Oral Care in Children with Type 1 Diabetes

Children with Diabetes are more prone to the development of oral infections and gum disease. Those who don't have good control over their blood sugar levels tend to have more oral health problems. Diabetes causes the blood vessels to thicken, which slows the flow of nutrients and the removal of harmful wastes. The body's reduced resistance to infection increases the risk of gum and bone tissue destruction.

Type 1 Diabetes and teeth

What is Type 1 Diabetes? It's a condition where the pancreas is unable to produce insulin. Insulin is a hormone that controls the amount of glucose (sugar) in the blood. Type 1 Diabetes is usually diagnosed in children and adolescents and is a lifelong (chronic) disease. In Type 1 Diabetes, the body is unable to make insulin to let glucose get into the cells. This leads to sugar build-up in the bloodstream where it can cause life-threatening complications.

Diabetes lowers the body's ability to fight infection and slows healing. People with Type 1 Diabetes must take insulin injections every day.

Studies prove that periodontal (gum) disease is the most common dental disease which can affect those who have Diabetes. Children with Diabetes face a higher risk of gum disease because of poor blood sugar management. In fact gum disease can actually cause a slight rise in blood sugar levels. Therefore, it is important to pay attention to the child's oral health to best avoid cavities and gum disease.

Diabetes can contribute to bacteria growth in the mouth, plaque build-up and gum disease while also weakening the body's ability to fight back. In order to maintain good blood sugar levels, one needs to maintain a good balance of food, exercise and medication. Hence, proper blood sugar control is the key to controlling and preventing oral health problems.

It is very important to understand the symptoms exhibited by children with diabetes. These include the following:

. Thirst

. Fatigue

. Weight loss

. Frequent urination

. Vision changes

. Fruity, sweet-smelling breath

Oral complications

Several oral complications occur in children with diabetes

1) Tooth Decay: Less saliva leading to dry mouth and higher chance of contracting cavities. Plaque is sticky film of bacteria that forms in the mouth. The bacteria feed on starches and sugar in the food and beverages and form acidic by-products that damage teeth and cause cavities. Regular dental visits, maintaining good oral hygiene and keeping blood sugar levels under control will help manage tooth decay.

2) Dry mouth: Dry mouth also leads to soreness, ulcers and infections. Dry mouth treatment includes taking medicine to keep your mouth wet that your doctor or dentist prescribes. Rinsing with a fluoride mouth rinse helps prevent cavities. Taking frequent sips of water helps. Using a humidifier, a device that raises the level of moisture in your home, at night might also help.

3) Inflamed gums: Gums may become inflamed due to accumulation of plaque. Overtime plaque hardens into calcium deposits known as tartar which can cause the gum line to become red and inflamed. It also causes the gum line to recede. Treatment includes daily brushing and flossing and regular cleanings at the dentist.

4) Oral wounds: Oral wounds take longer to heal. Treatment includes avoiding hot, spicy, salty, citrus-based and high- sugar foods. Gargling with salt water and taking pain medication as prescribed by the doctor is recommended. Eating ice or other cold foods helps alleviate pain. Avoid squeezing or picking at the sores or blisters.

5) Thrush: Thrush, a fungal infection occurs in the mouth. A high sugar level in the saliva promotes growth of fungus. Treatment includes medicine that the doctor or dentist prescribes to kill the fungus

Tooth care

1) Ensure your child brushes twice a day for two minutes at a time and flosses once per day. Use a soft toothbrush. Gently brush the teeth with the toothbrush angled towards the gum line. Use small, circular motions. Brush the front, back, and top of each tooth. Brush the tongue, too. Use dental floss to clean between your teeth at least once a day.

2) Flossing helps prevent plaque from building up on your teeth. When flossing, slide the floss up and down and then curve it around the base of each tooth under the gums use clean sections of floss as you move from tooth to tooth.

3) Make sure they stay hydrated as this will help keep their saliva levels high and fight plaque and dry mouth.

4) A diet rich in calcium and vitamin D helps to ensure strong bones and teeth.

5) Using a fluoridated toothpaste prevents plaque problems that cause cavities and gum disease

6) A visit to the dentist for professional dental cleanings should occur at least twice a year

7) Make sure the dentist knows that your child has Diabetes so that he/she can check for dry or white patches and see whether the gums are swollen or bleeding.

8) Keep your child's blood glucose numbers as close to the target as possible. Your child's doctor will help you set your target blood glucose numbers and teach you what to do if your numbers are too high or too low.

9) Eat healthy meals and follow the meal plan that you and your doctor or dietician have worked out.

10) Change the toothbrush every 3 months or sooner if the toothbrush looks worn or the bristles spread out. A new toothbrush removes more plaque.

Dr Reshma Shah is a qualified pediatric dentist and the director at '32 Reasons', a dental clinic in Mumbai.