Diabetes and oral health: gum disease, dry mouth and dental care

Looking after your mouth is part of looking after your diabetes. This article explains why diabetes affects the teeth and gums, which warning signs to watch for and how to protect your mouth. It draws on the US National Institute of Dental and Craniofacial Research (NIDCR), the CDC and the NIDDK.

1. Introduction

The CDC says that high blood sugar can make it harder to keep your mouth healthy ^[2]. The NIDDK explains that diabetes raises the risk of gum disease and cavities ^[3]. The effect works in both directions: NIDCR and the CDC say gum disease can make blood sugar harder to control, and the CDC notes that treating gum disease may help lower blood sugar over time ^{[1, 2]}.

2. Why diabetes affects the mouth

Saliva washes away food, limits bacteria and protects the teeth. The NIDDK says diabetes, and some diabetes medicines, can reduce the flow of saliva, which raises the risk of cavities and gum disease ^[3]. High blood sugar also raises the sugar level in saliva, which feeds the bacteria in plaque, the sticky film on teeth ^{[2, 3]}. Plaque left near the gum line hardens into tartar, which can cause gum disease ^[3]. The CDC adds that high blood sugar can weaken white blood cells, the body's main defence against mouth infections ^[2].

3. Common problems

Gum disease

Gum disease, or periodontal disease, is an infection of the gum and the bone that holds teeth in place ^[1]. The NIDDK describes two stages ^[3]:

• Gingivitis: the mild first stage, with red, swollen gums that bleed easily.
• Periodontitis: an infection of the gums and bone. Gums pull away from the teeth and form infected pockets, and teeth can become loose or need removal if it is not treated.

NIDCR says gum disease can cause pain, bad breath that does not go away, chewing problems and tooth loss, and that diabetes can slow healing, which may interfere with treatment ^[1]. The NIDDK reports that almost 25% of US adults aged 50 and older with diabetes have severe tooth loss, compared with about 16% of those without diabetes ^[3].

Dry mouth

Dry mouth means not enough saliva. NIDCR says it can cause soreness, ulcers, infections and tooth decay, and smoking makes these worse ^[1]. Its separate dry mouth page lists diabetes among the causes, along with many medicines, and says dry mouth is not a normal part of ageing ^[4].

Thrush

Thrush is a fungal infection that causes painful white patches in the mouth. NIDCR says extra sugar in saliva together with dry mouth can lead to it ^[1].

Other problems

The NIDDK also lists cavities, burning mouth (which it links to uncontrolled blood sugar) and changes in taste, and notes that mouth problems can make it harder to follow a healthy meal plan ^[3].

4. Warning signs

Check your mouth regularly. See a dentist for any of these signs ^{[1, 3]}:

• Red, swollen gums that bleed when brushing or flossing
• Gums that are pulling away from the teeth
• Loose teeth
• Dryness, soreness, white patches or a bad taste in the mouth
• Bad breath that does not go away

5. Prevention and daily care

Sources agree on these steps ^{[1, 2, 3, 4]}:

• Keep blood sugar within the target range set with your doctor. The NIDCR calls this key to preventing mouth problems.
• Brush at least twice a day with fluoride toothpaste, and floss at least once a day ^[2].
• Do not smoke. Smoking raises gum disease risk and can worsen diabetes ^{[2, 3]}.
• Have regular dental check-ups, which the CDC says include professional cleanings, X-rays and exams, and ask how often you need them ^{[2, 3]}. If cost or worry about dental visits is a barrier, the NIDDK says to tell your dentist so treatment can be adapted ^[3].
• Tell your dentist you have diabetes, how long you have had it, and about any complications and medicines ^[3].
• If you wear dentures, tell your dentist if they fit poorly or your gums are sore ^[1].
• For dry mouth, NIDCR suggests sipping water or sugarless drinks, chewing sugarless gum, limiting caffeine, avoiding tobacco and alcohol, and asking your doctor or dentist about the cause ^[4]. It also suggests a humidifier at night, and notes that spicy or salty foods may cause burning ^[4].

6. Treatment

Treatment depends on the problem and is decided by your dentist or doctor. NIDCR describes deep cleaning, referral to a gum specialist, or a special mouth rinse for gum disease, antifungal medicine for thrush, and measures to keep the mouth moist for dry mouth ^[1].

7. Dental procedures

The NIDDK says high blood sugar raises the risk of infection after mouth surgery and slows healing. Tell your doctor before oral surgery or extensive dental work, and ask whether you should check blood sugar more often or change the timing of medicines ^[3].

8. When to see a doctor

See a dentist promptly for any warning sign above ^{[1, 3]}. The CDC says gum disease can be more severe and slower to heal in people with diabetes and can make diabetes harder to manage, so follow your diabetes care schedule and mention mouth problems at your visits ^[2]. The NIDDK advises telling your dentist about any change in your health, including rises in blood sugar ^[3]. In an emergency, call your local emergency number (112 in India, 911 in the United States). Facial swelling that makes breathing or swallowing hard needs emergency care.

9. Conclusion

Diabetes raises the risk of gum disease, dry mouth, thrush and tooth loss, and mouth problems can make blood sugar harder to manage. Good blood sugar control, daily brushing and flossing, no smoking and regular dental visits protect your teeth and gums.