saliva, it encourages the multiplication of mouth bacteria and stimulates the development of inflammation, while accelerating the breakdown of the supporting structures (connective tissue, bones) of the teeth. Moreover, increased blood glucose weakens the immune system, making the body more susceptible to infections.

Dental problems are very common in people with diabetes. It is estimated that at the time of diagnosis, at least one in five people with type 2 diabetes (the most common form of the disease, representing nearly 95% of cases) have severe periodontal disease with damage to the tissues supporting the teeth (from soft tissues to the alveolar bone), and that one in five cases of tooth loss is related to increased blood sugar. Studies have shown that inadequate glycemic control is associated with increased frequency and severity of periodontal disease, with the level of glycemic control and the duration of diabetes directly related to its severity.

Oral candidiasis is also very common in people with diabetes because the responsible fungus, Candida, thrives when there are higher levels of glucose in saliva. Candidiasis creates a whitish membrane on the tongue and the inner part of the gums (cheeks), and it is more common in people who wear dentures.

However, the most important thing is that the diabetes-oral inflammation connection is bidirectional: other studies have shown that chronic inflammation in the mouth increases the body’s resistance to insulin, making glycemic control more difficult—and for someone already suffering from diabetes, this means additional strain on an already difficult condition. Thus, a vicious cycle begins that leads to even more difficult glycemic control and more severe periodontal disease, with an increased risk of developing other complications both short-term and long-term.

All of this essentially means that “uncontrolled diabetes is a contraindication for orthodontic treatment when accompanied by periodontal disease,” emphasizes Dr. Douma-Michelaki. “Orthodontic treatment should only begin once the periodontal disease has been treated and a thorough cleaning of the tartar that promotes gingivitis has been performed. Additionally, patients should maintain proper hygiene and regulate their blood sugar throughout the duration of orthodontic treatment and afterward, in order to maintain a good result and protect their overall health and specifically their oral health from new problems.”

It is also very important that patients keep their orthodontic appointments for re-evaluation of the orthodontic appliances that have been placed, as well as to assess the condition of the periodontal tissues and the pulp of the tooth (the pulp is the “living” part of the tooth located at its center).

The orthodontic appointment should be scheduled after the consumption of at least one meal to avoid any cases of hypoglycemia, while patients undergoing orthodontic treatment should avoid smoking. Furthermore, those using removable orthodontic appliances should clean them thoroughly, strictly following the orthodontist’s instructions, advises Dr. Douma-Michelaki. Finally, they should clean their teeth at least twice a day with a soft toothbrush and dental floss, and avoid foods that stick to the teeth, soft drinks, juices, and isotonic beverages, whether or not they contain sugar.