Do you have diabetes? Check your mouth!

By: Dr Cheah Chia Wei, Assoc. Prof. Dr. Lim Lee Ling

Diabetes affects 1 out of every 7 people living in Malaysia, close to half of them are undiagnosed. Malaysia has the highest rate of diabetes in Western Pacific region. The annual healthcare cost for diabetes was estimated at RM 4.4 billion in Malaysia.

Do you know that signs and symptoms of diabetes can be seen in the mouth too?

Studies have shown that the complications from diabetes include dry mouth/thirst, dental cavities, gum problems (swelling, bleeding pus discharge), increased tendency to fungal infections and burning mouth. This is in addition to the other types of diabetes-associated complications.

One important aspect to note is, about 50 % of the time people periodontitis are subsequently diagnosed as prediabetes (“borderline diabetes”), especially if they presented with severe stage periodontitis. Therefore, this poses an opportunity for the dentists to prompt these at-risk people to get themselves checked with their physicians. Meanwhile, a quick finger prick to test random blood sugar in the dental clinic can facilitate detection. In order to get a more accurate diagnosis, the physician can order other test such as HbA1c and oral glucose tolerance test (“glucose load test”). Notably, early detection of prediabetes with evidence-based intervention can prevent progression from prediabetes to overt diabetes and save the patients’ life.

Diabetes and gum problems can affect each other. Dentists always detect serious gum problems in people with poorly controlled diabetes. On the other hand, gum diseases that are not treated timely will also worsen blood sugar control. This means that physicians also play an important role to refer people with diabetes for gum treatment, to achieve an optimal control for diabetic conditions. Studies have shown that gum treatment can reduce the level of HbA1c by 0.3%. HbA1c is your average blood glucose (sugar) levels for the preceding three months. An ideal reading should be below 5.7%. If a person’s HbA1c is 5.7-6.4%, that is considered as prediabetes.

Untreated gum disease will progress and cause tooth loss. A compromised oral function affects one’s choice of food, which can affect the nutrition balance and overall health. Therefore, early detection and treatment for oral conditions has a significant role in the management of diabetes. People with diabetes and gum disease can also self-refer to the dental professionals for examination and treatment.

With the advancement in modern technology, patients can have their health records at their fingertips. There are many diabetes-related mobile apps to record and keep track of the disease, as well as to monitor dietary intake. The medical and dental professionals will work closely to ensure people with either prediabetes or overt diabetes are managed concurrently to have the optimal outcome. Controlling the progression of diabetes will reduce the risk of future complications and the financial burden to the people and healthcare system.

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Dr Cheah is a senior lecturer and consultant periodontist at the Department of Restorative Dentistry, Faculty of Dentistry; while Dr. Lim is an Associate Professor at the Department of Medicine, Faculty of Medicine, Universiti Malaya.