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Diabetes and Oral Health

Diabetes that is not well controlled can lead to periodontal (gum) diseases in both young and old people. Periodontal diseases are infections of the gums and bone that hold the teeth in place.

Diabetes and periodontal (gum) diseases

Diabetes causes blood vessel changes. The thickened blood vessels can impair the flow of nutrients and removal of wastes from body tissues. This impaired blood flow can weaken the gums and bone, putting them at greater risk for infection.

In addition, if diabetes is poorly controlled, higher glucose levels in the mouth fluids will promote the growth of bacteria that can cause gum disease. On the other hand, uncontrolled periodontal disease may make it harder to control the diabetes.

A third factor, smoking, is harmful to oral health even for people without diabetes. However, a person with diabetes who smokes is at a much greater risk for gum disease than a person who does not have diabetes.

Paired with poor oral hygiene, diabetes can lead to gingivitis, the first stage of periodontal disease, or to periodontitis, which is severe gum disease.

What are the signs and symptoms of periodontal disease?

These are the most common signs and symptoms of gum disease:

  • Red, swollen, tender gums

  • Bleeding while brushing or flossing

  • Receding gums

  • Loose or separating teeth

  • Persistent bad breath

  • Dentures no longer fit

  • Pus between the teeth and gums

  • A change in bite and jaw alignment

The signs and symptoms of gum disease may look like other conditions or medical problems. See a dentist or other oral health specialist for a diagnosis.

What are the different types of periodontal disease?

The different types of periodontal disease are often classified by the stage of the disease at the time of evaluation, including:

  • Gingivitis. Gingivitis is the mildest form of periodontal disease. The gums are likely to be red, swollen, and tender, causing them to bleed easily during daily cleanings and flossing. Treatment by a dentist and proper, consistent care at home help to resolve gingivitis.

  • Mild periodontitis. Untreated gingivitis leads to mild periodontitis. This stage of gum disease shows evidence of the development of periodontal pockets (gums pulling away from the teeth, causing the crevice between the teeth and gums to deepen) and early loss of bone around the teeth. Prompt dental care is needed to prevent further break down of bone and gum damage.

  • Moderate to advanced periodontitis. This is most advanced stage of gum disease. It causes serious bone and tissue loss, deepening of periodontal pockets, and possibly receding gums surrounding the teeth. Teeth may loosen and need to be pulled.

Treatment for periodontal disease

Your healthcare provider will figure out the best treatment based on:

  • How old you are

  • Your overall health and medical history

  • How well you can handle specific medicines, procedures, or therapies

  • How long the condition is expected to last

  • Your opinion or preference

Treatment may include the following:

  • Tartar and plaque removal beneath the gums. Deep cleaning (also called scaling and root planing) can help remove the plaque and calculus beneath the gum and infected tissue in the early stages of the disease, while smoothing the damaged root surfaces of the teeth. The gums can then reattach to the teeth.

  • Medicine. Your dentist may place antibiotics in the periodontal pockets or prescribe a pill.

  • Surgery. When the disease is advanced, your dentist will clean the infected areas under the gums, and reshape or replace the tissues. Types of surgeries include pocket reduction, periodontal regeneration, soft tissue graft, or crown lengthening.

Diabetes and other oral problems

Diabetes can also cause other oral problems, including:

  • Thrush. Thrush, a fungal infection of the mouth, occurs more often in people with diabetes because of high glucose (sugar) levels in the saliva. Fungus thrives on glucose.

  • Dry mouth. Dry mouth (often a symptom of undetected diabetes) means the mouth does not have enough saliva to keep itself wet. Saliva is needed to help digest food, and prevent infection and tooth decay by controlling bacteria and fungi. Dry mouth can make tasting, chewing, and swallowing food difficult, and can impede speech. In addition, dry mouth can cause mouth infections and tooth decay.

Symptoms of dry mouth may include:

  • Sticky saliva

  • Dry mouth

  • Dry lips

  • Sense of burning in the mouth or tongue

  • Mouth sores or infection

Always see your doctor or dentist for a diagnosis.

Treatment for dry mouth depends on the cause of the condition. Dry mouth can be caused by medicines, disease, cancer treatment, and nerve damage. Some tips to prevent dry mouth symptoms include:

  • Take frequent sips of water or sugarless fluids.

  • Avoid caffeine.

  • Drink fluids during meals.

  • Avoid spicy or salty foods.

  • Avoid tobacco and alcohol.

  • Use a humidifier at night.

  • Chew sugarless gum or sugarless candy.

  • Use a saliva substitute, or an over-the-counter aid to help stimulate salivary flow

Preventing periodontal disease and other oral problems

Proper care of your teeth and gums can go a long way in preventing the onset of mouth problems associated with diabetes. The following tooth brushing and flossing tips are recommended by the National Institute of Dental and Craniofacial Research:


  • Brush twice daily with a soft, nylon brush with rounded bristles and fluoride toothpaste.

  • Use small, circular motions and short back-and-forth motions (avoid hard back-and-forth motions).

  • Brush the tongue frequently.


  • Dental floss should be about 18 inches long with each daily use.

  • Do not use a "sawing" motion in between the teeth.

  • Curve the floss around each tooth and scrape up and down several times, from below the gum to the top of the tooth.

  • Rinse after flossing.

Online Medical Reviewer: Eakle, W. Stephan, DDS
Online Medical Reviewer: Kapner, Michael, DDS
Date Last Reviewed: 9/23/2015
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