His Sugars Were Off and So Was the Infection

Quick answer: Diabetes and dental infection make each other worse. High blood sugar impairs the immune response, so infections spread faster and heal slower; and an active infection raises blood sugar, which makes control harder. Both need treating at once.

The call

Yaakov, 58, from Migdal HaMayim, arrived on a Tuesday with a swollen lower jaw on the right that had been building for four days. He had type 2 diabetes, diagnosed nine years earlier, and — when we asked directly — had not checked his HbA1c in over a year. His home glucose readings that week had been running high, which he had put down to a bad few weeks generally.

What we found

Lower right second molar, non-vital, with a firm swelling in the buccal sulcus extending to the lower border of the jaw. The tooth had a deep untreated cavity. Mouth opening was reduced to about 25mm. Temperature 38.2. He looked unwell.

He also had generalised advanced gum disease, with 7 to 9mm pockets and several mobile teeth. That is not incidental. The relationship runs both ways and it is well established:

• Diabetes affects the mouth. Poorly controlled blood sugar impairs neutrophil function, reduces healing capacity and alters collagen metabolism. Gum disease is more common and more aggressive, infections spread more readily, and everything heals more slowly.
• The mouth affects diabetes. Chronic oral inflammation and acute infection both raise insulin resistance. His glucose readings had been climbing for a fortnight — the infection had been driving them up before the swelling appeared.

That is the cycle we needed to break at both ends.

What we did

Immediate: drainage. We anaesthetised, incised and drained the abscess, and extracted the tooth the same visit. It was not restorable — the decay ran below the bone on two surfaces, and in a patient with impaired healing and advanced periodontal disease, a heroic attempt to save it would have been the wrong call.

Antibiotics, at a full therapeutic dose, and reviewed at 48 hours rather than left to run.

Medical liaison. We phoned his kupah doctor the same afternoon. Two things needed saying: he had an acute infection that would elevate his glucose and might need short-term adjustment of his medication, and he needed his HbA1c checked. He was seen that week.

The gum disease. Once the acute episode settled, we started a course of periodontal treatment — deep cleaning under local anaesthetic over four quadrants, then three-monthly maintenance. Treating gum disease in diabetic patients has been shown to produce a modest but real improvement in glycaemic control, which is a genuinely useful thing to be able to tell a patient.

The outcome

The swelling resolved in five days and the socket healed slowly but uneventfully — slower than in a non-diabetic patient, which is normal and expected.

Over the following year his HbA1c came down substantially, with credit going mostly to his doctor and his own efforts, and partly to no longer carrying a chronic infection in his mouth. He kept every remaining tooth except one.

What to do if this happens to you

1. Tell your dentist you are diabetic, and give your most recent HbA1c if you know it.
2. Check your blood sugar more often during an infection. It will run higher than usual.
3. Do not wait. Infections in diabetic patients escalate faster and hesitating costs more.
4. Expect slower healing after extractions, and follow the aftercare precisely.
5. Have your gums assessed properly, with pocket measurements, not just a scale and polish.
6. Tell your doctor about dental infections. It affects your diabetes management.

Diabetic with a dental problem? Ramat Beit Shemesh Urgent Dental Care coordinates with your kupah doctor. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.