DIABETES AND ORAL PROBLEM

DIABETES AND ORAL PROBLEM Diabetes, as many of us know, is a chronic disease, which occurs when the pancreas does not produce enough insulin, or when the  body cannot effectively use the insulin it produces. This leads to an increased concentration of glucose in the blood (hyperglycaemia). Type 1 diabetes (previously known as insulin-dependent or childhood-onset diabetes) is characterized by a lack of insulin production. Type 2 diabetes (formerly called non-insulin-dependent or adult-onset diabetes) is caused by the body’s ineffective use of insulin. It often results from excess body weight and physical inactivity. Gestational diabetes is hyperglycaemia that is first recognized during pregnancy. Diabetes is a silent epidemic and according to WHO there are 246 million people in the world living with diabetes. This is almost 6% of the world's adult population. Diabetes is an important 'silent killer disease' as there is usually no early symptom of the disease. The commonest early symptom is feeling thirsty. Diabetes is the number one cause of kidney failure in the world. Besides this every year it is responsible for 5% or 5 million blindness in adults and one million limb amputations. Diabetes is also an important cause of heart disease, stroke and cataract. The current cost of treating diabetes and its complications in the world is estimated as US $ 215-375 billion. The disease is growing fastest in developing countries where there are more people in the lower and middle-income group. Almost 90 to 95% of diabetes is of type 2 or maturity onset type; that affects people in their middle age. Type 1 or juvenile diabetes affects 70,000 children under the age of 15 years every year. The major cause of increase in the incidence of diabetes is a sedentary lifestyle. Exercise and diet can either reduce or delay the incidence of diabetes by over 50%. Central obesity or apple shape of the body and insulin resistance is the main reason for diabetes increase in Indians  Global Diabetes Statistics According to the International Diabetes Foundation, there are more than 300 million people living with diabetes worldwide. Nearly 80 percent of diabetes deaths occur in low- and middle-income countries. China has overtaken India as the world leader in diabetes cases. Diabetes cost the global economy at least US $376 billion in 2010, or 11.6% of total world healthcare expenditure The World Health Organization estimates that by 2030, more than 366 million people will be suffering from diabetes around the world, 10 times the number affected by HIV/AIDS. Of that 366 million, more than 298 million will live in developing countries, where most will not have access to adequate healthcare. 21 million Americans have diabetes. Diabetes in Asians is five times the rate of the white population INDIAN SCENARIO :   India is the diabetes capital of the world. It is estimated that currently there are 40 million people with diabetes in India and by 2025 this number will swell to 70 million. This would mean every fifth diabetic in the world would be an Indian. Over 30 million  have now been diagnosed with diabetes in India. The CPR (Crude prevalence rate) in the urban areas of India is thought to be 9 per cent. In rural areas, the prevalence is approximately 3 per cent of the total population. The population of India is now more than 1000 million: this helps to give an idea of the scale of the problem. The estimate of the actual number of diabetics in India is around 40 million. This means that India actually has the highest number of diabetics of any one country in the entire world. IGT (Impaired Glucose Tolerance) is also a mounting problem in India. The prevalence of IGT is thought to be around 8.7 per cent in urban areas and 7.9 per cent in rural areas, although this estimate may be too high. It is thought that around 35 per cent of IGT sufferers go on to develop type 2 diabetes, so India is genuinely facing a healthcare crisis. In India, the type of diabetes differs considerably from that in the Western world. Type 1 is considerably more rare, and only about 1/3 of type II diabetics are overweight or obese. Diabetes is also beginning to appear much earlier in life in India, meaning that chronic long-term complications are becoming more common. The implications for the Indian healthcare system are enormous.   Thus, you must have realised, how frightening the picture is,especially in our country. The rate at which  the incidence of diabetes is rising and with it the cost of treating diabetes and the resultant complications because of diabetes, is indeed very fearful and worrisome. Much has written about diabetes being the number one cause of kidney failure in the world and that it is responsible for 5% or 5 million blindness in adults and one million limb amputations and it is also an important cause of heart disease, stroke and cataract. But not much has been written about its co -relation with Gum diseases.     Let's ask these questions:                                                                                                                            Is There an Association Between Gum Disease and Diabetes? Many of those that have diabetes, may be surprised to learn about an unexpected complication associated with this condition.Research shows that there is an increased prevalence of gum disease among those with diabetes, adding serious gum disease to the list of other complications associated with diabetes, such as heart disease, stroke and kidney disease. Is There a Two-Way Street? Emerging research also suggests that the relationship between serious gum disease and diabetes is two-way. Not only are people with diabetes more susceptible to serious gum disease, but serious gum disease may have the potential to affect blood glucose control and contribute to the progression of