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Gum Disease and Diabetes

6 Minute Read

Key takeaways:

  • Diabetes increases the risk of gum disease by raising blood sugar levels, which contributes to plaque buildup.
  • Gum disease progresses through stages, from gingivitis (reversible with good hygiene) to periodontal disease, which can cause irreversible damage to the gums.
  • Preventing gum disease involves regular dental checkups, maintaining good oral hygiene at home, managing blood sugar levels, and seeking treatment early to avoid severe complications.

One-third of people with diabetes have severe gum disease, and the American Dental Association suggests that one in five cases of tooth loss is related to diabetes. Gum disease, also known as periodontitis, is an infection of the gums that can lead to tooth loss if left untreated.  

How does diabetes cause gum disease?

People with diabetes may have high blood sugar, which can increase the amount of glucose in their saliva. This glucose feeds bacteria in the mouth and combines with food to cause a buildup of plaque. Without regular daily brushing and flossing, this plaque can harden into tartar, which can only be removed by a dental professional. High blood sugar can also lead to dry mouth, which reduces the saliva flow needed to wash away food particles and bacteria.

Diabetes can also cause blood vessels to narrow, which reduces blood flow to the gum tissue and makes it harder to fight off infections. The inflammation caused by gum disease can also lead to high blood sugar, making diabetes management more difficult. 

It’s a vicious cycle – having diabetes with elevated glucose levels both contributes to the problem and makes it difficult for your body to fix the problem. A recent study found that periodontal disease is a risk factor for developing gestational diabetes. Understanding how gum disease progresses, though, can help you recognize when it’s time to get help and prevent further damage.

Stages of gum disease

There are two stages of gum disease: gingivitis and periodontitis, explained Dr. Wenche Sylling Borgnakke, a professor at the University of Pittsburgh School of Dental Medicine.

stages of gum disease
Image Source: National Institute of Diabetes and Digestive and Kidney Diseases

The initial stage is gingivitis, which occurs when plaque and tartar build up along the gum line. This can cause gums to become red, swollen, and more prone to bleeding. Borgnakke said that gingivitis is reversible with good brushing and flossing, as well as professional dental cleaning.

If left untreated, gingivitis can progress to periodontitis, which is an infection that affects the gums and bones that support teeth. The gums may recede, creating pockets that become infected. This can cause the tissue and the bone holding the teeth in place to loosen.

 “You may not be aware of it until a tooth is loose,” Borgnakke said. “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.” 

Treating gum disease

While gum disease isn’t curable, appropriate treatment in the early stages (i.e., gingivitis) focuses on getting routine dental cleanings and improving oral hygiene at home to prevent tooth loss and the need for surgery.

People with mild gum disease may require deeper cleanings known as “scaling and rooting” or “subgingival instrumentation,” which is when the dentist uses tools to clean beneath the gums to remove plaque and tartar. This deeper cleaning may require local anesthesia.

With moderate or severe gum disease, more invasive “pocket reduction” surgeries involve making an incision in the gums to remove tartar around the teeth roots. Bone and gum grafting may also be done to replace any tissue or bone that is lost to gum disease.

How to prevent gum disease

To avoid needing dental surgery, “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,” said Borgnakke. If your dentist or dental hygienist 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,” she recommended.

It’s important to make sure that your dentist knows you have diabetes, as well as any medications you are taking, and if you are reaching your blood sugar targets. See your dentist right away if you are experiencing red, swollen, or bleeding gums, loose or sensitive teeth, increased spaces between your teeth, dry mouth, and/or bad breath that doesn’t go away after brushing and flossing your teeth.

As with most diabetes-related complications, working towards keeping your glucose levels in range as much as possible is key to keeping your gums healthy. Daily dental care at home and a minimum of twice-a-year visits to the dental hygienist and dentist are also crucial for healthy gums. “If your teeth are wobbly, go more often than that,” Borgnakke added.

The American Diabetes Association recommends the following brushing and flossing techniques for a healthy mouth:

  • Brush your teeth for two minutes, at least twice a day, using a soft toothbrush or an electric toothbrush and fluoride toothpaste. Place the toothbrush at a 45 angle toward the gums and gently move the brush back and forth along the outer, inner, and chewing surfaces of your teeth.
  • Floss twice a day, if you can. Carefully work the floss around each tooth in a C shape, sliding it up and down the tooth and beneath the gum line.
  • Your dentist may also suggest an antibacterial mouth rinse or antibiotics depending on your gum health.

Interestingly, taking better care of your teeth could be a sign of improved blood sugar management as well. A recent review found that frequent toothbrushing in people with type 2 diabetes was associated with better self-reported blood sugar management, as well as better measures of oral health.

The bottom line

Diabetes significantly increases the risk of developing gum disease, which can lead to tooth loss if not managed properly. Preventative care, including regular dental visits, proper brushing and flossing, and maintaining healthy blood glucose levels, is essential to protecting both your teeth and overall health. If you have diabetes, make oral health a priority to prevent complications that could affect both your smile and your diabetes management.

Learn more about managing diabetes-related complications here: