Mouth Care And Diabetes

Proper mouth care can keep your loved one with diabetes from developing dangerous infections.

Periodontal diseases are infections of the gum and bone that hold the teeth in place. In advanced stages, they lead to painful chewing problems and even tooth loss. Like any infection, gum disease can make it difficult for your loved one to keep his or her blood sugar under control.

What Is The Link Between Diabetes And Periodontal Disease?

People with poor blood-sugar control get gum disease more often and tend to lose more teeth than persons with good blood-sugar control. In fact, people whose diabetes is well controlled have no more periodontal disease than persons without diabetes. Good diabetic control, therefore, is the best protection against periodontal disease.

Blood Vessel Changes

Thickening of blood vessels is a complication of diabetes that may increase risk for gum disease. Blood vessels deliver oxygen and nourishment to body tissues, including the mouth, and carry away waste products. Diabetes causes blood vessels to thicken, which slows the flow of nutrients and the removal of harmful wastes. This can weaken the resistance of gum and bone tissue to infection.


Many kinds of bacteria thrive on sugars, including glucose—the sugar linked to diabetes. When diabetes is poorly controlled, high glucose levels in mouth fluids may help germs grow and set the stage for gum disease.


Smokers are five times more likely than nonsmokers to have gum disease. For smokers with diabetes, the risk is even greater. If your loved one is a smoker with diabetes, age 45 or older, he or she is 20 times more likely than a person without these risk factors to get severe gum disease.

How Does Periodontal Disease Develop?


Poor brushing and flossing habits allow dental plaque—a sticky film of germs—to build up on teeth. Some of these germs cause gum disease. The gums can become red and swollen and may bleed during brushing or flossing. This is called gingivitis, the first stage of periodontal disease.

Gingivitis can usually be reversed with daily brushing and flossing and regular dental cleanings. If it isn’t stopped, gingivitis could lead to a more serious type of gum disease called periodontitis.


Periodontitis is an infection of the tissues that hold the teeth in place. In periodontitis, plaque builds and hardens under the gums. The gums pull away from the teeth, forming pockets of infection. The infection leads to loss of the bone that holds the tooth in its socket and might lead to tooth loss.

There are often no warning signs of early periodontitis. Pain, abscess, and loosening of the teeth do not occur until the disease is advanced. Since periodontitis affects more than just the gums, it cannot be controlled with regular brushing and flossing. Periodontitis should be treated by a periodontist (a gum disease specialist) or by a general dentist who has special training in treating gum diseases.

How Is Periodontal Disease Treated?

Plaque Removal

Treatment of periodontitis depends on how much damage the disease has caused. In the early stages, the dentist or periodontist will use deep cleaning to remove hardened plaque and infected tissue under the gum and smooth the damaged root surfaces of teeth. This allows the gum to reattach to the teeth. A special mouth-rinse or an antibiotic might also be prescribed to help control the infection.

Deep cleaning is successful only if the patient regularly brushes and flosses to keep the plaque from building up again.

Periodontal Surgery

Gum surgery is needed when periodontitis is very advanced and tissues that hold a tooth in place are destroyed. The dentist or periodontist will clean out the infected area under the gum, then reshape or replace the damaged tooth-supporting tissues. These treatments increase the chances of saving the tooth.

It’s important for your loved one to know how well his or her diabetes is controlled and to tell the dentist this information at each visit. Your loved one also should see his or her doctor before scheduling treatment for periodontal disease, and make sure that the doctor informs the dentist or periodontist about your loved one’s overall medical condition before treatment begins.

Your loved one may need to change his or her meal schedule and the timing and dosage of his or her insulin if oral surgery is planned. Postpone non-emergency dental procedures if your loved one’s blood sugar isn’t under control. However, acute infections, such as abscesses, should be treated right away.

