Oral Care — Secret Key to Diabetes Success

Caring for your mouth helps your diabetes. Healthier gums will lower your HbA1c (a measure of blood sugar levels over the previous 2–3 months) and help prevent complications.

Gum infection (“periodontitis”) increases insulin resistance and blood sugar levels. Higher glucose levels make infections worse by giving the germs sugar to feed on. A study at Marquette University found that periodontitis “can produce an insulin resistance syndrome…and initiate destruction of pancreatic beta cells.”


An analysis done in the Netherlands found that treating periodontitis lowered HbA1c levels. A study of Pima Indians with diabetes in Arizona found that, “when their periodontal infections were treated, the management of their diabetes markedly improved.” Another study of the Pima found that those with the worst gum disease had triple the rate of death from heart and kidney disease as those with healthier gums.

Gums get infected because mouths have germs in them. When bacteria get into your gums and cause gum disease, they inflame your whole body. According to the Mayo Clinic, untreated gum infections contribute to heart disease, diabetes, osteoporosis (fragile bones), and Alzheimer’s disease. Gum infections can lead to ear, sinus, jaw, and blood infections. They also cause teeth to fall out.

Dentures — false teeth — that do not fit well can rub on the gums causing inflammation and infection.

Symptoms of gum disease include:

• Red, sore, swollen gums
• Bleeding gums
• Gums pulling away from your teeth so your teeth look long
• Loose or sensitive teeth
• Bad breath
• A bite that feels different

You may also have pain if the infection becomes severe. If you have these symptoms, consider it a top health priority. Periodontitis is raising your sugar levels and inflaming your blood vessels every minute of the day.

What to do?
First, brush and floss as often as you can. The American Dental Association recommends brushing twice a day for two minutes each time, and flossing once a day. Others say this may not be enough. Some experts say floss after each meal and snack, or at least twice a day.

Dental floss is made from spun nylon or Teflon. While a toothbrush can reach about 60% of a tooth’s surface, floss can get between your teeth and reach the other 40%. It breaks up the germy film which food leaves on your teeth and allows you to brush or rinse the germs away.

If not removed, tooth film turns into a harder substance called plaque. Long-term plaque turns to an even harder, stickier substance called tartar that irritates your gums and causes inflammation and infection.

Tips on flossing
• Floss in a “C” shape. Run the floss down the side of a tooth. Go back and forth and up and down, gently curving the floss around the base of the tooth. Then work it up and out and go on to the next tooth.

• Flosses come in different widths. Find a width that fits between your teeth. Wider ones may be more comfortable.

• Flosses come in waxed and unwaxed. They both work well, but waxed might feel better.

• At the beginning, there will probably be bleeding. (If not, great, your gums aren’t so bad.) Don’t let the blood scare you — as you floss regularly, bleeding will slow down and then stop as you heal.

• You can read techniques for flossing here. It involves some finger strength, and it might take practice to get good at it. If your hands aren’t up to it, you might try a floss pick, a “Y” or “F” shaped plastic wand with a piece of floss strung across. Some people find flossing with picks easier.

• If your dentist recommends it , follow flossing with an antiseptic mouthwash. Not a candy-flavored breath mouthwash, but one that says antiseptic or antibacterial and tastes more like medicine, like Listerine® or chlorhexidine (Peridex, Periogard, Periochip). You might ask your doctor or dentist for a prescription, which may be covered by insurance.

• Floss can be expensive, up to $4.00 a package retail. But you can buy from a large discounter or wholesaler for under $1.00 a package. Historically, people have used strands of hair or thread, reeds, or grass to floss. Monkeys floss with human hair or coconut fibers.

Other cleaners
Interdental brushes are toothbrushes with very small tips that fit between your teeth for brushing. They might be easier than floss for some people.

Waterpiks® and other oral irrigators use a stream of pulsating water to clean between the teeth, above and below the gum line. According to St. Lawrence Dentistry, “If used correctly, Waterpik is said to be a better way to reduce gum bleeding and is also effective in reducing buildup of plaque.”

Other between-teeth tools include toothpicks and electric flossers. If using a toothpick, be gentle and careful not to injure the gum, according to experts quoted in this article from Uganda’s Daily Monitor.

You can see a catalog of various flossing products here.

Brushing is equally important. Brush at least twice a day if you can. The Mayo Clinic suggests replacing your toothbrush every three to four months.

Wikipedia has great information on floss and other dental cleaners here.

Foods that hurt teeth and gums
The American Dental Association lists foods not to eat:

• Hard candies like lollipops

• Citrus fruits because of the acid

• Sugary drinks including sodas, sports drinks, and tea or coffee with sugar

• Sticky foods such as dried fruits and trail mix

• Chips because starchy crumbs stick between teeth

If you do eat or drink any of these, be sure to drink plenty of water along with them, and brush and floss afterward (but not within 30 minutes of eating if you’ve had something acidic, as this can weaken tooth enamel).

Get professional help
Flossing and brushing will deal with plaque. When plaque turns to tartar, it is too hard for floss and needs professional cleaning. People with diabetes need dental care at least twice a year.

If you have signs of periodontitis, antibiotics might be needed. Dr. Richard Bernstein, author of Dr. Bernstein’s Diabetes Solution, recommends long courses of antiobiotics for people with diabetes and dental infections to help them regain blood sugar control. A study at The University at Buffalo concluded, “The treatment of chronic periodontal infection is essential in the diabetic patient.”

One more thing — stop smoking. “Smoking weakens your body’s ability to fight infection,” according to the Centers for Disease Control. “Smokers are four times as likely as people who have never smoked to have gum disease. But if they quit, by 11 years after quitting, their risk is not significantly different from those who have never smoked.”

Living with diabetes requires creativity, kind of like doing improvisational theater. I wrote about life as improv in my blog The Inn by the Healing Path. If you enjoy it, click subscribe under the picture to receive monthly notifications of new posts.