Diabetic Neuropathy and Oral Care Needs

Nearly 10% of the American population has diabetes. That’s more than 23 million people diagnosed, 7 million undiagnosed, and 1.5 million new diagnoses each year. Another 84 million adults have pre-diabetes. If you’re one of them, or care about someone who is, chances are you’ve heard at least a little bit about how the condition impacts oral health-- the links between diabetes and gum disease are well established.

Approximately 95% of people with diabetes have gum disease and those with gum disease are statistically more likely to develop diabetes too. In other words, these conditions influence one another. People with untreated gum disease often have trouble controlling their blood sugar and those with uncontrolled diabetes will usually see a rapid deterioration in oral health. One in five cases of total tooth loss is linked to diabetes because of this. But, for those with diabetic neuropathy, there are even more concerns. To be clear, 50% of those with Type 2 diabetes and 20% of those with Type 1 will develop diabetic neuropathy.

Diabetic neuropathy, nerve damage caused by uncontrolled blood sugar and other factors, most often impacts nerves in the legs and feet, but nerves throughout the body may be affected. It starts early, too. One study looking into people between the ages of 45 and 64 found that half already have the early signs of peripheral neuropathy when they’re newly diagnosed as pre-diabetic or with Type 2 diabetes.

A Myriad of Oral Health Concerns Emerge with Diabetic Neuropathy

Although they aren’t talked about nearly as much as they should be, people with diabetic neuropathy often suffer from debilitating complications that impact their oral health and thus the ability to eat, talk, smile, or even feel comfortable in many cases. These include:

• Dry mouth
• Burning mouth syndrome
• Impairment of taste and smell
• Periodontitis
• Tooth loss
• Temporomandibular joint dysfunction

We’ll break these complications down individually below and go over ways to help relieve the symptoms, but it’s important to note that this is something you should work with your dentist and physician on. Ignoring the symptoms, trying to treat them without a professional overseeing your care, or even assuming these symptoms are associated with your diabetes, can have catastrophic outcomes. The following should be used for information purposes only and should not be treated as medical advice.

Dry Mouth

Clinically known as xerostomia, dry mouth relates to diminished salivary flow or changes in saliva that prevent it from functioning properly. It’s a side-effect of many conditions, including certain types of neuropathy and even high blood sugar, plus can be brought on by medications as well. People who have xerostomia may experience a persistent dry feeling or have saliva that’s thick, ropy, or stringy. It makes it difficult to eat and speak, can cause bad breath, impacts the taste of food, make it difficult to wear dentures, and can contribute to tooth decay.

Methods to Address Dry Mouth

Dry mouth that’s brought on by high blood sugar will usually dissipate when levels are brought back into a normal range, but when it’s brought on by diabetic neuropathy, the approach tends to be palliative care. Per the Mayo Clinic, it’s important to work with your dentist to identify the cause and treat dry mouth, but the following the following solutions may help:

• Change medications. Oftentimes, medications are to blame for persistent dry mouth. Check with your physician and/or pharmacist to see if changing medications may help.
• Use products to increase moisture. Specialty saliva substitutes, moisturizers, and products containing xylitol may help keep your mouth lubricated and increase saliva production.
• Be diligent with oral care. Dry mouth increases the risk of tooth decay exponentially. Connect with your dentist to find out if you should have more frequent visits.
• Sip water. People often reach for sugary drinks to address the dryness or hoarseness, but this increases the risk of tooth decay.
• Chew sugar-free gum. Again, xylitol is great here. It not only boosts saliva production but may help fight off cavities too.
• Breathe through your nose. If you snore at night, report this to your doctor as you may need treatment for it.
• Keep the air moist at night. Using a humidifier may help.
• Moisturize your lips. This reduces painful cracks and infection risk.
• Avoid things that can worsen the symptoms. The list is long, but includes alcohol-containing mouthwashes, caffeine, alcohol, tobacco, antihistamines, decongestants, and foods that are sugary or acidic.

Burning Mouth Syndrome

As the name implies, burning mouth syndrome (BMS) is characterized by a burning, tingling, scalding sensation in the mouth that occurs for days, months, or even years at a time. Per the National Institute of Dental and Craniofacial Research, a division of NIH, can be persistent, come and go, or be triggered by specific activities, such as eating or drinking. It’s painful and impacts the tongue most often, but you may feel its presence on your lips, the roof of your mouth, or throughout your whole mouth. There isn’t a singular test that confirms a BMS diagnosis and it’s an “invisible” condition in that there are no visual hallmarks your dentist will notice when he does an exam. In most cases, it’s up to the individual to report the issue to a dentist or physician.

