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Gum Disease and Diabetes

By Cheryl Alkon

High blood sugar levels can contribute to gum disease and tooth trouble in people who have diabetes, but there are ways to take care of your mouth

Diabetes packs a double punch when it comes to gum disease.

First, high blood sugar can increase the amount of sugar in your saliva. This allows more plaque to build up on the teeth. This can lead to gum swelling, soreness and bleeding—all signs of inflammation and the first step toward gum problems. Second, that inflammation can cause the immune system to work less efficiently to clear out bacteria that grow due to the excess plaque, causing more dental problems.

Plaque is a sticky, colorless film that comes from old food and debris that isn’t cleared away from the teeth by regular daily brushing and flossing. It can harden into tartar, which can only be removed from the teeth by a dental professional.

Having diabetes with elevated glucose levels both contributes to the problem and makes it difficult to fix the problem properly.

What is Gum Disease and Diabetes?

There are two forms of gum disease: gingivitis and periodontitis, explains Dr. Wenche Sylling Borgnakke from the University of Michigan’s dentistry school.

Gingivitis happens when the gum’s soft tissues around the teeth become inflamed, or swollen. Depending on one’s skin tone, healthy gums can range from pink to brown or black. Red gums mean that something isn’t healthy, usually a sign of a plaque buildup and inflammation. Notably, gingivitis is reversible with good brushing and flossing, as well as a professional dental cleaning, but some people can have gingivitis without knowing it, Dr. Borgnakke said. But if gingivitis continues, it can lead to tooth loss, or periodontitis. See below for how common this is!

As background, with periodontitis, spaces open up between the teeth and gums and become inflamed. This can cause the tissue and the bone holding the teeth in place to loosen and the tooth may eventually fall out. “You may not be aware of it until a tooth is loose,” Dr. Borgnakke says. “Once tissue or bone is damaged, it can’t be replaced. When the teeth don’t have any bone to support them, they will loosen and either need to be taken out (extracted) or will fall out by themselves. This is rare, as most people will seek care before that happens,” she says.

To avoid getting to that point, “there is nothing as important as prevention by getting dental checkups on a regular basis, even without any symptoms, such as bleeding, pus, foul smell or bad taste,” says Dr. Borgnakke. If your dentist or hygenist notices space between the teeth and gums, “make sure to have the depth of the space measured to make sure it is not getting too deep.”

How Common Is It?

Extremely. Dr. Borgnakke was the lead author in a chapter about gum disease in Diabetes In America, 3rd edition, published by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Dr. Borgnakke said that about 90 percent of all adults in the United States (regardless of whether they have diabetes) have gingivitis, while about half of all adults over age 30 have periodontitis. An estimated 30.2 million people – 12 percent of US adults – have diabetes though only about 22 million are diagnosed. The field is working toward improving diagnoses so that more complications like gum disease can be avoided.

How to Treat/Avoid Gum Disease

Watch your mouth: as with everything about diabetes, keeping glucose levels in range as much as possible (especially by avoiding high carbohydrate and sugary foods) is key to keeping your gums healthy. Daily dental care at home and twice-a-year visits to the dentist/dental hygienist are also crucial, said Dr. Borgnakke, adding, “If your teeth are wobbly, go more often than that.”

The NIDDK recommends the following guidelines for a healthy mouth:

  • Gently brush your teeth carefully at least twice a day, using the softest toothbrush you can find. Brush two teeth at a time, and focus on the front, back, and top of each tooth.

  • Use toothpaste with fluoride to strengthen your teeth and help prevent tooth decay (though fluoride doesn’t help the gums directly).

  • Brush in the morning, before bed, and after meals and snacks if possible.

  • Floss at least once a day. Carefully work the floss back and forth between the teeth and curve it at the bottom of the teeth near the gumline.

  • Change your toothbrush every three months, or sooner if the bristles are worn. “A new toothbrush removes more plaque,” notes the NIDDK website.

  • When visiting the dentist for a cleaning and a checkup, tell them you have diabetes. Know your A1C and time in range and share it with your dentist.

  • Don’t ignore pain in the mouth: see a dentist if you have any problems and follow dental advice to prevent or halt any issues.

  • Don’t smoke, and if you do smoke, work to stop – talk to your healthcare team about how.

About Cheryl

Cheryl Alkon is a seasoned writer and the author of the book Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby. The book has been called “Hands down, the best book on type 1 diabetes and pregnancy, covering all the major issues that women with type 1 face. It provides excellent tips and secrets for achieving the best management” by Gary Scheiner, the author of Thinking Like A Pancreas. Since 2010, the book has helped countless women around the world conceive, grow and deliver healthy babies while also dealing with diabetes.

Cheryl covers diabetes and other health and medical topics for various print and online clients. She lives in Massachusetts with her family and holds an undergraduate degree from Brandeis University and a graduate degree from the Columbia University Graduate School of Journalism.

She has lived with type 1 diabetes for more than four decades, since being diagnosed in 1977 at age seven.

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