Diabetes and Your Mouth

Here’s a good diabetes New Year’s Resolution. Repeat after me: This year I will take care of my mouth! Having healthy gums is one of the very best things you can do for your diabetes.

Why is mouth care so important? It’s because gum problems in diabetes create a vicious cycle. As gums become more inflamed, the whole body reacts by becoming more insulin resistant and raising blood sugars. That is part of the inflammatory response.


Then the higher sugar levels feed the germs that cause the gums to become infected. Your gums start bleeding and swelling, your breath gets worse, your teeth become loose, and the infection raises your sugar levels even more.

Studies find that people in certain populations with diabetes and severe gum disease die at three times the rate from cardiac or kidney disease as people who have diabetes but don’t have gum disease. This increase is what you would expect from an A1C of 12%, which corresponds to extremely high blood sugar levels.

The Mayo Clinic explains how this happens. “When starches and sugars in food and beverages interact with bacteria [in your mouth], a sticky film known as plaque forms on your teeth.”

If you don’t scrape the plaque off with regular brushing and flossing, it gets under the gums and forms a hard substance called tartar. Tartar causes inflammation in the gums, known as gingivitis. After a while, gingivitis can lead to a gum infection called periodontitis. As the Mayo Clinic puts it, periodontitis “destroys the soft tissue and bone that support your teeth…caus[ing] your gums to pull away from your teeth and your teeth to loosen and even fall out.”

How to prevent this
Dental care is mostly self-management. It starts with:

• Brushing and flossing. Experts at the American Diabetes Association and American Dental Association say brush at least twice a day and floss at least once a day. Learn how to brush correctly and floss correctly by clicking on these links for maximum benefit.

Brushing should last at least two minutes. The Mayo Clinic advises “Use a soft-bristled toothbrush and toothpaste that contains fluoride. Avoid vigorous or harsh scrubbing, which can irritate your gums.”

Brushing breaks up and removes the plaque forming on the front and back of the teeth, about 60% of total tooth surface. Flossing gets between the teeth, the 40% brushing can’t reach.

Experts say plaque takes 24 hours to solidify, so flossing once a day should be enough. I have not found that to be the case. When I was flossing once a day, my gums were bleeding quite a bit. When I got to twice a day, the bleeding became rare, and when I got to three times a day, it stopped.

However, dental floss is not cheap and not pleasant for some people. Dentist Peggy Rosen says you can use a dental pick or water irrigator instead. In poor countries, people use threads or even blades of grass, but these items probably aren’t as effective as manufactured floss.

• Professional help. Self-care is not enough for most people. Studies show that people who see a dentist once a year for cleaning have lower rates of heart attacks, probably because they have less inflammation.

People with diabetes probably will benefit even more, because of being at higher risk to start with. So you may want to get a professional dental cleaning twice a year, especially if you are having gingivitis symptoms. These symptoms include bleeding, swelling, or receding gums, loose teeth, or noticeably bad breath.

You don’t need a super-expensive, top-of-the-line dentist for teeth cleaning. Any good dentist or hygienist can do it for most people. You could consider going to a dental school clinic or a public health dental clinic if cost is a major barrier for you. But do it.

• Antiseptics. You can kill more germs by rinsing your mouth with an antiseptic (sometimes called “antimicrobial”) mouthwash after flossing and/or brushing. I’m not talking about candy-flavored breath mouthwashes. It needs to say antiseptic or antimicrobial on the label and taste kind of medicinal, in my experience.

Some flosses are coated with antiseptic, so they provide some of the same benefits as the antimicrobial mouthwash.

• Eat right. Avoid sticky things like ice cream, yogurt or candy. If you do eat some, brush and probably floss right away.

• Don’t smoke. It substantially increases the risk of gum disease.

• Better blood sugar control helps. High blood sugar interferes with the function of infection-fighting white blood cells, so germs can run wild. Better control will help your gums, and healthier gums will help your blood sugar control.

Dental hygienist Shirley Gutkowski wrote on Diabetes Self-Management about other ways to protect your gums. A big one is to avoid dry mouth, which can be caused by medications, prolonged high glucose levels, dehydration, and certain illnesses.

Gutkowski says, “Dry mouth raises the risk of tooth decay, periodontal disease, and other oral infections, because the lack of saliva allows harmful bacteria to proliferate in the mouth.”

She writes that the important thing is to keep your mouth moist, so you should “Sip plain water throughout the day. Tap water is preferable to bottled water since it contains fluoride, which helps prevent tooth decay.”

If any of our readers have noticeable gum disease, I hope you start focusing on it. When it comes to diabetes management, gum care is probably as important as exercise or glucose monitoring.