When thinking about diabetes we don’t often think of the health of our mouth, gums, and teeth known as our oral health. Our mouth is the gateway to our bodies and can affect everything including our heart. The same issues that high blood sugar can cause in other parts of our body (e.g., eyes, nerves, etc.) can affect our mouth.
High blood glucose slows healing and decreases the body’s ability to fight infection—including in the mouth. Having good oral hygiene (brushing teeth and flossing every day) as well as keeping blood glucose in target range as much as possible can prevent issues in the mouth. Maintaining good oral hygiene habits helps keep harmful germs down and reduces the chance of infections, tooth decay, gum disease and bone loss around the teeth leading to tooth loss (which can, in turn, increase blood glucose levels). Having well-managed glucose can help the body fight bacterial and fungal infections in the mouth and helps relieve dry mouth caused by diabetes.
Dr. Diana Sandu, director of Ellis Dental Care and the Ellis Medicine Dental Residency Program explains, “The condition of our mouth not only affects blood glucose levels it can trigger other systemic diseases in our body such as your heart, lungs and certain cancers as well as miscarriages. So, brushing and flossing twice a day as well as following-up with your scheduled dental exams and professional cleanings not only assures a beautiful smile and a life free of dental pain, but also good general health.”
- One in five cases of total tooth loss is linked to diabetes.
- 90 percent of people with diabetes have oral problems (problems in their mouth) due to diabetes.
- Oral infections and other problems in the mouth are more common in people with a higher HbA1c and longer duration of diabetes.
Dry mouth is more common in people with diabetes — almost half of the people with diabetes experience it which can affect their quality of life including speech, eating habits and increase their risk of developing cavities, periodontal disease (gum disease) and tooth loss. It is important to talk to your dental hygienist or dentist about this to get proper treatment and prevent further issues in the mouth. Symptoms include:
- Dryness in the mouth or throat
- Bad breath
- Saliva that seems thick or foamy
- Difficulty chewing, speaking or swallowing
- Hoarse or raspy voice
- Dry or sandpaper feeling on the tongue
- Change in taste
- Problems wearing dentures
Keeping blood glucose as close to the target range as possible is key. Certain medications may also cause dry mouth, so please ask if there are any side effects of medications that may be causing this. In addition:
- Drink water regularly.
- Stop smoking.
- Avoid using any mouth rinses with alcohol.
- Chew sugar-free gum.
- Limit caffeine intake.
- Avoid antihistamines and decongestants if possible.
- Use a humidifier at night.
- Use over-the-counter and/or prescription mouth rises and lozenges that help moisturize the mouth.
- If dry mouth is severe, there are prescription medications that help the body produce more saliva.
There is a significantly higher prevalence of tooth decay in people with diabetes than people without diabetes. Tooth decay (also known as cavities or caries) is the breaking down of the tooth enamel (the hard, outer layer of the tooth) due to a combination of factors including lack of properly removing the sticky film of bacteria (plaque) through daily brushing and flossing as well as eating and drinking sugary foods. In addition, constantly high blood glucose levels can change the PH in saliva increasing bacteria as well as cause dry mouth. When bacteria stay on teeth, the acids in the plaque start eroding (breaking down) tooth enamel.
To prevent tooth decay, brush and floss twice daily with a toothpaste that has fluoride. In addition, after treating a low (hypoglycemic reaction) it is important to rinse with water after drinking juice and/or eating sugary low treatments to prevent cavities.
Symptoms of tooth decay include toothache, tooth sensitivity when eating or drinking hot and cold items as well as sweets, pain when chewing/biting, hole or pits in the tooth and black, brown or white staining on the tooth.
Early treatment of tooth decay is important so it doesn’t develop into more serious issues such as tooth infections or damage to the nerve of the tooth, so getting regular dental check-ups is critical. Treatment for tooth decay is filling the tooth that has the cavity, crowns if there are more extensive decay, root canals and tooth extraction for more severe tooth decay.
Gum disease (also known as periodontal disease) is a series of infections that affect the soft tissue (e.g., gums) that surround the teeth. This is caused by a build-up of bacteria (known as plaque) due to a lack of daily brushing and flossing to remove the plaque. This can lead to bone loss around the teeth and, if left untreated, will lead to tooth loss.
There is a bidirectional relationship (meaning the relationship goes both ways) between periodontal disease and diabetes. Regular daily oral hygiene and treatment can help to improve blood glucose and improved glucose management can help with gum infections (periodontal disease).
In the early stages, the gums become swollen, red, bleed when you brush and floss, and the person may have bad breath. This is called gingivitis. It is important for this to be caught early (at regularly scheduled three-to-six month check-ups) so treatment can start and prevent further destruction of the tissues and bone around the teeth.
