Diabetes mellitus, or diabetes, is a disease affecting blood glucose (sugar) levels. An organ called the pancreas creates the hormone insulin, which helps keep blood sugar levels in a healthy range.
With diabetes, the pancreas either doesn’t make enough insulin, or the body doesn’t respond to it well. Without proper insulin function, blood sugar levels rise and can lead to health problems if left untreated.
Diabetes is becoming more prevalent worldwide. As of 2015, 30.3 million people in the United States, or about 9.4 percent of the population, had diabetes. Unfortunately, more than 1 in 4 people with diabetes don’t know they have it. Having undiagnosed diabetes increases the risk of complications from lack of prompt treatment.
Many people also have prediabetes, a condition where blood sugars are slightly elevated but not high enough to be considered diabetes. Having prediabetes is a major risk factor for eventually developing type 2 diabetes. The U.S. Centers for Disease Control (CDC) estimates that up to 30% of people with prediabetes will develop type 2 diabetes within five years of their prediabetes diagnosis.
Diabetes affects all parts of the body because it impacts blood supply and blood vessels. A surprising side-effect many people might not be aware of is how diabetes can impact oral hygiene and breath. In fact, people with diabetes are more likely to suffer from oral health issues, including bad diabetes breath.
Causes of bad breath and diabetes
Higher blood sugar levels (hyperglycemia) are associated with an increased risk of infections and poor wound healing. As a result, people with chronically high blood sugar levels are at greater risk of developing periodontal disease or gum disease.
Periodontal disease impacts both the gums and the bones that hold teeth in their place. A potential consequence of periodontal disease is tooth and bone loss. Periodontal disease can also result in bad breath from bacterial infection.
Severe periodontal disease can further increase blood sugar levels. This occurs because one of the body’s responses to infection is to increase blood sugar. It can then become a dangerous cycle – periodontal disease increases blood sugar, which further worsens the infection and delays healing.
Signs of periodontal disease include:
- Red, swollen or tender gums or other pain in your mouth
- Bleeding while brushing, flossing, or eating hard food
- Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
- Loose or separating teeth
- Pus between your gums and teeth
- Sores in your mouth
- Persistent bad breath
- A change in the way your teeth fit together when you bite
- A change in the fit of partial dentures
Risk factors for developing periodontal disease include:
- Older age (65+)
- Smoking and tobacco use
- Certain medications
- Clenching or grinding teeth
- Diseases (including diabetes and heart disease)
- Poor nutrition
People with diabetes are also more likely to have bad breath because of increased plaque on their teeth. Plaque is a layer of bacteria found on and between the teeth. Bacteria eat sugar, which releases the odor associated with bad breath.
People with diabetes can have higher concentrations of sugar (glucose) in their saliva, increasing the production of plaque. If plaque isn’t adequately removed through good oral hygiene habits such as brushing, flossing, and regular dental care, it can cause inflammation and gum disease.
A buildup of plaque can lead to dental caries or tooth decay (cavities). This occurs when bacteria eat away at the tooth’s enamel, exposing the inner parts of the teeth that are meant to be protected. Cavities are associated with bad breath due to the high bacteria count in the mouth.
Symptoms of dental caries include:
- Toothache, spontaneous pain, or pain that occurs without any apparent cause
- Tooth sensitivity
- Mild to sharp pain when eating or drinking something sweet, hot or cold
- Visible holes or pits in your teeth
- Brown, black or white staining on any surface of a tooth
- Pain when you bite down
People with type 1 diabetes are at risk of developing a serious diabetic ketoacidosis condition, or DKA. DKA happens when your blood sugar is very high and acidic substances called ketones build up to dangerous levels in your body. This can occur from things such as missing a dose of insulin or not eating well due to illness.
This causes the body to start producing ketones to use as fuel instead of glucose. A sign of ketone bodies being present is fruity-smelling breath. DKA can cause coma or death, so prompt medical attention is required.
Some symptoms of DKA include:
- Fruity breath
- Excessive thirst
- Frequent urination
- Abdominal pain
- Nausea and vomiting
People with diabetes are more likely to suffer from dry mouth. The exact reasons aren’t quite understood, but part of the reason could be that high blood sugars can lead to dehydration, resulting in loss of saliva coating the mouth. Untreated, dry mouth can lead to bad breath.