diabetes. Research suggests that people with diabetes are at higher risk for oral health problems, such as gingivitis (an early stage of gum disease) and periodontitis (serious gum disease). People with diabetes are at an increased risk for serious gum disease because they are generally more susceptible to bacterial infection, and have a decreased ability to fight bacteria that invade the gums. The Surgeon General's Report on Oral Health states that good oral health is integral to general health.So be sure to brush and floss properly and see your dentist for regular checkups. If I Have Diabetes, am I at Risk for Dental Problems? If your blood glucose levels are poorly controlled, you are more likely to develop serious gum disease and lose more teeth than non-diabetics. Like all infections, serious gum disease may be a factor in causing blood sugar to rise and may make diabetes harder to control. Other oral problems associated to diabetes include: thrush, an infection caused by fungus that grows in the mouth, and dry mouth which can cause soreness, ulcers, infections and cavities. How Can I Help Prevent Dental Problems Associated with Diabetes? First and foremost, control your blood glucose level. Then, take good care of your teeth and gums, along with regular checkups every six months. To control thrush, a fungal infection, maintain good diabetic control, avoid smoking and, if you wear them, remove and clean dentures daily. Good blood glucose control can also help prevent or relieve dry mouth caused by diabetes. What Can I Expect at My Checkup? Should I Tell My Dental Professional About My Diabetes? People with diabetes have special needs and your dentist and hygienist are equipped to meet those needs - with your help. Keep your dentist and hygienist informed of any changes in your condition and any medication you might be taking. Postpone any non-emergency dental procedures if your blood sugar is not in good control. GOOD ORAL HYGIENE What Is Good Oral Hygiene? Good oral hygiene results in a mouth that looks and smells healthy. This means: Your teeth are clean and free of debris Gums are pink and do not hurt or bleed when you brush or floss Bad breath is not a constant problem  If your gums do hurt or bleed while brushing or flossing, or you are experiencing persistent bad breath, see your dentist. Any of these conditions may indicate a problem. Your dentist or hygienist can help you learn good oral hygiene techniques and can help point out areas of your mouth that may require extra attention during brushing and flossing. How Is Good Oral Hygiene Practiced? Maintaining good oral hygiene is one of the most important things you can do for your teeth and gums. Healthy teeth not only enable you to look and feel good, they make it possible to eat and speak properly. Good oral health is important to your overall well-being. Daily preventive care, including proper brushing and flossing, will help stop problems before they develop and is much less painful, expensive, and worrisome than treating conditions that have been allowed to progress. In between regular visits to the dentist, there are simple steps that each of us can take to greatly decrease the risk of developing tooth decay, gum disease and other dental problems. These include: Brushing thoroughly twice a day and flossing daily Eating a balanced diet and limiting snacks between meals  Using dental products that contain fluoride, including toothpaste  Rinsing with a fluoride mouthrinse if your dentist tells you to  Making sure that your children under 12 drink fluoridated water or take a fluoride supplement if they live in a non-fluoridated area. I] Proper Brushing Technique: As shown in the pictures below, there are three steps involved: 1] Tilt the brush at a 45° angle against the gumline and sweep or roll the brush away from the gumline. 2] Gently brush the outside, inside and chewing surface of each tooth using short back-and-forth strokes. 3] Gently brush your tongue to remove bacteria and freshen breath  I] Proper FlossingTechnique: These pictures (below) show the proper flossing technique.  Use about 18" of floss, leaving an inch or two to work with. Gently follow the curves of your teeth. Be sure to clean beneath the gumline, but avoid snapping the floss on the gums. III] Selection of proper tooth brush: What Type of Toothbrush Should I Use? With so many shapes, sizes and styles of toothbrushes on the market, deciding which kind to buy can be confusing. Here's what you should look for: Most dental professionals agree that a soft-bristled brush is best for removing plaque and debris from your teeth. Small-headed brushes are also preferable, since they can better reach all areas of the mouth, including hard-to-reach back teeth. When it comes to the type of handle (such as non-slip grip or flexible neck), shape of the head (tapered or rectangular), and style of bristles (such as rippled, flat or trimmed to a dome shape), pick whatever is most comfortable for you. The best toothbrush is one that fits your mouth and allows you to reach all teeth easily. For many, a powered toothbrush is a good alternative. It can do a better job of cleaning teeth, particularly for those who have difficulty brushing or who have limited manual dexterity. How Often Should I Replace My Toothbrush? You should replace your toothbrush when it begins to show wear, or every three months, whichever comes first. It is also very important to change toothbrushes after you've had a cold, since the bristles can collect germs that can lead to reinfection.   A worn toothbrush (top) can damage gum tissue. Replace your toothbrush every three months or when it becomes worn.  The purpose of writing this article was to educate those have diabetes and be of some help to them, and I do hope that I have succeeded in my endeavour, at least to a certain extent.    Vinay Trilokekar