Diabetes has become a common disease in recent years, and if not managed properly, it can have severe implications for different organs and systems, including the teeth. Recent research shows the negative impact of diabetes on bone remodeling and, consequently, its effect on the outcome of dental procedures.
Although diabetes itself isn’t a contraindication to orthodontic treatment, unmanaged diabetes might have considerable consequences for the result of the procedure.
Recognizing the significant relationship between braces and diabetes, we’ve decided to dedicate this article to discussing the effect of diabetes on oral health and providing valuable tips for prevention.
Different Types of Diabetes
Type 1. It’s known as insulin-dependent diabetes. Unfortunately, it’s commonly prevalent among people below the age of 20, but it can also occur as late as the fourth decade of life. Type 1 diabetes mellitus occurs when the body’s immune system destroys the pancreatic beta cells, leading to the inability of the body to secrete insulin.
Type 2. It’s known as non-insulin-dependent diabetes and typically occurs beyond the age of 40 due to a combination of insulin resistance, inadequate secretion of insulin from pancreatic beta cells of Langerhans, and excessive secretion of glucagon.
Type 3. Type 3 is known as gestational diabetes. Typically, women are more susceptible to this type of diabetes, especially during their pregnancy, due to hormonal changes.
Effect of Diabetes on Oral Health
Diabetes is the prevailing endocrinological disorder characterized by impaired glucose metabolism. This impairment can occur due to various mechanisms, such as pancreatic beta cell destruction, insulin resistance, insufficient insulin secretion, inappropriate glucagon secretion, or a combination of these factors.
It’s estimated that in the United States alone, over 30 million people, including 1.25 million children and approximately 0.24% of individuals below the age of 20, suffer from diabetes.
Let’s delve into the subject and enumerate its effects on our oral health.
Diabetes and gum disease
Periodontitis, known as gum disease, is a type of gum infection that can severely harm the bone supporting the teeth. Poor oral care can lead to an increased buildup of bacteria in your mouth and, consequently, tooth loss.
Always remember the direct connection between oral health and the level of blood sugar. Prolonged hyperglycemia (a high level of blood sugar) can lead to many dental issues.
When it comes to braces and diabetes, complications may arise due to the increased risk of inflammation associated with diabetes. This inflammation can cause bone loss and shift teeth into an undesired position. Moreover, gum disease puts added stress on the gums, which can complicate the orthodontic treatment, potentially leading to the need to stop the treatment early on, as braces also cause stress on the gums.
If you’re undergoing orthodontic treatment while you’ve got diabetes, consider these tips:
- Inform your orthodontist about your problem
- Avoid smoking
- Maintain a healthy diet and stay active.
- Brush your teeth after each meal, or at least twice a day
- Floss at least once a day
Gingivitis and Orthodontic Treatment
Gingivitis is the early stage of gum disease, which can lead to redness, swelling, and tenderness in the gums. It’s also associated with bad breath and gum bleeding.
Swelling of the gums in gingivitis brings the capillaries closer to the surface, increasing the risk of bleeding if traditional braces accidentally tear the skin. Gum swelling, if untreated, can obstruct the brackets.
Diabetes and tooth decay
Tooth decay is one of the most common problems that may occur for everyone, and it’s caused by the accumulation of bacteria on the teeth’s surface.
Generally speaking, the saliva helps balance the acid produced by bacteria. But in diabetes patients with high blood glucose levels, saliva may fail to effectively balance the acid, resulting in an increased risk of tooth decay.
Dry mouth and oral infection
Insufficient saliva and a high glucose level resulting from diabetes increase the susceptibility of our mouth to oral infection, particularly a fungal infection known as thrush. If you’re undergoing orthodontic treatment, these infections can get worse. Moreover, diabetes diminishes salivary production, leading to persistent thirst.
The symptoms of Gum Disease During Orthodontic Treatment
- An alteration in your bite.
- Tooth sensitivity is caused by receding gums.
- Redness, swelling, or tenderness in the gums.
- Bleeding when brushing or flossing.
Diabetes and Orthodontic Treatment
Although orthodontic treatment is a more common procedure among adolescents and young people, we have witnessed a significantly increased number of older people seeking orthodontic treatment. we see more and more people experiencing issues associated with diabetes and orthodontic treatment.
Based on the NCBI, at least 5% of people looking for orthodontic treatment suffer from diabetes, and around 4% of people were first diagnosed with diabetes at orthodontic clinics.
There’s a tight connection between braces and diabetes, as diabetes is associated with a local, systematic, and inflammatory response that severely damages our teeth.
Therefore, our advice to our patients dealing with diabetes is to properly control it by sticking to healthy diet and taking prescribed medicine to diminish the dental complications of the disease.
Again, based on the NCBI, 50% of people who have diabetes encounter oral and dental problems due to their disease at least once in their lives.
Common oral symptoms of diabetes include:
- Mouth dryness and burning
- Brittle teeth
- Gingivitis
- Dental caries
- Periodontitis (gum disease)
- Mouth ulcerations
- Oral acetone smells in poorly controlled patients
- Altered taste sensation
- Delayed healing of mucous membranes
- Recurrent oral infections, e.g., oral candidiasis
- Teeth disposition and misalignment
Braces and Diabetes: Treatment Considerations
When it comes to orthodontic treatment for diabetes patients, there are three considerations, as below:
Consideration before deciding on orthodontic treatment
Diabetes patients often experience misalignment and undesirable shifting of their teeth due to the erosion of gum bones caused by diabetes. Poor bone turnover in diabetes patients contributes to bone destruction and tooth misalignment.
