Diabetes & Oral Health

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Diabetes & Oral HealthClinical Content Reviewed by Dr. Jay Khorsandi, DDS
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Table of Contents

  1. How Diabetes Affects the Mouth
  2. Why Are Mouth Problems More Common with Diabetes
  3. Oral Symptoms of Untreated Diabetes
  4. What Happens If I Have Plaque?
  5. Most Common Mouth Problems from Diabetes
  6. Signs & Symptoms
  7. Prevention
  8. Tips for a Healthy Mouth with Diabetes
  9. References

Diabetes can cause a host of health problems, including mouth and dental health issues.

Diabetes results in too much sugar (glucose) in your blood. When you have too much in your blood, you also have too much sugar in your saliva and mouth.

White blood cells, which are important for fighting off infections, are weakened due to high blood sugar. Diabetes also increases your risk for gum disease and dry mouth.

Practicing good oral hygiene and eating a balanced, nutritious, and low-sugar diet can minimize your risk for diabetes and oral health concerns. If you recognize the early signs of diabetes, you can form a plan for keeping the disease under control and improving your oral and overall health.

How diabetes affects the mouth

People with diabetes are more likely to also have gingivitis (early-stage gum disease) and periodontitis (advanced gum disease), the American Diabetes Association warns. Close to 60 percent of people with periodontal disease also have diabetes, compared to the less than 38 percent of the general public that has periodontal disease but not diabetes.

Diabetes leads to an increased amount of sugar in the bloodstream, and therefore the saliva, which can raise the odds for tooth decay and cavities. A study on type II diabetic patients shows rates of dental caries (cavities) in nearly three-quarters of the diabetic group and in only a third of the control group. Diabetic patients therefore had dental caries at rates more than double people without diabetes.

Dry mouth is also common in people with diabetes. Xerostomia, or dry mouth, is found between 12.5 percent and 53.5 percent of the time in people with diabetes, and it is found up to 30 percent of the time in the population without diabetes.

Dry mouth can cause a myriad of dental issues, including a higher incidence of tooth decay and gum disease, bad breath, more pain, mouth ulcers, and infections as well as a higher rate of fungal infections, such as thrush.

Why are mouth problems more common in people with diabetes?

Diabetes occurs when your body cannot regulate the amount of sugar in your blood, which can cause a variety of health problems. When too much sugar builds up in your mouth, the naturally present bacteria can increase and form plaque, the sticky substance that forms on the teeth.

Nearly everyone can develop plaque regardless of whether or not they have diabetes, but sugar is a known culprit for increasing plaque buildup on the teeth. When plaque is left on the teeth, this is what causes tooth decay, gum disease, and holes in the teeth, or cavities.

Other oral health issues related to diabetes are a higher rate of inflammation and more difficulties fighting off infections. The higher your blood sugar, the weaker your white blood cells, which are vital for fighting infections, the CDC explains.

This can mean it takes mouth infections longer to heal. It also raises the risk for developing infections in the first place.

Inflammation of gum tissue can cause pain, redness, and bleeding. It can also develop into gingivitis and then periodontal disease without prompt treatment.

Dry mouth can be a side effect of diabetes directly or related to medications. Either way, chronic dry mouth can create oral health issues, as less salivary flow means that bacteria and food particles are not as easily washed away. This can create a higher risk for tooth decay, gum disease, bad breath, mouth sores, and infections.

Oral symptoms of untreated diabetes

Diabetes can often be spotted by dental professionals due to oral health concerns. If you notice changes in your teeth, mouth, or gums, talk to your dentist, as it could be a sign of a bigger, underlying medical condition such as diabetes.

Type II diabetes develops most commonly in adults over the age of 45 when the body does not create enough insulin to control blood sugar.

Oral symptoms of diabetes can include the following:

  • Irritated and swollen gums
  • Gums that bleed easily when you brush and floss
  • Dry mouth
  • Mouth sores and infections
  • Wounds that take longer to heal
  • White patches in the mouth
  • Bad taste and/or bad breath
  • Difficulties tasting food
  • Higher rate of cavities

The American Dental Association (ADA) reports that in children with untreated diabetes, teeth can erupt (come in) earlier than usual.

What happens if I have plaque?

