Diabetes and oral health

Diabetes is a common condition affecting millions of people. Diabetes affects several organs and systems throughout the body. The most well-known complications of diabetes include heart disease, poor blood circulation, diminished eye-sight and kidney function, slower healing of wounds, and a reduced resistance to infections. Oral health is also associated with diabetes. Good oral health can be enjoyed if the blood glucose levels can be maintained and the mouth is well looked after with thorough daily oral hygiene and regular dental check-ups.


How frequently should you now attend check-ups?
Is your oral hygiene good? Does it need to be improved?
How often should you have professional cleanings and check with the dental hygienist?
Do you need referral to a periodontist (gum health specialist)?
What should you do if your mouth becomes dry?
If you need dental treatment, how should it be scheduled around mealtimes and dosing of any medication?


Names and dosages of all prescription and over-the-counter medicines
The contact details of your primary care physician and/or endocrinologist
Your HbA1C level if you know it (a measure of glucose in the blood)
If you have had any hypoglycemic episodes or insulin reactions


Follow the advice and instructions of your dentist and dental hygienist
Take all drugs as prescribed and follow the advice of your medical professionals
Call your dental office if you encounter any problems between scheduled check-ups, such as bleeding gums
Schedule regular dental check-ups


Diabetes affects many aspects of your overall health and well-being
Good blood glucose control helps minimize the complications of diabetes
Follow the advice and instructions of your physician and dentist—they can help you stay healthier
Tell your physician and dentist of any changes you notice in your mouth, especially bleeding or dryness.
Quit smoking – smoking is a major cause of gum disease

Years of research by medical and dental researchers have shown a link between diabetes and oral health. In patients with diabetes many body systems and organs can be affected by complications. The complications that may occur in the mouth include:

  • Gum diseases
  • Dry mouth
  • Root caries (tooth decay of the root of the tooth)
  • Fungal infections
  • Denture problems
  • Poor healing

Figure: Diabetes may be associated with several complications in the mouth.

Gum diseases are a complication because diabetes results in a stronger inflammatory response to dental plaque. People with diabetes are much more likely to have gum disease than people without diabetes. The common forms are caused by the bacteria in the dental plaque leading to an inflammatory reaction from the body. The signs of inflammation are redness, bleeding, and swelling.

The milder form of gum disease (gingivitis) is generally reversible with improved removal of dental plaque and a professional cleaning. The most noticeable changes in gingivitis are gums that look red and puffy, and that bleed on gentle brushing.

Figure: Gingivitis. The right hand side of the tooth shows red, puffy and swollen gums. The left side shows health for contrast.

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The more severe form of gum disease (periodontitis) leads to destruction of the bone that holds the tooth into the jaw resulting in loose teeth, a changing appearance of the gums making the teeth appear longer, gum abscesses, foul breath, and eventually loss of the teeth. Periodontitis can progress rapidly in people with diabetes.

Figure: Periodontitis. The right hand side of the tooth shows inflammation, gum recession, and destruction of the bone.

Dry mouth is a complication of diabetes due to a decrease in saliva production. Saliva is important for good oral health through cleansing the mouth of food debris that may lead to dental decay, protecting the tissues by lubrication enabling speech and swallowing, and providing a plentiful supply of minerals to nourish the teeth. Any decrease in saliva will compromise oral health and may lead to dental decay, ulcers, and infections. If removable dentures are worn, a lack of saliva as in dry mouth will result in poor retention and stability of the denture. Without this natural lubrication, the denture will rub the tissues, causing sores that may become infected.

Root caries can be a dental complication of diabetes in people who have gum recession and exposed roots. The cause is not clear, other than with dry mouth there will be reduced protection from saliva. Root caries can be challenging for a dentist to treat successfully.

Fungal infections may be a complication of diabetes. When taking any antibiotics, the bacteria in the mouth change and enable fungi to grow, forming an infection of the soft tissues and lining of the mouth. Commonly known as thrush, these white or red areas of fungal infection may lead to a burning feeling of the mouth or tongue.

Denture problems may arise as a complication of diabetes. Diabetes increases the risk of fungal infections under and around the denture, so cleaning and routine check-ups with your dentist are essential. Removable dentures should be cleaned thoroughly by brushing with a proprietary cleanser at least once per day, and removed and rinsed after meals to remove food debris. A loose fitting denture is likely to cause mouth sores and, if the blood glucose levels are not well-controlled, these will become infected and not heal. Taking your dentures out at night and soaking them in a cleaning solution will help prevent fungal infections and sores as well as give your mouth a rest from the presence of the denture.

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Poor healing is a complication of diabetes after any type of oral surgery, as wounds heal more slowly and are more likely to become infected. Dental implants cannot generally be fitted in diabetic patients who have poor blood glucose control, as the implants are more prone to poor healing and infection.

Gum disease is caused by the body reacting to the bacteria in dental plaque. The main feature of this reaction is inflammation—redness and swelling of the tissues that may bleed easily, even on gentle toothbrushing. The body produces many different chemicals in tissues that are inflamed—to defend against infecting bacteria, to help remove damaged and dead cells, and to encourage the repair and growth of new cells and tissues. These chemicals spread around the body in the bloodstream and may make it more difficult for people who have diabetes to control their blood sugar, only making their diabetic condition worse.

There are three things you must do:

  • Control your blood glucose level. Follow the advice and instructions of your medical professional and schedule routine checks as prescribed.
  • Take the best care you can of your teeth and gums every day. Good oral hygiene and plaque control are essential for a healthy mouth and body.
  • Brush all teeth and gums thoroughly with a quality toothbrush that is designed to reach into and help clean all the areas that are difficult to reach. It is here that the dental plaque builds-up—especially along the gum margin, under the gums, and between teeth. Use a fluoride toothpaste to help prevent dental decay.

Figure: Toothbrushes with extremely tapered bristles can reach further under the gum and between the teeth in the hard to reach areas than regular ‘end-rounded’ bristles.

  • Hold the brush so the bristles are pointing toward the gum margin at 45-degrees to the tooth roots and move the brush back and forth with short strokes, making sure all surfaces, and all sides of all teeth, get brushed equally. This should take about two minutes to do well. Check with your dental hygienist for the technique that suits your mouth best.

Figure: Position the brush so that the bristles make a 45-degree angle with the tooth.

  • Toothbrushes are not able to clean perfectly in the hard to reach areas between teeth—a place where bleeding often happens and gum disease starts. Each day, use an interdental brush to clean between each and every tooth. With the correctly designed product, this between-teeth-cleaning is both very simple and very effective. Dental floss may also be used in place of, or as well as, an interdental brush but flossing is perceived to be more difficult to perform and is not any more effective.
  • Visit your dentist as soon as you have received a confirmed diagnosis of diabetes, and discuss your current dental health and any changes you should make in your dental routine.