Diabetes and Oral Health 

Introduction

Diabetes is a disease that affects how the body uses glucose, a sugar that is a source of fuel.  Normally, insulin, a hormone, helps glucose enter the body cells where it is used for energy.  There are different types of diabetes.  People with Type 1 Diabetes do not produce insulin, and they must take insulin each day.  People with Type 2 Diabetes produce insulin, but they either do not produce enough or the insulin does not work like it should.  As a result, glucose does not get into the body cells. 

People with diabetes need to check their blood glucose levels, alter their diets, exercise, and in some cases, take medications to maintain healthy blood glucose levels.  Too much or too little glucose in the blood can make people ill and result in medical and dental complications.  Uncontrolled diabetes can change the way that food tastes.  It can promote dental-related infections and also slow the healing process of infections. 

Dental problems can result from uncontrolled blood glucose levels associated with diabetes.  Uncontrolled blood glucose levels impair white blood cells that are needed to fight infection.  Infections can cause blood glucose levels to rise in people with diabetes.  High glucose levels in saliva are fuel for the bacteria in your mouth.  Bacteria in the mouth contribute to plaque and tartar build-up on your teeth and gums.  This can cause tooth decay and periodontal (gum) disease.  People with poor blood glucose control tend to develop periodontal disease more severely and more frequently than people with good control of their diabetes.

People with diabetes are more likely to develop mouth infections.  People with diabetes that smoke, have high blood glucose levels, or take antibiotics have the highest risk for developing mouth infections.  Some people develop dry mouth, a condition that causes a decrease in saliva production and contributes to infection.  All of these factors can lead to fungal infections in the mouth such as oral candidiasis (thrush). 

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Symptoms
You should contact your dentist if you have the symptoms of a gum or mouth infection.  Infections can make your gums bleed easily.  You may notice this especially after you have just brushed or flossed your teeth.  Your gums may look swollen or red.  They may hurt or be tender when you touch them.  Pus may develop on your gums.  You may have bad breath or a bad taste in your mouth.  Your teeth may separate or become loose.  Loose teeth can cause your bite pattern to change.  When you close your mouth to chew, your tooth alignment may feel different than it did before.  Additionally, periodontal disease can change the way that your dentures fit.

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Diagnosis
Your dentist can diagnose dental problems associated with diabetes.  You should tell your dentist that you have diabetes even if your blood glucose levels are controlled.  Tell your dentist what your A1C level is and provide a list of medications that you take.  Tell your dentist about your dental symptoms.
 
Your dentist can diagnose periodontal disease and mouth infections by examining your teeth, gums, and soft structures in your mouth.  Your dentist will check for loose teeth.  Your dentist will gently insert a small periodontal probe between your teeth and gums to check for and measure gum detachment and pockets.  X-rays help identify changes in your teeth, bones, or gums.

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Treatment
Your dentist can treat dental conditions related to diabetes.  Candidiasis is treated by removing or controlling the causative factors.  You should brush and floss your teeth according to your dentist’s instructions.  Clean your dentures thoroughly.  Do not wear dentures at night.  If you have dry mouth, saliva substitutes can help. 
 
Treatment for periodontal disease depends on the type of disease and how far it has spread.  Initial treatments usually include a professional dental cleaning with scaling and root planning.  Scaling is a procedure that removes plaque, tartar, and stains from the tooth surface.  Root planning removes plaque and tartar while smoothing the root surface.  The smooth surface makes it more difficult for plaque to attach to it.  Root planning allows the gum tissues to heal next to the teeth.
 
Some cases of periodontitis may require medications in addition to scaling and root planning.  Your dentist may apply antibiotics to the site of infection.  You may receive a prescription for antimicrobial mouth rinses to fight the bacteria that contribute to periodontitis.  Advanced periodontitis may require tooth extraction and surgical treatment.
 
After receiving professional treatment for periodontal disease or a mouth infection, good oral health care and blood glucose management can prevent the condition from recurring.  Brush your teeth at least twice a day.  Floss daily to remove plaque.  Eat well-balanced meals, limit sugary or starchy foods, and avoid in between meal snacks.
 
Make and attend regular dental appointments for professional cleaning and examinations.  You should have your teeth examined and cleaned at least twice a year.  Contact your dentist at the first sign of any diabetes-related dental problem.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.