Diabetes and Gum (Periodontal) Disease

Poorly controlled diabetes can lead to gum (periodontal) disease. This can happen at any age. Gum disease is infection of the gums and the bones that hold the teeth in place.

Diabetes causes changes to blood vessels. This affects the flow of nutrients. It also affects how waste is removed from body tissues. This can weaken the gums and bones and raise risk for infection.

Also, if diabetes is poorly controlled, higher blood sugar levels in the mouth fluids will help bacteria grow that can cause gum disease. Poor blood sugar control makes it harder for your immune system to fight infections. Uncontrolled gum disease may also make it harder to control the diabetes.

Smoking is a third factor that is harmful to oral health. This is true even for people without diabetes. But if you have diabetes and you smoke, you are at a much greater risk for gum disease than a person who doesn't have diabetes.

Along with poor oral hygiene, diabetes can lead to gingivitis. This is the first stage of gum disease.

What are the symptoms of gum disease?

These are the most common symptoms of gum disease:

• Red, swollen, sore gums

• Bleeding while brushing, flossing, or both

• Receding gums

• Loose or separating teeth

• Ongoing (chronic) bad breath or a strange taste in your mouth

• Dentures that no longer fit

• Pus between the teeth and gums

• A change in bite and jaw alignment

The symptoms of gum disease may look like other conditions. Talk with a dentist or other oral health specialist for a diagnosis.

What are the types of gum disease?

Gum disease is staged when the dentist assesses it. The stages are:

• Gingivitis. This is the mildest form of gum disease. The gums become red, swollen, and tender. They may bleed easily during daily cleanings and flossing. Treatment by a dentist and correct, consistent care at home help stop gingivitis.

• Mild periodontitis. Untreated gingivitis leads to mild periodontitis. In this stage of gum disease, gums pull away from the teeth. This causes a pocket between the teeth and gums. Bacteria can settle here. This can lead to early loss of bone around the teeth. Prompt medical care can stop more damage.

• Moderate to advanced periodontitis. This is the most advanced stage of gum disease. There is major bone loss, deepening of gum pockets, and possibly receding gums around the teeth. Your teeth may change in relation to each other, interfering with biting. Teeth may loosen and need to be pulled.

Treatment for gum disease

Treatment may include any of the following:

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

• Medicine. Antibacterial medicines may be put in the gum pockets. Or you may take this medicine by mouth.

• Surgery. When the disease is advanced, the dentist will clean the infected areas under the gums. Then they will reshape or replace the tissues. Types of surgeries include:

  • Pocket reduction

  • A regeneration procedure

  • A soft-tissue graft

  • Crown lengthening

• Dental implants . These can permanently replace teeth that have been extracted. They can also serve as an anchor for dentures. If you have false teeth (dentures), they should fit well and not be loose.

Diabetes and other oral problems

Diabetes can also cause other oral problems. These include:

• Thrush. Thrush is a fungal infection of the mouth. It happens more often in people with diabetes because of high blood sugar in the saliva. Fungus thrives on sugar.

• Burning feeling. Uncontrolled blood sugar can cause a burning feeling in your mouth.

• Dry mouth. Dry mouth is often a symptom of undiagnosed diabetes. It means the mouth doesn't have enough saliva to keep itself wet. Saliva helps digest food. It also helps prevent infection and tooth decay by controlling bacteria and fungi. Dry mouth can make tasting, chewing, and swallowing food difficult. It can also affect how you speak and cause mouth infections and tooth decay.

  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.

  • Don't drink caffeine.

  • Drink fluids during meals.

  • Stay away from spicy or salty foods.

  • Don't use tobacco or 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 gum disease and other oral problems

Correct care of your teeth and gums can go a long way to prevent oral problems linked to diabetes. These tooth brushing and flossing tips are advised by the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK):

Brushing	Brush twice daily with a soft, nylon brush with rounded bristles and fluoride toothpaste. Use small, circular motions and short back-and-forth motions. Don't use hard back-and-forth motions. 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.
Flossing	Use about 18 inches of dental floss each time you floss.. Floss at least once a day. Don't 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. Also, share some of your diabetes test results, such as your A1C test or your fasting blood glucose test. This 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.