Symptoms of dry mouth include:
- Dryness or a feeling of stickiness in your mouth
- Saliva that seems thick and stringy
- Bad breath
- Difficulty chewing, speaking, and swallowing
- Dry or sore throat and hoarseness
- Dry or grooved tongue
- A changed sense of taste
- Problems wearing dentures
Managing bad breath from diabetes
Oral hygiene: The best treatment for bad breath is practicing good oral hygiene to prevent it from occurring in the first place. It’s recommended to brush teeth twice daily and floss daily. Using mouthwash can help cover up bad breath and kill germs causing bad breath, but it shouldn’t be used in place of brushing or flossing.
For dry mouth, it’s recommended that people with diabetes drink plenty of fluids, as well as suck on sugar-free candy or chew sugar-free gum to stimulate saliva production.
Preventive dental visits: Regular visits to the dentist are crucial in preventing bad breath, as well as promoting good oral health. Having a dental cleaning and check-up every 6 months is ideal, but check-ups might be recommended more often by a dentist for concerning issues.
During a routine dental exam, the dentist or hygienist will:
- Evaluate your overall health and oral hygiene
- Evaluate your risk of tooth decay, root decay, and gum or bone disease
- Evaluate your need for tooth restoration or replacement
- Check your bite and jaw for problems
- Remove stains or deposits on your teeth
- Demonstrate proper cleaning techniques for your teeth or dentures
- Assess your need for fluoride
- Possibly take dental X-rays or, if necessary, do other diagnostic procedures
Blood sugar management: Another good treatment for bad breath is to promote healthy blood sugar levels. When glucose levels are lower, it provides less food for bacteria in the mouth. Better blood sugar control also promotes better healing from infections, which can help with bad breath.
There are many ways to help promote healthy blood sugar levels. There are several approaches to manage diabetes, including:
- Metformin: Helps to reduce the amount of sugar released by the liver and improves insulin sensitivity
- Sulfonylureas: Stimulate the pancreas to secrete more insulin
- GLP1 receptor agonists: Promote insulin production, decrease glucose release from the liver, and slows stomach emptying to increase satiety
- DPP-4 inhibitors: Promote insulin production, decrease glucagon (a hormone that increases blood sugar) production, and delays gastric emptying.
- Insulin is available in different types: long-acting, short-acting, rapid-acting, intermediate-acting, and mixed. They differ in how quickly they take to work, how long until they are working the most to lower blood sugar and how long they last to provide blood sugar control. People with type 1 diabetes are insulin-dependent and usually take at least two types of insulins on a daily basis.
Lifestyle changes: Making sustainable lifestyle changes can help promote healthy blood sugar levels.
- Cut back on sugar. While eating sugar doesn’t cause diabetes, a higher sugar intake has been associated with increased blood glucose levels. In particular, added sugars are detrimental to tooth health by providing a lot of food for bacteria to survive on, causing plaque buildup. The American Heart Association recommends that women consume no more than 6 teaspoons of added sugar per day (24 grams) and men consume no more than 9 teaspoons of added sugar per day (36 grams).
- Exercise. Being physically active is a very important way to help control diabetes. 150 minutes per week of moderate physical activity, such as brisk walking, is recommended.
- Eat a high-fiber diet. Plant-based foods rich in fiber tend to raise blood sugar levels more slowly than low-fiber plant-based foods. Fiber is in foods such as fruits, vegetables, grains, nuts, seeds, and legumes. High-fiber foods such as apples and carrots may also have an anti-cariogenic (fights cavities) effect by helping to scrape away plaque on the teeth through their fibrous texture.
Having diabetes can increase the risk of bad breath from high blood glucose levels. High blood sugar provides more food for bacteria in the mouth, which increases the likelihood of gum disease, cavities, and infections.
People with type 1 diabetes can experience a condition called diabetic ketoacidosis (DKA) from very high blood sugar levels. One of the symptoms of DKA is foul/fruity breath from the breakdown of ketones for energy in the absence of insulin.
While some products might cover up bad breath, it’s best to treat the cause at the source. Practicing good oral hygiene, keeping up with preventive dental exams, and having a good diabetes self-management plan to promote healthy blood sugar levels are the best ways to treat and prevent bad breath.