Diabetes and Your Gums

After five years of writing about diabetes, I still think gum care is among the most important and least appreciated aspects of self-management. Studies keep showing how gum (periodontal) disease and diabetes make each other worse. So are you flossing yet?


Severe gum disease (periodontitis) can cause diabetes. According to researchers at Marquette University, “Periodontitis may [raise levels of inflammatory cytokines and serum lipids]… These cytokines can produce an insulin resistance syndrome similar to that observed in diabetes and initiate destruction of pancreatic beta cells leading to development of diabetes.”

Just as gum disease contributes to diabetes, having diabetes worsens gum conditions. According to the American Academy of Periodontology (AAP), “Periodontal disease is often considered the sixth complication of diabetes. Those people who don’t have their diabetes under control are especially at risk.”

The link between diabetes and gum disease is that both cause inflammation, not just locally, but through the whole body. Inflammatory cytokines like interleukin 1 (IL-1) and tumor necrosis factor (TNF) inflame blood vessels, creating small scars. Soon the vessels block up with plaque. These blockage are linked with heart disease, kidney disease, and strokes, all major complications of diabetes.

A study from Bangalore, India looked at 200 people, half of whom had recent strokes or heart attacks. Researchers controlled for family history of stroke, diet, smoking and alcohol consumption, diabetes, hypertension, total serum cholesterol level, and education level. Those with worse gums (pocket depths greater than 4.5 millimeters) had far higher risk of strokes.

Along with inflammation, infection of the gums creates a vicious diabetes circle. Gum infections can raise blood glucose levels. At the same time, high blood glucose makes it harder to fight infections. High glucose seems to weaken white blood cells called “neutrophils,” so they can’t kill germs as well.

And one more thing. The latest research indicates that gum disease is a major risk factor for erectile dysfunction (ED), very common in men with diabetes. Improving the gum disease may cause erections to return.

Diagnosing Gum Disease
The National Diabetes Information Clearinghouse lists seven possible symptoms of gum disease. These are:

• 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

• dentures — false teeth — that do not fit well

If you have any of these symptoms, you should see a dentist or periodontist right away. And keep in mind that diabetes means you are more likely to have gum disease, even without symptoms.

What Can You Do?
Ninety percent of dental care is self-care. The most important thing is to brush, floss, and rinse with antiseptic mouth rinse at least once a day, preferably more. Jenny Ruhl at Diabetes Update says, “If at first your gums bleed a lot or are painful, keep at it, over time they should toughen up and get healthier and bleeding will stop.” This Web page gives good flossing instructions.

But professional dental care is also super-important. According to The Gum Disease — Diabetes Project, gum disease causes “pockets” that are much deeper than the normal gap between tooth and gum. When this happens, you can no longer reach into the pocket with floss or a toothbrush, so it’s hard to get the germs out, although using a toothpick sometimes helps. That’s where professional help comes in.

Researchers at University of Buffalo (UB) found that “Elimination of periodontal infection and reduction of periodontal inflammation in diabetic patients resulted in a significant short-term reduction in the concentration of glycosylated hemoglobin (HbA1c).” (Apparently there was no long-term follow-up.)

Another UB report found that simple tooth cleaning is not enough for many people with diabetes. Antibiotics can also be important. “Studies incorporating systemic antibiotics along with mechanical debridement [cleaning] result in a reduction …in [A1C]… The treatment of chronic periodontal infection is essential in the diabetic patient.”

The AAP cites another study of Pima Indians with both diabetes and gum disease. This study found that, “when their periodontal infections were treated, the management of their diabetes markedly improved.”

So you want to have your teeth cleaned by a professional at least twice a year, probably more if you have diabetes. Richard Bernstein, MD, author of Dr. Bernstein’s Diabetes Solution, advocates long (several months) courses of antibiotics “to help people with diabetes regain excellent blood sugar control.”

Of course, all this dental care can be expensive. Medical insurance should cover dental care for people with diabetes, because it’s a vital part of care, but sometimes it doesn’t. If there’s a dental school near you, that might be an option for affordable care.

When I started taking gum care seriously, my gums bled like crazy while flossing, and they hurt. Now they don’t bleed or hurt, and Aisha says I taste better, too. So let’s get flossing, and see a good dentist if you possibly can. You might see a dramatic payoff in your A1C levels!

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  • Carl H.

    I recommend taking Coenzyme Q-10 (often called CoQ10) if you have diabetes. Really, really helps the gums if your sugar’s been out of whack. My dentist could not believe the difference once I started taking it – tho’ focusing on keeping my sugar down had to have helped too.

    I used 100mg a day at first, after a while one of the smaller 30mg or 50mg pills a day will keep you in pretty good shape. The stuff’s not cheap, but I felt like I got my money’s worth (still have teeth!)

  • Ferne

    I go to a dentist for diabetics and get excellent care. I found out how much my former dentist didn’t know and was really depressed when I learned from the new dentist. She assured me it wasn’t as bad as many and I began my new treatment that day. I go 4 times a year and my mouth and teeth are in excellent condition.