Plaque is common. A good oral hygiene routine can help to keep it from hardening and remaining on your teeth.

Plaque is a sticky substance created from the interaction between naturally occurring bacteria in your mouth and the acids in foods. A high-sugar diet can increase the production of plaque.

The same is therefore true for high blood sugar. Even if your diet is not necessarily high in refined sugar, your body cannot control the level of sugar in your blood when you have diabetes, which can cause plaque to form at faster rates. Brushing and flossing your teeth can help to remove plaque before it hardens.

When left on your teeth, plaque buildup hardens. At this point, it can only be removed by a dental professional through a professional cleaning. If it’s not removed, plaque eats away at the outer layer of your teeth (the enamel) and can irritate your gums.

Irritated gums can cause inflammation and early-stage gum disease. Essentially, plaque on your teeth destroys the enamel, causing tooth decay and then eating holes in the teeth called cavities.

Most common mouth problems from diabetes

These are the most common dental issues related to diabetes:

Gingivitis

This is the early stage of gum disease. It involves inflammation and infection of the tissues that support your teeth, including the gums and jawbone. Symptoms of gingivitis include the following:

  • Tender gums when touched
  • Gums that bleed when brushing or flossing
  • Swollen gums
  • Mouth sores
  • Bad breath
  • Gums that look shiny

Gingivitis is treated with a thorough professional teeth cleaning at your dentist. The dental professional can remove the plaque from your teeth and just under your gum line to sooth the irritation and remove the infection.

Early gum disease is treated through proper hygiene techniques that includes twice-daily toothbrushing and daily flossing after the professional cleaning.

Periodontitis

This is a more advanced stage of gum disease that generally occurs when gingivitis progresses after plaque remains on the teeth. It is a serious infection that damages the soft tissues and gums.

It can also migrate to the bones supporting the teeth. Pockets of infection can form between the teeth and the bones where bacteria can build up. It can range in severity with the most significant progression leading to bone and tooth loss.

Symptoms include the signs of early gum disease as well as the following:

  • Gums recession or gums that pull away from the teeth
  • Pain in the gums and teeth
  • Gums that bleed easily
  • Teeth feeling loose
  • Bad breath, foul taste, and pain while chewing that becomes significant
  • Tooth loss (in advanced stages)
  • Inflammatory response throughout the body

Treatment for periodontitis depends on the severity of the disease progression, but it will be aimed at removing the infection. Often, a more advanced deep cleaning, such as a root scaling and planing, will be necessary to scrape the infection out.

Your dentist may also prescribe antibiotics to fend off infection. Surgical treatments can be necessary if periodontitis persists and is significantly advanced.

Tooth decay

When bacterial buildup creates plaque that damages your tooth’s enamel, this is tooth decay. This causes the minerals to be lost. Early stages of tooth decay can create a white spot on your tooth.

Symptoms of tooth decay can include the following:

  • Tooth pain
  • White or brown stains on the tooth
  • Tooth sensitivity to hot and cold
  • Abscess formation

Tooth decay can be reversed in the early stages through proper oral hygiene and professional dental cleanings. Once more minerals are lost and enamel is destroyed, it cannot be replaced.

Cavities

A cavity is a hole in your tooth caused by tooth decay and the destruction of the enamel. Symptoms of a cavity are similar to tooth decay, but they can also include a hole appearing in your tooth.

Treatments for cavities include the following:

  • Professional fluoride treatment
  • Dental fillings
  • Root canals
  • Crowns
  • Tooth extraction (in severe cases)
Dry mouth

Dry mouth occurs when there is not enough saliva in your mouth. This can be uncomfortable. It can also cause more bacterial buildup and therefore an increased rate of infections.

These are symptoms of dry mouth, or xerostomia:

  • Dry or sticky feeling in the mouth
  • Rough and dry tongue
  • Cracked or chapped lips
  • Burning sensation in mouth
  • Difficulties chewing, swallowing, tasting food, and talking
  • Throat feeling dry
  • Mouth sores
  • Infections in the mouth

Dry mouth treatment can include chewing sugar-free gum and drinking small sips of water throughout the day, as well as avoiding caffeine, alcohol, and tobacco products. More significant dry mouth can be treated with medications, over-the-counter or prescription mouthwashes, and artificial saliva or moisturizers.