Methods to Address Burning Mouth Syndrome

According to the NIH, it’s a good idea to avoid acidic products, such as citrus juices and fruit, mouthwashes that contain alcohol, alcoholic beverages, tobacco, and spicy foods. The Mayo Clinic makes the following suggestions:

• Address dry mouth. Diminished salivary flow is often associated with BMS and can contribute to the symptoms.
• Use specific oral rinses or lidocaine. Although they don’t address the underlying issue, they may provide pain relief.
• Take prescription medications. A myriad of medications show promise in addressing BMS, including clonazepam, certain antidepressants, and medications that block nerve pain.
• Engage in cognitive behavioral therapy. People who suffer from BMS often experience anxiety and depression. A therapist can help you cope with chronic pain and learn strategies to address the emotional aspects of the condition.

Impairment of Taste and Smell

Research presented by the Practical Diabetes journal for medical professionals indicates that changes in taste and smell are relatively common among diabetics who experience complications. Diminished taste, especially to glucose, is a regular occurrence.

Methods to Address Impairment of Taste and Smell

According to Practical Diabetes, it’s incredibly rare for taste and smell impairments to be caused by diabetic neuropathy. In fact, just 0.05% of diabetic neuropathy cases involve cranial diabetic neuropathies. Because of this, physicians typically look for other causes first. For example, metformin is known to cause a metallic taste in some patients. Infections and sinus issues may be culprits for taste and smell issues too. Treating the underlying condition often resolves the issue in these cases. However, for those whose symptoms are truly attributed to neuropathy, the following tips are suggested:

• Avoid excess sugar. High tolerance to the taste of glucose often causes people to increase their sugar intake; a dangerous prospect.
• Don’t smoke. Smoking not only impacts taste and smell but increases oral health issues too.
• Avoid spicy and highly-flavored foods. This can help those who are prone to sweating, a common issue for those with diminished taste sensation.
• Be vigilant with hygiene. People often rely on their sense of smell or taste to gauge oral health. Without the senses, you’ll need to focus on routine and working with your doctor and dentist to evaluate health even more. The same is true for general health. As difficulty with wound healing is a major issue for diabetics, scent, or even touch sensations, cannot be relied upon. You’ll need to perform visual inspections of yourself on a regular basis.
• Engage in cognitive behavioral therapy. People who lose taste and smell report intense feelings of loss; not being able to feel comforted by the familiar scents of places and foods. Safety issues may also arise. Some report not being able to smell things like gas or smoke. Learning how to live with the complications is often a team effort. Consider working with a therapist and defer to your medical team for help.

Periodontitis and Tooth Loss

Early-stage gum disease is known as gingivitis. At this stage, the gums may be mildly inflamed or red. They seem a bit “angry” due to the buildup of plaque and often bleed when you brush or floss. People can usually get their oral health back on track at this stage by being extra vigilant with brushing and flossing and seeing their dentist for additional treatment as necessary. As gum disease advances, it becomes known as periodontitis or periodontal disease. At this stage, the gums start to separate from the teeth, which creates pockets. Plaque collects in them and begins adhering to the roots of the tooth as well as surrounding fibers and bone. Treatment is still possible at this stage, but additional treatments are necessary, including a more intensive dental cleaning to remove plaque below the gumline. If left unchecked, the condition morphs into “advanced periodontitis.” The structures below the gumline are destroyed and, as a result, teeth become loose.

For the diabetic patient, especially one coping with neuropathy that impacts the oral structures, it’s the perfect storm. Teeth are already likely struggling with decay, brought on by issues like dry mouth, supportive tooth structures are being decimated by advanced gum disease, and diabetic neuropathy may eliminate some or all the traditional warning signs, like discomfort or bad tastes and smells. It’s sadly no wonder why so many people with diabetes lose their teeth.

