Poor oral health is common in children and adolescents with type 1 diabetes, even in those with optimal glycaemic control.
More specific information for parents on how to manage night-time feeding to prevent hypoglycaemic episodes may be one strategy to reduce the damage.
A cross sectional study of 80 young people attending the Royal Children’s Hospital diabetes clinic in 2018 comprised an oral examination and questionnaire about oral hygiene and dietary habits.
Participants had a mean HbA1c of 7.7% and half reported hypoglycaemic episodes at least three or more times-a-week, requiring home management with rapid-acting carbohydrates.
The study, published in Paediatric Diabetes, found 58.7% of the participants experienced dental caries including advanced carious lesions.
Almost two-thirds of the children had moderate gingivitis (62.5%) or mild gingivitis (31.2%) and only 6.3% had healthy gums.
Most participants had normal to high salivary flow rate (77.5%) and neutral salivary pH (75.0%) while almost half had normal acid buffering capacity (48.0%).
“The findings of this study are of major importance for children with T1D as poor oral health and untreated caries adds to their overall treatment burden and can significantly impact their overall quality-of-life,” the study authors said.
There was no evidence of an association between HbA1c or other diabetes-related factors and caries experience or gingival health.
Not surprisingly, there was a strong association between daily oral hygiene practices – tooth brushing and flossing – and better oral health.
The study authors noted that more than half of the children (56.6%) consumed sweets and candies several times-a-week or more, and (52.6%) consumed sweet cakes and biscuits several times-a-week or more.
“A total of 24/80 (30.0%) parents reported regularly giving additional snacks either before bed or overnight to prevent a hypoglycaemic episode from occurring. Snacks included a combination of rapid- acting and sustaining CHO-containing foods.”
“Episodes of hypoglycaemia are inevitable in children with T1D; however, the potential adverse effects of frequent hypoglycaemic treatment with sugary foods or drinks on the dentition cannot be overlooked,” the study said.
“For instance, it is known that different types of foods have varying levels of retentiveness in the oral cavity, and therefore can influence the rate of clearance from the oral cavity. This in turn can influence the pH of the plaque biofilm which has a significant role to play in the development of dental caries.”
The study authors said choosing less sticky or chewy foods, ensuring adequate consumption of fluoridated water, and using drinking straws to minimise contact between sugary drinks and tooth surfaces were advisable.