Diabetes and oral care: Guide to a healthy mouth

Diabetes mellitus is a complex disease that brings extra health risks. Diabetes care is a balancing act of maintaining good blood sugar level control in connection with your health care providers.

When diabetes goes untreated or is not well-managed, blood sugar levels rise and cause many other disease processes. 

Uncontrolled diabetes puts individuals at an increased risk of developing periodontal disease. In people without diabetes, periodontitis is associated with higher HbA1c and fasting blood glucose levels, and severe periodontitis is associated with an increased risk of developing diabetes. In people with type 2 diabetes, periodontitis is associated with higher HbA1c levels and worse diabetes complications.

Treatment of periodontitis in people with diabetes has been shown to result in overall improved glycemic control. “The risk for periodontitis is increased two to three times in people with diabetes compared to individuals without, and the level of glycemic control is key in determining risk.”1. Because of the excess blood glucose circulating in the blood, dental health problems can occur. Indicators that there may be an issue:

  • You may have less saliva, causing dry mouth. (xerostomia)

  • Because saliva protects your teeth, you’re also at a higher risk of tooth decay and dental caries.

  • Gums may become inflamed and often bleed (gingivitis) and can result in gum recession

  • You may experience delayed wound healing.

  • For children with diabetes, teeth may erupt at an age earlier than is typical

  • You may be susceptible to infections inside of your mouth.

  • You may have problems tasting food.

What are the symptoms of dental health problems?

Dental care in diabetes and oral health should be a top priority. The higher your blood glucose level is, the higher the risk of oral health problems. Too much glucose in your blood from diabetes can cause pain, infection, and other problems in your mouth. Your mouth includes teeth, gums, tongue, tissues in your mouth and jaw.  

Diabetic patients must be sure to take time to check their mouths regularly for any problems. Things to take note of include:

  • Gums appearing swollen. Bleeding gums may occur when you brush and floss.

  • Dryness, soreness of tongue or cheeks.

  • White patches.

  • Bad taste in the mouth. 

Taking the time to inspect your mouth regularly enables you the ability to note changes. All of these are reasons to visit a dentist.

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Diabetes and gum diseases

Glucose is present in all saliva. When glucose levels are uncontrolled, plaque bacteria arise. Bacteria in your mouth or elsewhere thrive on sugar. When the bacteria meet with food in your mouth, they combine to form plaque. Sticky plaque is that is not removed turns into tartar which difficult to remove. This makes flossing and brushing complicated. Some bacteria cause caries (cavities), and some cause bad breath.

Gingivitis, commonly known as gum disease, is one of the major complications of diabetes. Gingivitis starts with inflammation at the gum line, where plaque builds up. Everyone’s mouth contains bacteria. But we know that diabetes is a disease in an inflammation state.

If gum disease is untreated, jaw erosion can occur, as in periodontitis. The gums will start to pull away from the teeth. The space left behind forms pockets and oral infection can occur.

Unfortunately, if this is undetected, the infection can go on for quite some time. Your body tries to fight the bacterial infection, but the plaque will continue to form under the gum line. The plaque buildup and infection can cause jaw erosion. This may lead to tooth loss and cause further gum loss.

Tissues that support the teeth are destroyed. If tooth loss does not occur, you may need a dental procedure that includes extraction. “You may need deep cleaning, antibiotics, or even oral surgery depending on how advanced the gum disease is”3. If you have high blood sugar levels in uncontrolled diabetes, you may have more frequent periodontal disease occurrences. If the disease process is addressed, blood sugar levels often will decrease. 

Dental hygiene, diabetes, and heart problems

Coronary plaque buildup can occur quickly in patients with diabetes compared with those without diabetes. Bacteria can actually get into the bloodstream causing the arteries to build up plaque and harden. This hardening of the arteries is called atherosclerosis, and it is dire. It leads to blood flow problems and heart blockages, increasing the likelihood of having a heart attack. The damaging impact on the arteries and blood vessels can lead to hypertension and increase stroke risk.

Endocarditis can also develop, which is an often-fatal condition that occurs when the lining of the heart becomes infected. In a study that reviewed dental health in diabetics, a correlation was found between tooth loss and cardiovascular disease was greatest in men; it concluded that tooth loss was associated with an elevated risk of coronary heart disease.5

Research summarized in Clinical Cardiology urged that compliance with preventative oral care is necessary for ensuring cardiac health.5 Good oral health can be the first step in preventing heart disease. If you have diabetes and have moderately advanced periodontal disease, it can be more difficult for you to control your blood sugars.

Oral thrush (mycosis) is another type of fungal infection caused by diabetes. It primarily affects several areas of the body, particularly the genital and anal areas. Fungi are most likely to thrive and infect body areas that are warm and damp. These include areas such as the mouth, below the breasts, armpits, and foreskin. The usual signs of thrush:

  • Burning sensation on the infected area

  • Buildup of white patches that looks like cottage cheese

  • Thick and white discharges with itchiness and red rashes.  

Diabetes mellitus is one of the main risk factors of fungal infections of the oral cavity, the lower part of the gastrointestinal tract, skin, foot, urogenital system, and blood. Mycosis (fungal infection) in the GI tract has a direct correlation to the HbA1C level. Researches emphasize the connection between the effective treatment of mycosis and glycemic control5. Following good dental hygiene practices may help reduce your risk of developing candida infections.