  • Meta

    I cannot support you enough in getting this critical information out. I was diagnosed with Type 1 way back in the early 70s, My gums were so bad that they couldn’t be normalized, and I had to undergo radical gum surgery. Along with over 10 teeth extracted, the amount of bone loss was severe. The surgeon told me that I would be lucky to have any teeth by the time I was 50. After undergoing gastric bypass surgery in 2005, the remainder of my teeth actually fell out, and I had to get dentures. They do not fit correctly because there is not enough bone ridge to hold them in place. Believe it or not, I was not familiar with periodontal disease being caused by ill fitting dentures. I am plagued by sore gums due to the horrible fit. Now I will take a closer look at my gums and be even more careful with them. Thank you for writing about this oh so horrible complication. I think this should be on every doctor’s list of precautions for the newly diagnosed as well as a part of long term care.

    Thank you again for such a wonderful article. I’m sure you’ve helped many today.

  • Boo-Hoo

    Recommended taking vitamin C in whole form like Acerola powder.

    Seems to work. If stop taking the gums bleed, take Acerola and the gum stops bleeding completely.

  • Lynne Nelson

    Earlier this year when I went for a routine cleaning, my dentist noted that one of my crowns on an upper molar had worn through to the metal. As it happened, I had an infection within my gum that had not caused any pain or swelling but was very deep and difficult to clear. By coincidence, I had just read an article in Diabetes Management which discussed “chronic painless gum infections” that diabetics may have.
    I wouldn’t have believed that an infection so severe would not cause a severe swelling, but it didn’t. Once the infection was cleared my fasting readings which had been steadily rising for a period of months, slowly began to retreat again to high normal or less. So I can verify from experience that a diabetic can’t be too careful. I also take co-q 10 and vitamin c, and my gums never bleed from brushing and routine care.

  • Michelle Rafferty

    I went to the dentist today and found out I have poor gums. I have known for a little while ss so painful. more so when brushing. so I have to go back and see the hygienist so I thought I look on the net to see what steps I can take. it is interesting to see what you all have done but it’s hard as I don’t know what the prouducts are and what the similar products would be over here in the uk.

  • David Spero RN

    Michelle, the main products you need are dental floss (twice a day, after meals or at bedtime) and an antiseptic mouthwash (not one of those candy flavor breath washes, but a medicinal one that kills germs.)

    Vitamin C is good, and ask your dentist if antibiotics are a good idea for you.

  • Scott Hogge

    I have had type 1 diabeties for 41 years. For the most part my teeth have been ok but to a point. I have not had money to do anything but have one pulled if it was a problem. I have been lucky . On both sideds I have had several teeth removed and still can chew faily well I’m only 55.
    I have in the last year noticed the tooth and gum getting a ridge developing . Its like someone has gone around my front teeth mostly. And it has been severely eaten away !!!!! The worst are my two front theeth. This is to deep to be filled .have not been tk the dentist because I can’t afford one . I am on disability and medicare. Thats it. All I have coming in and just can’t work. I have tried but I’m on pain mamagement and not able to work from that. This is not helping my depression at all. Is this a medical condition that medicare will pay some on , well all on ? I am to the point I know they are hurting but the pain managment
    Saine . Where can I go for help ? A dental colledge a hour from me still charges but at a reduced rate. For sure I will need implants on several of my front upper teeth . I’m willing to make the drive to have everything done at once. I am worried about what is going to happen when one of them break off. Any one have any information that would help which direction I need to go ? We have a free clinic here one a year but its for only one thing at a time and these are not a one visit kind of thing. I would hate to have denture worse than anything I can think of ,,,,, any suggestions ?????

  • Manjitsingh Bhalla

    Completely agreed with survey conveyed by researchers at Marquette University! A connection between periodontitis and triggering condition such as inflammatory cytokines is really awful that creates an insulin resistance syndrome and contributes to diabetes development. Vice versa, diabetes may also generate many dental problems, activating the bacterial growth the most in mouth simply due to an increased level of blood sugar being largely fed to them. Dental plaque, tooth decay, periodontitis and tooth loss may be the end-results.

    Dentist’s visit is necessary. Prescribed medications like antibiotics will ease the condition. Otherwise, proper dental care, teeth cleaning, certain dental treatments may also be required under the guidance of dentist or periodontist.

  • hudawasim

    gum bleeding,sweeling and gaps and have a smelly odur from mouth what should i do to solve it?
    please answer my question

  • David Spero RN


    As the article says, brush, floss at least twice a day, avoid sugary foods and drinks, see a dentist if you can afford one. A professional gum cleaning and antibiotics should help. As readers suggested, vitamin C and coenzyme Q-10 will likely improve things.

    Good luck with this. You might be surprised how much better your body feels if you can heal your gums.

    David Spero RN