Early treatment usually reverses symptoms of gingivitis and prevents progression to more serious gum disease and tooth loss. In addition to the treatment professionals provide, the dental team will recommend a daily homecare routine including brushing, flossing, water picking, non-alcohol antimicrobial rinses, etc.
Treatment by the dental team includes dental cleaning(s). The dental team will do a deep cleaning of the teeth and gums to thoroughly remove plaque, tartar (the hard build of plaque) and bacteria. The dental team may schedule a regular routine of follow-up appointments if necessary.
It is important to note that gingivitis is reversible, so treating early is key. If it gets worse and progresses to periodontitis, there has already been damage to the bone and it is harder to maintain.
When gingivitis progresses, it is called periodontitis. This is when the gums pull away from the teeth. If treatment isn’t started early bone can be lost and then teeth may loosen or fall out. It is important to note that symptoms of periodontitis are similar to gingivitis at early stages but as the disease progresses and the infection goes deeper, teeth may loosen. This is usually not painful so often people don’t know it is happening, which is why regular check-ups are important.
The goal of treatment for periodontitis is to thoroughly clean the pockets (the space between the tooth, surrounding tissue and bone) that have formed around teeth and prevent further loss of bone. In addition to the treatment professionals provide, the dental team will recommend a daily homecare routine including brushing, flossing, water picking antimicrobial rinses, etc. If the periodontal disease is mild, treatment by the dental team will include a schedule of dental cleaning(s). During the cleaning, the dental team will do a deep cleaning of the teeth and gums to remove plaque, tartar and bacteria. The dentist may also prescribe topical (mouth rinses or gels) or oral antibiotics if needed that can help manage the bacterial infection.
If the periodontitis is more advanced oral surgery(s) may be needed. This may include flap surgery, laser-assisted surgery, soft tissue grafts, bone grafts and several other possible treatments. Early and consistent treatment is key to both oral health and blood glucose management.
Oral infections and other common complications
People with high blood glucose tend to have slow healing of wounds and delayed healing after surgeries, which is also true for oral dental procedures. So, if a person with diabetes has a dental procedure or an oral ulcer, tight management of glucose is critical to reduce infection and improve healing from procedures and infections.
About 25 percent of people with diabetes have oral candidiasis, also called an oral fungal infection, which is known to be one of the early signs of high blood glucose. A combination of high blood glucose and dry mouth may be contributing factors. Symptoms can include a white-coated tongue or white patches on the other areas of the tongue and throat. There may be soreness, dry mouth, loss of taste and difficulty swallowing. A doctor or dentist can prescribe medications called antifungals to treat this infection.
Burning mouth and/or tongue syndrome is a burning sensation in the mouth and is often linked to dry mouth and thrush (oral fungal infection). There appears to be some neuropathic reasons for this, so people with diabetic neuropathy seem to be more susceptible to burning sensations in the mouth. Talking to your dentist about this when symptoms begin is important.
Halitosis, known as bad breath, is significantly more common in people with diabetes than those without. There are many causes including smoking, poor oral hygiene (brushing and flossing), dry mouth, medications and mouth infections. Treatments include improving oral home hygiene routines and treating any issues in the mouth—periodontal disease, candidiasis, dry mouth, etc. Talk to a dentist if you are experiencing bad breath—it usually the result of another issue in the mouth.
Prevention of oral complications from diabetes
There are several things we can do to prevent these oral complications including:
- Keeping blood glucose as close to the target range as possible
- Stopping smoking
- Brushing your teeth for two minutes twice a day with fluoride toothpaste and flossing daily
- If you wear any type of denture clean it each day
- Go to your regular dental cleanings every three to six months or more if the dentist recommends it
Psychosocial aspects of oral health issues
“The mouth and teeth are front and center, so if a person is having an issue with their teeth it affects every aspect of your life—from eating, to having bad breath, to being embarrassed to talk or smile, and even a person’s self-confidence is affected. Good oral health can even improve your mental health!” says Elizabeth McAuliffe, RDH.
An issue with ones’ mouth can affect a person’s quality of life. From pain, bad breath, dry mouth and visible issues with a person’s teeth or gums—a person’s oral health can affect how a person behaves. Diabetes increases the risk of tooth loss, leading to poor diet and decreased self-esteem. Maintaining good oral hygiene can prevent many of these mouth complications and other associated issues. However, if you are experiencing difficulty coping with your mouth complications, please talk to your doctor or dentist.
Educational content related to diabetes complications is made possible with support from Allergan, an active partner of Beyond Type 2 at the time of publication. Editorial control rests solely on Beyond Type 2.