How chronic diseases affect oral health

Since the most common chronic diseases are diabetes, high blood pressure and heart disease, and because all three are significantly involved in the victim’s oral health, I will examine the implications.Diabetes mellitus commonly called “sugar” is really a syndrome and not a disease. While a disease is essentially a single entity, diabetes (mellitus and insipidus) is condition in which nearly every system is seriously affected. In fact, over 300,000 people die every year from this syndrome in the United States alone.

Diabetics suffer from a lack of an enzyme called insulin which is responsible for utilizing glucose. Without insulin, the blood sugar rises until it “spills over” in the urine. Protein and fat are burnt for energy, water is removed from the tissues and electrolyte (vital mineral particles) is lost.

Excessive lipolysis (fat breakdown) leads to a large amount of free fatty acids in the bloodstream. The acid in the blood interferes with the uptake of oxygen by the cells and may depress consciousness to the point of a coma. In addition, the high concentration of sugar in the blood eventually leads to glaucoma, skin disorders, heart disease, arthritis and an increased inclination for gangrene with amputation of the feet.

In a lecture to the general membership of the Guyana Diabetic Association, I highlighted three major consequences of diabetes on the oral health of its victims. First, there is oral thrush (candidiasis). This appears as a whitish, creamy deposit on the gums. The gums may also appear red. Thrush is actually a fungus infection and can be found also in babies as well as people with AIDS.

Another problem of uncontrolled diabetes is the lack of proper healing after an extraction or oral surgery since the condition somewhat hampers the regeneration process. So while the treatment for advanced gum disease is extraction, this should be avoided in a diabetic. The key therefore is prevention through meticulous oral hygiene. One must also avoid dentures that damage the gums. The oral tissues reflect the cellular dehydration by being prone to gingivitis and candidiasis.

Hypertension, (high blood pressure) is a major cause of excessive bleeding after an extraction. The condition also exposes dental patients to stroke (brain hemorrhage) because the dental anesthetic contains a substance capable of further elevating the blood pressure.

Some stroke risk factors cannot be changed, such as increasing age, gender (more men have strokes), diabetes mellitus, prior stroke and family history of stroke. Others can be controlled, including hypertension, heart disease, cigarette smoking, and lack of exercise, high cholesterol and high red blood cell count. Women using oral contraceptives tend to have more strokes.

Normal blood pressure is when the systolic pressure (when the heart contracts) measures less than 160 and diastolic pressure (when the heart relaxes between beat), measures less than 95. Ninety percent of hypertensive persons do not present a specific underlying cause. However, excessive salt intake, alcohol use, obesity, stress and genetic attributes are common contributory factors. These patients are susceptible to arteriosclerosis (hardening of artery wall) and enlargement of the heart due to that organ having to do extra work. The result is often death by heart failure.

Persons who have defective heart valves should be extra careful about their oral health. An extraction done in such individuals may lead to subacutebacterial endocarditis, a potentially fatal disease. In event that an extraction must be done, the patient must be covered with heavy doses of penicillin over a period of at least three weeks.

It is clear that many diseases cannot exist in isolation. There is always the involvement of other systems and organs. The principal cause of death among all human beings is cardiovascular disease (hypertension, heart disease, stroke etc). But the good news is that you need not be in statistics if you adopt a healthy lifestyle.

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