Dental hygiene tips

Follow these tips to steer clear of gum disease:

  • Avoid acidic drinks like soda, energy drinks, and water with lemon. These can erode the enamel of your teeth, which can lead to decay.

  • Floss daily between each tooth, sliding up and down and back and forth gently to avoid bleeding. If neuropathy is a concern for you, utilize oral picks or a floss handle.

  • Brush your teeth and gum line for two full minutes, two times each day. Soft bristle brushes are preferred as those with firm bristles can be overly rough on gums. Use gentle strokes, and make sure you reach all of your teeth. The goal is to get rid of plaque buildup. To do this, vibrate your brush across the tooth surface, the gum line, and your gums. Consider using an electric toothbrush. The vibration is superior in breaking up plaque compared to a handheld brush.

  • Remember to gently brush your tongue for a few seconds, too, to get rid of bacteria. This can help clean the tongue of bacteria that form candida and thrush.

  • While fluoride toothpaste is recommended, some studies have found a correlation with fluoridated water intake, increased fluorosis, and an increased impaired glucose tolerance7

  • See your dentist at least twice a year and report any of the signs mentioned above immediately. Regularly scheduled visits can help identify a dental problem early on.

  • Rinse your mouth. If you need to use a corticosteroid inhaler, be sure to rinse your mouth with water or brush your teeth after taking your medication. Corticosteroids can cause side effects, including thrush, a local yeast infection in the mouth and throat. This is because the steroid’s anti-inflammatory effect also reduces the immune response against microbes, including viruses, bacteria, & fungi.

  • Check your dentures. Remove your dentures at night. Make sure dentures fit properly and don’t cause irritation. Clean your dentures daily. Ask your dentist for the best way to clean your type of dentures. If food is in between your dentures and gums, it can lead to irritation and bacteria growth. 

  • Watch what you eat. Try limiting the amount of sugar-containing foods you eat. These may encourage the growth of candida.

  • Maintain good blood sugar control if you have diabetes. Well-controlled blood sugar can reduce the amount of sugar in your saliva, discouraging the growth of candida.

  • Treat dry mouth. Ask your doctor about ways to avoid or treat your dry mouth. Some ideas include sipping water throughout the day or occasionally chewing on sugar-free gum.

  • Check your blood sugars regularly and try to keep them within the desired ranges. 

  • Strictly follow your insulin regimen and medications as outlined by your doctors.

  • Don’t smoke – smoking weakens your immune system, making it harder for you to fight gum infection. And once you have oral disease, smoking makes it harder for your gums to heal. 


When one is diagnosed with diabetes, there may be an instant feeling of burden. Suddenly there are more doctors, medications, disease processes to worry about. Not to mention what you are eating, what to avoid, and which appointments you may have to schedule. Once you can move through the process of acceptance, you will hopefully feel some empowerment. While the diagnosis may feel difficult, taking control of your health is truly in your hands. 

Good oral health is intertwined with choosing a healthy, balanced diet that is low in sugar. By choosing the right food and drink, you can prevent gum infection, thrush, and cardiovascular disease. Statistics have proven the health benefits of oral health. 

Performing one more tooth brushing a day was associated with a 9% significantly lower risk of cardiovascular events. Regular dental visits (once a year or more) for professional cleaning were also shown to reduce cardiovascular risk by 14%. Improving oral hygiene practices decreased the cardiovascular risk originating from periodontal disease, dental caries, and tooth loss6.

When visiting the dentist, be prepared to share pertinent information. Tell your dentist about any changes in your health or medicines. Share the results of some of your diabetes blood tests, such as the A1C test or the fasting blood glucose test. If you are aware of any problems, share your concerns. Follow your dentist’s advice. If your dentist tells you about a problem, take care of it right away.

Prolonging treatment can only exacerbate the problem. Follow any steps or treatments from your dentist to keep your mouth healthy. In between visits, good oral hygiene can be put into practice as part of your daily routine. Oral health can be seen as a picture of your overall general health. 

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  1. Preshaw, P., Bissett, S. Periodontitis and diabetes. Br Dent J 227, 577–584 (2019).
  2. https://doi.org/10.1038/s41415-019-0794-5
    NIDDK. (2014).
  3. Oral Thrush. Available: diseases-con. Last accessed 3/13/21.
    G David Batty1, Keum Ji Jung2,3, Yejin Mok4, Sun Ju Lee3, Joung Hwan Back5, Sunmi Lee5, and Sun Ha Jee. (2018).
  4. Oral health and later coronary heart disease: Cohort study of one million people. European Journal of Preventative Cardiology. 25 (6), 598-605
    Shin-Young Park 1 2, Sun-Hwa Kim 3, Si-Hyuck Kang 3 4, Chang-Hwan Yoon 3 4, Hyo-Jung Lee 1, Pil-Young Yun 5, Tae-Jin Youn 3 4, In-Ho Chae. (2019).
  5. Improved oral hygiene care attenuates the cardiovascular risk of oral health disease: a population-based study from Korea. Eur Heart J .. Apr 7;40 (740 (14)), 1138-45
    Michael Connett. (2015).
  6. FLUORIDATED WATER CAUSES SEVERE DENTAL FLUOROSIS IN CHILDREN WITH DIABETES INSIPIDUS. Available: https://fluoridealert.org/studies/diabetes-insipidus/. Last accessed 3/14/21

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