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Diabetes and Periodontal (Gum) Disease

Diabetes that is not properly controlled can lead to periodontal (gum) diseases in both young and old people. Periodontal diseases are infections of the gums and bone that hold the teeth in place.

Because of blood vessel changes that occur with diabetes, the efficiency of the flow of nutrients and removal of wastes from body tissues may become impaired. This impaired blood flow can weaken the gums and bone, making them more susceptible to infection.

In addition, if diabetes is poorly controlled, higher glucose levels in the mouth fluids will encourage the growth of bacteria that can cause gum disease. On the other hand, uncontrolled periodontal disease may also make it more difficult to control the diabetes.

A third factor, smoking, is harmful to oral health even for people without diabetes. However, a person with diabetes who smokes is at a much greater risk for gum disease than a person who does not have diabetes.

Paired with poor oral hygiene, diabetes can lead to gingivitis, the first stage of periodontal disease, or to periodontitis, severe gum disease.

What are the signs and symptoms of periodontal disease?

The following are the most common signs and symptoms of gum disease. However, each individual may experience symptoms differently. Signs and symptoms may include:

  • Red, swollen, tender gums

  • Bleeding while brushing and/or flossing

  • Receding gums

  • Loose or separating teeth

  • Persistent bad breath

  • Dentures that no longer fit

  • Pus between the teeth and gums

  • A change in bite and jaw alignment

The signs and symptoms of gum disease may resemble other conditions or medical problems. Consult a dentist or other oral health specialist for a diagnosis.

What are the different types of periodontal disease?

The different types of periodontal disease are often classified by the stage the disease has advanced to at the time of evaluation, including:

  • Gingivitis. With gingivitis, the mildest form of periodontal disease, the gums are likely to become red, swollen, and tender, causing them to bleed easily during daily cleanings and flossing. Treatment by a dentist and proper, consistent care at home help to resolve the problems associated with gingivitis.

  • Mild periodontitis. Untreated gingivitis leads to mild periodontitis. This stage of gum disease shows evidence of the development of periodontal pockets (gums pulling away from the teeth, causing the crevice between the teeth and gums to deepen), and early loss of bone around the teeth. Prompt medical attention is necessary to prevent further erosion and damage.

  • Moderate to advanced periodontitis. This most advanced stage of gum disease shows significant bone loss, deepening of periodontal pockets and possibly receding gums surrounding the teeth. Teeth may loosen and need to be extracted.

Treatment for periodontal disease

Specific treatment for periodontal disease will be determined by your dentist based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment may include any, or a combination of, the following:

  • Tartar and plaque removal beneath the gums. Deep cleaning (also called scaling and root planing) can help remove the plaque and calculus beneath the gum and infected tissue in the early stages of the disease, while smoothing the damaged root surfaces of the teeth. The gums can then reattach to the teeth.

  • Medication. Antibacterial medications may be placed topically in the periodontal pockets or taken orally.

  • Surgery. When the disease is advanced, the infected areas under the gums will be cleaned, and the tissues will then be reshaped or replaced. Types of surgeries include:

    • Pocket reduction

    • A regeneration procedure

    • A soft-tissue graft

    • Crown lengthening

  • Dental implants

Diabetes and other oral problems

Diabetes can also cause other oral problems, including:

  • Thrush. Thrush, a fungal infection of the mouth, occurs more often in persons with diabetes because of high glucose (sugar) levels in the saliva. Fungus thrives on glucose.

  • Dry mouth. Dry mouth (often a symptom of undetected diabetes) means the mouth does not have enough saliva to keep itself wet. Saliva is necessary to help digest food, and prevent infection and tooth decay by controlling bacteria and fungi. Dry mouth can make tasting, chewing, and swallowing food difficult, and can impede speech. In addition, dry mouth can cause mouth infections and tooth decay.

    Although each individual may experience symptoms differently, symptoms of dry mouth may include sticky, dry mouth, dry lips, sense of burning in the mouth, tough tongue, and mouth sores or infection.

    Always consult your doctor for a diagnosis.

    Treatment for dry mouth depends on the cause of the condition. Dry mouth can be caused by medication, disease, cancer treatment or other salivary gland damage, and nerve damage. Some tips to prevent dry mouth symptoms include:

    • Take frequent sips of water or sugarless fluids.

    • Avoid caffeine.

    • Drink fluids during meals.

    • Avoid spicy or salty foods.

    • Avoid tobacco and alcohol.

    • Use a humidifier at night.

    • Chew sugarless gum or sugarless candy.

Preventing periodontal disease and other oral problems

Proper care of your teeth and gums can go a long way in preventing the onset of oral problems associated with diabetes. The following toothbrushing and flossing tips are recommended by the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK):

Brushing

  • Brush twice daily with a soft, nylon brush with rounded bristles and fluoride toothpaste.

  • Use small, circular motions and short back-and-forth motions (avoid hard back-and-forth motions).

  • Brush the tongue each time you brush your teeth.

  • Brush for about three minutes to clean all of the teeth well.

  • Brush the top, back, and front of each tooth. 

Flossing

  • Dental floss should be about 18 inches long with each use.

  • Do not use a "sawing" motion in between the teeth.

  • Curve the floss around each tooth and scrape up and down several times, from below the gum to the top of the tooth.

  • Rinse after flossing.

Your dentist is part of your diabetes management team. The NIDDK suggests that you alert your dentist to changes in your health or medications on each visit. In addition, sharing some of your diabetes test results, like your A1C test or your fasting blood glucose test, can help the dentist better manage your dental care. Finally, if your diabetes is not well controlled, ask your dentist if you need antibiotics before and after dental treatment. 

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