If your loved one’s blood sugar is under control, periodontal or oral surgery can probably be done in the dentist’s office. Because of diabetes, healing may take more time, but with good medical and dental care, your loved one should experience no more post-surgery complications than would a person without diabetes. Once the periodontal infection has been successfully treated, your loved one will probably find it easier to control his or her blood-sugar levels.
Other Oral Problems Linked To Diabetes

Dental Cavities

Young people with diabetes have no more tooth decay than do children without diabetes. In fact, youngsters with diabetes who are careful about their diet and take good care of their teeth often have fewer cavities than other children because they don’t eat many foods that contain sugar.


Thrush is an infection caused by a fungus that grows in the mouth. People with diabetes are at risk for thrush because the fungus thrives on high glucose levels in saliva. Smoking and dentures (especially when they are worn constantly) can also lead to fungal infection. Medication is available to treat this infection. Good diabetes control, no smoking, and removing and cleaning dentures daily can help prevent thrush.

Dry Mouth

Dry mouth is often a symptom of undetected diabetes and can cause more than just an uncomfortable feeling. Dry mouth can cause soreness, ulcers, infections, and tooth decay.

The dryness means that a person doesn’t have enough saliva, the mouth’s natural protective fluid. Saliva helps control the growth of germs that cause tooth decay and other oral infections. Saliva washes away sticky foods that help form plaque, and strengthens teeth with minerals.

One of the major causes of dry mouth is medication. More than 400 over-the-counter and prescription drugs, including medicines for colds, high blood pressure, or depression, can cause dry mouth. If your loved one is taking medications, make sure he or she informs a doctor or dentist about any problems with dry mouth. Your loved one may be able to try a different drug or use an “artificial saliva” to keep his or her mouth moist. Good blood glucose control can help prevent or relieve dry mouth caused by diabetes.

Avoiding Tooth Loss

Serious periodontal disease not only can cause tooth loss, but also can cause changes in the shape of bone and gum tissue. The gums become uneven, and dentures may not fit well. People with diabetes often have sore gums from dentures.

If chewing with dentures is painful for your loved one, he or she might be tempted to choose foods that are easier to chew but not right for his or her diet. Eating the wrong foods can upset blood sugar control. The best way to avoid these problems is to help your loved one keep his or her natural teeth and gums healthy.

Protecting Teeth And Gums

Harmful germs attack the teeth and gums when plaque builds up. Your loved one can stop plaque build-up and prevent gum disease by brushing and flossing carefully every day. Have him or her use the following guide:

  • Use a piece of dental floss about 18 inches long.
  • Using a sawing motion, gently bring the floss through the tight spaces between the teeth.
  • Do not snap the floss against the gums.
  • Curve the floss around each tooth and gently scrape from below the gum to the top of the tooth several times.
  • Rinse the mouth after flossing.
  • Gently brush teeth twice a day with a soft nylon brush with rounded ends on the bristles.
  • Avoid hard back-and-forth scrubbing.
  • Use small circle motions and short back-and-forth motions.
  • Gently brush the tongue, which can trap germs.
  • Use a fluoride toothpaste to protect teeth from decay.

Checking For Plaque

Dental plaque is hard to see unless it is stained. Plaque can be stained by chewing red “disclosing tablets” sold at grocery and drug stores or by using a cotton swab to smear green food coloring on the teeth. The color left on the teeth shows where there is still plaque. Extra flossing and brushing will remove this plaque.

Dental Check-Ups

People with diabetes should have dental check-ups at least every 6 months, or more often if recommended by a dentist. Be sure to tell your loved one’s dentist that he or she has diabetes. Frequent dental check-ups are needed to find problems early when treatment is most effective. Make sure your loved one sees a dentist as soon as possible if he or she has any problem with his or her teeth or mouth. Preventing or controlling gum disease depends on teamwork. The best defense against this complication of diabetes is good blood sugar control, combined with daily brushing and flossing and regular dental check-ups.

© Copyright FamilyCare America, Inc. All Rights Reserved.

Adapted from Diabetes and Periodontal Disease: A Guide for Patients, prepared by the National Institutes of Health National Institute of Dental and Craniofacial Research.

You are in the
Click for related topics:
Heart Disease, HIV/AIDS 
and more...

Caregivers Handbook

This handy guide provides resources, checklists and worksheets
 - all in one place.