Poorly managed diabetes increases risk of oral health problems, and vice versa.

For individuals with diabetes, taking care of their oral health also helps them take care of their diabetes.

Research shows that poorly managed blood sugar or blood glucose levels puts people with diabetes at greater risk for developing oral health problems such as gum disease, fungal infections, tooth decay, taste impairment, dry mouth and delayed healing. It can also make it more difficult to wear dentures and other oral appliances.

Poor oral health puts people at increased risk of diabetes-related problems such as the impact of periodontal disease on maintaining proper blood glucose levels. Poorly managed blood glucose levels may also contribute to more severe gum disease and at an earlier age.

The risk of gum disease is significant. “People with diabetes have a greater prevalence of periodontal disease than the general population,” notes Dr. Martin Gillis, past member of the Diabetes Education Consultative Section for the International Diabetes Federation.

If gum disease is not properly managed, he says, it can adversely affect control of blood glucose. At the same time, poor blood glucose control can have a negative impact on managing gum disease.

Gum disease is a type of bacterial infection caused by the build-up of plaque, the sticky, colourless film that forms on teeth every day. Gum disease, which can lead to tooth loss, affects both the gums and the bones supporting the teeth. It appears in two forms: gingivitis and periodontitis, the more serious type. It is believed the toxins produced by the bacteria can affect the inflammatory response leading to insulin resistance and an increase in blood glucose levels. In fact, gum disease may increase the risk of developing type 2 diabetes.

According to the National Diabetes Education Program, treatment of gum disease in people with type 2 diabetes can lower blood glucose levels over time. Gum disease treatment can also lower the likelihood of having other problems from diabetes, such as heart and kidney disease.

Diabetes and oral disease have numerous risk factors in common, such as smoking. Poor nutrition is another significant issue, notes Dr. Gillis, who has been actively involved with the International Diabetes Federation and has presented on this topic at conferences around the world. “Poor nutrition contributes to the obesity and type 2 diabetes epidemic while the consumption of high quantities of sugary snacks and sugar-sweetened beverages contributes to dental cavities,” he says.

Effective diabetes management and prevention of oral health problems start with regular visits to the dentist, at least once a year. During an oral examination, your dentist can explain how diabetes affects your teeth and gums and teach you how to check for signs of gum disease at home. Your dentist will also look for existing problems, such as cavities or gum disease, and treat these while helping you learn to address other issues such as dry mouth. As part of the oral examination, dentists can also detect conditions that could signal a need for you to be tested for diabetes.

Taking care of your teeth by brushing regularly, flossing, using fluoride toothpaste, maintaining a healthy diet, and having regular dental exams can help you manage your diabetes. “Research has shown that developing positive health behaviours in relatively simple tasks such as brushing and flossing can build self-efficacy and enhance the development of more complex behaviours such as diabetes self-management routines,” notes Dr. Gillis.

You will want to work with your dentist to create a health plan for your oral health that meets your individual needs. This will include learning the best way to take care of your teeth at home, determining how often you should visit the dentist, and what to do if you start to have problems with your teeth or gums. Oral health care providers such as dentists and dental hygienists are an important part of the diabetes management team.

Diabetes and oral health interconnected

A special report prepared last year for health professionals by the National Diabetes Education Program identified the seriousness of poor oral health care for people with diabetes. This includes the following statistics:

• Among young adults, those with diabetes have about twice the risk of developing periodontitis, serious gum disease, as those without diabetes.
• Adults ages 45 or older with poorly controlled diabetes are 2.9 times more likely to have severe periodontitis than those without diabetes.
• People who smoke and have persistently elevated glucose levels have a 4.6 times greater risk for developing gum disease.
• About one third of people with diabetes have severe gum disease.

The signs of gum disease

Individuals with diabetes should keep a close eye on their oral health. Gum disease, in particular, can indicate serious problems. The following may be signs of gum disease and should prompt a visit to the dentist:

• Red, shiny, or swollen gums
• Bleeding when you brush or floss
• Gums pulling away from teeth
• Sores on the gums
• Loose teeth or change in bite or tooth position
• Bad breath that won’t go away