Mouth infections

Mouth sores and infections can include viral and bacterial infections that can be caused by dry mouth or a lowered immune system, both related to diabetes. Symptoms can include the following:

  • Pain
  • Open wound
  • White patches
  • Blisters
  • Inflammation

Treatment for the infection will depend on the type of infection, the direct cause, and its severity. Mouth sores and infections can be treated with topical treatments and medications when needed.

Signs & symptoms that mouth problems are due to diabetes

Many of the oral issues that can be related to diabetes are also common in general, so it can be tricky to know that diabetes is the cause. Watch for early stages of gum disease and tooth decay as well as an increased rate of mouth infections and wounds that seem to take longer to heal than they should.

If you notice dry mouth, gum irritation, bad breath, or any changes in your dental health, talk to your dentist. A blood test can help to determine if you have diabetes.

Prevention with proper dental care

Preventing oral health issues and diabetes often starts with diet and nutrition. Eating a balanced and healthy diet that is low in processed foods and refined sugars can help.

Consider these other nutritional tips:

  • Eat a variety of foods from all the food groups.
  • Stick to raw and natural foods when possible.
  • Include foods that are high in calcium, vitamin C, and phosphorus to support bone, teeth, and gum health.
  • Drink plenty of water.
  • Limit caffeine and alcohol.
  • Try to minimize snacks between meals.

Regular exercise, along with a balanced diet, can also help to keep you healthy and limit the risk for diabetes and climbing blood sugar levels.

It is also important to stick to a healthy oral hygiene routine that includes the following:

  • Brush your teeth for two minutes at least two times per day.
  • Floss your teeth daily.
  • Use a fluoride toothpaste.
  • Get regular dental examinations and professional cleanings.
  • Consider a daily fluoride mouthwash.

Tips for a healthy mouth with diabetes

When you have diabetes, you will need to pay extra attention to your mouth and take some additional steps beyond regular dental hygiene to keep it healthy.

  • Keep your glucose levels under control. Exercise regularly, eat a healthy diet, and take medications when needed. Lower blood sugar levels can minimize the risk for infections and other oral health concerns.
  • Do not smoke. Smoking increases the rate and progression of gum disease. It can also make diabetes worse.
  • If you wear dentures, be sure to clean them properly every day. Talk to your dentist if the fit seems off.
  • Maintain your oral hygiene by brushing and flossing daily. See your dentist as recommended, generally two times per year on average.
  • Let your dentist know you have diabetes. Talk to them about your health and any potential changes, pain, inflammation, or irritation in the mouth.

Diabetes is a disease that can be successfully managed with medical help. It is essential to keep up with your oral hygiene and monitor your gums, teeth, and mouth when you have diabetes.

Your dentist can help you to develop and carry out a plan for keeping your overall and oral health under control along with your diabetes.

References

Diabetes and Oral Health. (2021). American Diabetes Association.

Disparities in Preventative Oral Health Care and Periodontal Health Among Adults with Diabetes. (May 2021). Centers for Disease Control and Prevention (CDC).

Dental Caries Prevalence Among Type II Diabetic and Nondiabetic Adults Attending a Hospital. (December 2016). Journal of International Society of Preventive & Community Dentistry. (JISPCD).

Xerostomia, Hyposalivation, and Salivary Flow in Diabetes Patients. (July 2016). Journal of Diabetes Research.

Diabetes and Oral Health. (May 2021). Centers for Disease Control and Prevention (CDC).

Type 2 Diabetes. (November 2021). Centers for Disease Control and Prevention (CDC).

Diabetes and Your Smile. Mouth Healthy American Dental Association (ADA).

Gingivitis. (February 2020). U.S. National Library of Medicine. (NLM).

Periodontitis. (July 2020). Merck Manual.

Tooth Decay. (September 2021). U.S. National Library of Medicine (NLM).

Cavities. Mouth Healthy American Dental Association (ADA).

Dry Mouth. (November 2021). U.S. National Library of Medicine (NLM).

Mouth Sores and Inflammation. (June 2020). Merck Manual.

Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to serve as dental or other professional health advice and is not intended to be used for diagnosis or treatment of any condition or symptom. You should consult a dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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