Methods to Address Periodontitis and Tooth Loss

“For a long time it was thought that bacteria was the factor that linked periodontal disease to other disease in the body; however, more recent research demonstrates that inflammation may be responsible for the association,” the American Academy of Periodontology (AAP) explains. “Therefore, treating inflammation may not only help manage periodontal diseases but may also help with the management of other chronic inflammatory conditions.” Tips to cope with periodontitis and tooth loss include:

• Follow the treatment protocol prescribed by your dentist. At a basic level, this usually means getting a “deep cleaning” or having scaling and root planing done to remove the buildup. Dentists often apply medication or antimicrobial agents or prescribe antibiotics during this stage. Afterward, more follow-ups are typically needed. Depending on the amount of destruction, your dentist may also recommend surgery to repair the damage.
• Brush after every meal and snack. Your gums need all the help they can get in order to become healthy again.
• Floss or use products to clean between your teeth at least once per day. Floss is the golden standard, but if you struggle with it, explore alternatives like picks and interdental cleaners. Water picks are great options too.
• Consider an electric toothbrush. While the debate rages on as to whether they actually clean better or not, people tend to have an easier time cleaning their teeth with them and most have a built-in timer, which increases the likelihood you’ll brush for the full two minutes suggested.
• Skip tobacco. It increases the risk of health complications of all types and impacts healing.
• Address any underlying issues. If things like dry mouth or an imbalanced diet are contributing to the issues, make sure they’re taken care of, so your oral ecosystem has everything it needs to be healthy.

Temporomandibular Joint Dysfunction

Given that diabetes is an inflammatory condition, it can impact the bones and joints throughout your body, but those who have diabetic neuropathy on top of it can lose sensation or experience chronic pain. The temporomandibular joint (TMJ) is sometimes impacted by this, resulting in temporomandibular joint dysfunction (TMD).

Methods to Address Temporomandibular Joint Dysfunction

As with the other complications outlined here, TMD treatment often differs depending on whether it’s truly related to neuropathy or not, so your doctors are likely to run tests to determine which treatments are best for your situation. A few TMD treatments WebMD mentions include:

• Connect with your dentist and perhaps a specialist. There are many medical interventions, ranging from night guards through trigger point injections and surgery, that may help. It’s also worth noting that a traditional home remedy for TMJ pain is the use of NSAIDs, like ibuprofen. These are generally not recommended for people with Type 2 diabetes, so speak with your doctor to find out what pain reliever he or she recommends.
• Have your dental work done. If you’re missing teeth or struggling with decay, your bite will probably be off, meaning your teeth won’t come together right and your jaw will be under even more strain. Even if you’re fighting an uphill battle in terms of work that needs to be done, start working through it as soon as you can.
• Cook foods thoroughly and use the blender when you can. Getting adequate nutrition is essential, but fresh fruits and veggies are harder on the jaw.
• Use moist heat or cold compression. Both have benefits, so use what feels best to you for ten-minute increments throughout the day.
• Try cognitive behavioral therapy. Sometimes daily stressors can have people clenching and grinding throughout the day, which can worsen the symptoms of TMD. Learning better coping techniques and how to catch yourself before the pain starts can help.

ORL Products May Help with Certain Oral Diabetic Neuropathy Complications

Again, it’s essential to work with your dentist and physician on a diagnosis and treatment, but ORL’s line of oral health care products offer a number of benefits that could help address some of the mouth-related issues associated with diabetic neuropathy.

Neutralize Your pH for Comfort and Health

Unfortunately, many other toothpastes and mouthwashes are lower on the scale; they’re acidic. That means they could make some of your symptoms worse or contribute to tooth demineralization and enamel erosion, which can result in tooth decay and sensitivity. ORL products are, by intentional design, a perfect 7.0 pH balance, so they’re not acidic and can help neutralize your oral ecosystem.

Tap into the Soothing and Cavity-Fighting Power of Organic Xylitol

It’s been shown to stimulate salivary flow, diminish plaque, and support the natural remineralization process. That means it may keep you more comfortable, help you stave off cavities, and fight gum disease.

Calm Your Symptoms and Support Oral Health with Natural Plant-Based Essential Oils

ORL toothpastes and mouthwashes contain a diverse mixture of wholesome essential oils ranging from coconut oil, which has been shown to fight gum disease and cavities, through clove oil, a time-tested analgesic and antibacterial agent.

Prevent Decay with Fortifying Vitamins and Minerals

Research shows that when the pH balance of your mouth is restored, your teeth will naturally pick up the vitamins and minerals in your saliva and become stronger. ORL products are packed with nourishing vitamins and minerals from calcium to phosphorus, reducing risk of tooth decay.

Explore ORL for Yourself

The products ORL creates are full of natural ingredients that support optimal oral health and are free of the things that don’t. Put your current oral health care products to the test—use our quick comparison tool to see the difference or pick some up and experience the difference for yourself.