Diabetes and Periodontal (Gum) Disease
Diabetes that is not properly 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.
Because of blood vessel changes that happen with diabetes, the efficiency of the flow
of nutrients and removal of wastes from body tissues may become impaired. This impaired
blood flow can weaken the gums and bone. This makes them more susceptible to infection.
In addition, if diabetes is poorly controlled, higher glucose levels in the mouth
fluids will encourage the growth of bacteria that can cause gum disease. Poor blood
sugar control decreases the ability of the immune system to fight infections. On the
other hand, uncontrolled periodontal disease may also make it more difficult to control
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, severe gum disease.
What are the signs and symptoms of periodontal disease?
The following are the most common signs and symptoms of gum disease. However, each
individual may experience symptoms differently. Signs and symptoms may include:
Red, swollen, tender gums
Bleeding while brushing and/or flossing
Loose or separating teeth
Persistent bad breath
Dentures that no longer fit
Pus between the teeth and gums
A change in bite and jaw alignment
The signs and symptoms of gum disease may resemble other conditions or medical problems.
Talk with 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 the disease
has advanced to at the time of evaluation, including:
Gingivitis. With gingivitis, the mildest form of periodontal disease, the gums are likely to become
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
the problems associated with 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 medical attention is necessary to prevent further erosion
Moderate to advanced periodontitis. This most advanced stage of gum disease shows significant bone loss, deepening of
periodontal pockets and possibly receding gums surrounding the teeth. Teeth may loosen
and need to be extracted.
Treatment for periodontal disease
Specific treatment for periodontal disease will be discussed with you by your dentist
Your age, overall health, and medical history
Extent of the disease
Your tolerance for specific medicines, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Treatment may include any, or a combination of, 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
Medicine. Antibacterial medicines may be placed topically in the periodontal pockets or taken
Surgery. When the disease is advanced, the infected areas under the gums will be cleaned, and
the tissues will then be reshaped or replaced. Types of surgeries include:
A regeneration procedure
A soft-tissue graft
Diabetes and other oral problems
Diabetes can also cause other oral problems, including:
Thrush. Thrush, a fungal infection of the mouth, happens 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 necessary 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.
Although each individual may experience symptoms differently, symptoms of dry mouth
may include sticky, dry mouth, dry lips, sense of burning in the mouth, rough tongue,
and mouth sores or infection.
Always talk with your healthcare provider for a diagnosis.
Treatment for dry mouth depends on the cause of the condition. Dry mouth can be caused
by medicine, disease, cancer treatment or other salivary gland damage, and nerve damage.
Some tips to prevent dry mouth symptoms include:
Take frequent sips of water or sugarless fluids.
Drink fluids during meals.
Avoid spicy or salty foods.
Avoid tobacco and alcohol.
Use a humidifier at night.
Chew sugarless gum or sugarless candy.
Taking a medicine your dentist may prescribe that can help keep your mouth moist.
Preventing periodontal disease and other oral problems
Proper care of your teeth and gums can go a long way in preventing the onset of oral
problems associated with diabetes. The following toothbrushing and flossing tips are
recommended by the National Institutes of Diabetes and Digestive and Kidney Diseases
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
Brush the tongue each time you brush your teeth.
Brush for about 3 minutes to clean all of the teeth well.
Brush the top, back, and front of each tooth.
Dental floss should be about 18 inches long with each use.
Flossing should be done at least once a day.
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.
Your dentist is part of your diabetes management team. The NIDDK suggests that you
alert your dentist to changes in your health or medicines on each visit. In addition,
sharing some of your diabetes test results, like your A1C test or your fasting blood
glucose test, can help the dentist better manage your dental care. Finally, if your
diabetes is not well controlled, ask your dentist if you need antibiotics before and
after dental treatment.