Those with uncontrolled or poor-controlled diabetics may experience a burning sensation in the mouth or tongue due to a reduced salivary flow.  There may also be an increased risk to tooth decay and fungal infections.

How is periodontitis treated in a diabetic patient?

The Periodontist (dental surgeon who specializes in gum disease) needs a certain amount of medical information such as the patient’s blood sugar level and the type of medication he/she is on.  Treatment may need to be modified according to the medication the patient is on and how well the diabetes is controlled.

A well-controlled diabetic is usually treated similar to a non-diabetic with periodontal disease unless there are other medical conditions present.  Patients are instructed to take their medications as perscribed and eat a normal breakfast.  Early morning appointments are preferred as a certain type of hormone that reduces stress is in greater quantities in the morning.

A poorly-controlled diabetic will be treated in collaboration with his/her doctor or endorinologist.  Gum treatment is still encouraged though these patients may not respond as well as well-controlled diabetics.  Early studies in the United States suggest that controlling periodontitis in the poorly-controlled diabetics may contribute to better blood sugar control.

In general, gum treatment consists of multiple sessions of deep scaling beneath the gums usually with local anaesthetic.  In certain cases, surgical treatment may be recommended.  Periodontal treatment may also be combined with treatment from other dental specialities especially if replacement of lost teeth is required.

What should I do to keep my oral health optimal at all times?

Prevention is always best.  Once periodontitis occurs, the amount of bone supporting the teeth that is lost cannot be regained.  Periodontal treatment will control the disease and helping the prevention of tooth loss buy may not fully correct the receded gums or lessen the looseness of teeth that has already occurred.

Optimal oral health can be achieved via:

1. Good control of diabetes via medication, diet, exercise as advised by the doctor.
2. Regular dental check ups that include gum checks and X rays.
3. Regular periodontal maintenance by a dentist or periodontist for patients who have had gum disease.
4. Good personal oral hygiene or home care.  Efficient tooth brushing and flossing techniques should be learned from the dentist or periodontist.

What is periodontitis?

Periodontal disease, more commonly called gum disease, is a chronic (long-standing) bacterial infection of the gums.  It is caused by plaque, which is a stickly, colourless or slightly yellow layer that accumulates on teeth.  In the early stage of the gum disease called gingivitis, the bacteria in plaque produces toxins (poisons) that leads to red and swollen gums.  As the disease progresses to periodontitis, the toxins destroy the bone supporting the teeth.  Although there is little pain in the early stages of periodontitis, gum swellings, pain and loosening of teeth may develop later.

How will I know if I have gum disease?

The following are some signs of gum disease:

• Red and bleeding gums
• Swollen and receding gums
• Bad breath
• Spaces appearing between teeth
• Loosening and shifting of teeth
• Vague itchiness or ache in the gums

How does having diabetes affect my gums?

In diabetic patients, the white blood cells (which protect against infection) are defective.  The amount of collagen necessary for healthy gums and good healing capacity are also reduced.  This is worse in poorly-controlled diabetics.  Hence, poorly-controlled diabetics have a poor healing capacity and an increased risk to periodontitis.  Periodontitis is also more severe in diabetics with more advanced diabetic complications and in those who have had diabetes for a longer time.

Well-controlled diabetics have a lesser risk to periodontitis compared to poorly-controlled diabetics.

Dr Yasmin Akrum, Gum Specialist, Singapore

I am Dr Yasmin Akrum.  I graduated from the National University of Singapore with a Bachelor of Dental Surgery in 1992. I was then based in the Institute of Dental Health followed by the Government Dental Clinic for 2 years. 

I embarked on specialist training thereafter and proceeded to complete my Masters in Science (Periodontology) at the Eastman Dental Institute, University of London in 1995. After working in the private sector for 5 years as a periodontist, I returned to the National Dental Centre (NDC) Singapore.

While in NDC, apart from a clinical practice restricted to the speciality of periodontics, I was also involved in the training of dental surgery assistants, dental hygienists/therapists and general dentists. My job scope there includes conducting research; providing consultations to general dentists and other specialists; conducting study clubs and lectures for Continuing Professional Education.

After 8 years, I left NDC to start The Oral Care Centre in 2008, with Dr Adeline Wong, a Prosthodontist. Presently, she is a visiting specialist at NDC overseeing clinical postgraduate studies as well as an adjunct senior clinical tutor in the Faculty of Dentistry, National University of Singapore, undergraduate programme.

With more than 12 years of speciality training experience, I honed my clinical skills to not only stabilise patients with periodontitis via conservative and surgical treatment but to also restore the function and aesthetics of patients utilising various soft and hard tissue grafting techniques and implant surgery.

I am a member of the Society of Periodontology (Singapore) , Academy of Medicine (Singapore) and registered on the Board of Dental Specialists.

I will be giving you tips on dental care at the Healthy Times Blog from time to time.  Do visit me often at the blog or at my clinic The Oral Care Centre located at Novena Square.

Dr Yasmin Akrum, Periodontist

Dr Yasmin Akrum's clinic The Oral Care Centre