As a result, it is not uncommon for diabetes patients to seek orthodontic treatment. We highly advise diabetes patients to tightly control their glycemic states by monitoring their glucose levels before undergoing orthodontic treatment. Good oral hygiene and periodontal health are also crucial for successful treatment.
Please note that diabetic patients who undergo orthodontic treatment without proper glucose level control are at a high risk of experiencing periodontal breakdown.
Diabetes has been linked to an increased risk of periodontal disease, which can lead to weak bones and tooth loss. Moreover, certain oral conditions may negatively affect diabetes management. For example, periodontitis has been shown to significantly elevate blood glucose levels and their variations.
However, researchers have found that diabetic individuals’ blood glucose levels can be brought under control after receiving treatment for their gum condition.
Since diabetes patients frequently experience periodontitis, it is essential to rule it out before starting orthodontic treatment, as inflammation can increase the chances of teeth moving erratically during orthodontic procedures.
Considerations during the process of orthodontic treatment
We’re fully aware that the teeth and dental tissue of diabetes patients are fragile, so during the orthodontic procedure, we apply light physiological forces and take all necessary measures to ensure their safety.
Please notice that the immune system of diabetes patients is often compromised, which may necessitate the consumption of antibiotic prophylaxis during orthodontic procedures. Patients who undergo band orthodontic placement, separator placement, or screw insertion are at high risk for oral infection, so prescribing prophylactic antibiotics as a preventive measure may be required.
Also, please keep in mind that simple adjustments or replacements of orthodontic appliances don’t require antibiotics.
Braces and diabetes: Diabetic emergencies during orthodontic procedures
The most dangerous emergency that may occur during the procedure is hypoglycemia, which occurs when the level of serum blood glucose drops below 50 mg/dL. To prevent this, patients are advised to have a meal on the day of orthodontic treatment.
If the level of blood glucose drops below 50 mg/dL, patients may go through two stages:
- Neurogenic (or adrenergic) stage: This stage is characterized by shivering, clod sweating, tremors, and tachycardia (rapid heartbeat).
- Neuroglycopenic stage: If the above stage is misdiagnosed, the patient may experience dizziness, blurred vision, confusion, generalized weakness, and, in severe cases, coma and death.
Dr. Mir, with many years of experience, is well-trained to manage and early identify hypoglycemia. Please note that if you’re suffering from diabetes, consult with Dr. Mir and let him know about your disease before undergoing orthodontic treatment.
Here is a summary of orthodontic considerations for diabetes patients:
| Considerations before orthodontic treatment | ·       Prioritize good oral hygiene and dental health
·       Tight control of diabetes ·       Exclude periodontitis ·       Monitor blood glucose before initiating orthodontic treatment |
| Considerations during the orthodontic treatment | ·       Apply light physiological forces to teeth during the procedure
·       Antibiotic prophylaxis may be needed before: orthodontic band placement, separator placement, screw insertion ·       Antibiotic prophylaxis isn’t required in: simple adjustments or replacements of appliances |
Conclusion
Diabetes is a common disease that can have a negative impact on your bone remodeling, which can subsequently lead to tooth misalignment.
Please notice that diabetes is not a contraindication to orthodontic procedure; however, uncontrolled diabetes can have significant consequences on the result of the treatment.
We want to assure you that Dr. Mir and the staff at York Orthodontics have solid background knowledge about diabetes, ensuring your safety and satisfaction with the result. We’re committed to providing you with a beautiful, long-lasting smile.
FAQ
Can diabetics get braces?
Yes, diabetes isn’t a contraindication to orthodontic treatment; however, before undergoing the procedure, it necessitates fully controlling the level of your blood glucose.
Why is sugar bad for braces?
Generally speaking, there is no good connection between sugar and braces, as sugar can increase the risk of tooth decay and gum disease.
When you consume sugary foods, the bacteria in your mouth start producing acids that attack the enamel, causing cavities.
If you have braces, the situation can get worse because it’s relatively harder to effectively clean the teeth. Therefore, food particles and plaque accumulate on the surface of the teeth, creating a perfect environment for bacteria to develop.
To prevent this, maintaining good oral hygiene is necessary, including regular brushing, flossing, and limiting sugar intake while wearing braces.
Regular dental check-ups and following your orthodontist’s instructions are crucial for maintaining oral health during your treatment.
How does diabetes affect orthodontic treatment?
Diabetes has a negative impact on bone remodeling, which is a crucial process for tooth movement during orthodontic treatment.
Poor bone quality and prolonged healing processes in people with diabetes may result in slower tooth movement and extend the duration of treatment.
Moreover, uncontrolled diabetes can lead to gum disease and infection, making patients more susceptible to tooth decay and oral infections.
To minimize the risk and achieve an optimal result, close monitoring and control of the level of blood sugar are essential during the orthodontic procedure.
Collaboration between your orthodontist and endocrinologist can ensure the optimal result and address any specific concerns that may arise during your procedure.
