Diabetes educators enthusiastically encourage patients with diabetes to visit their dentist on a regular basis because we know the health of your gums can have a significant impact on your blood sugar control.
Actually, the research indicates the relationship between diabetes and gum disease works both ways: people with high blood sugar are more at-risk for gum disease and people with gum disease have more trouble controlling their blood sugars1. In both situations, good home care and regular dental office care are important.
Good Home Dental Care
Dentists recommend that you brush your teeth twice per day for two minutes with a soft-bristled brush and a fluoride-containing toothpaste. Brushing daily removes plaque (a sticky film of bacteria) before it turns into troublesome calculus, and fluoride strengthens tooth enamel to make them more resistant to decay.
Flossing helps keep the space between teeth and gums clean. When we don’t floss, that small space (1-3 millimeters) can grow into larger and deeper pockets (3+ millimeters), trapping bacteria and leading to infection and gum disease. As we know, any infection in the body can wreak havoc on blood sugars for people with diabetes. From the common cold, to an open wound on your foot, to an infection in your gums, blood sugars can soar. Dental home care is part of prevention.
Regular Dental Office Care
Dentists generally recommend dental “preventive maintenance visits”, better known as “hygiene visits,” two times per year. If teeth are not professionally cleaned they can develop calculus under the gum line, which leads to gingivitis (gum infection) and eventually periodontal disease (“pocketing” around the teeth greater than 3 mm). During a dental exam, the dentist or hygienist will measure the pockets around your teeth using a tiny ruler called a “probe”. Ask for a description of your pocket measurements and about the health of your gums2.
Unfortunately, sometimes dental health declines, and your dentist may diagnose “periodontal disease.” In this care, the American Dental Association recommends special “periodontal maintenance visits” 3-4 times per year. Untreated periodontal disease is a significant cause of high blood sugar for people with diabetes and leads to tooth loss.
Deep pockets are beyond the reach of your home toothbrush and floss. Your dentist will recommend “deep cleanings,” or more accurately “periodontal scaling and root planning” which has been shown to significantly reduce HbA1c levels at 3 months, with even more reduction after 6 months3. At this point, although home care is still important, periodontal maintenance visits are key to preservation of gum tissue and tooth stability, as well as blood sugar control.
Don’t Wait Too Long!
Some people don’t go to the dentist until they develop mouth pain. However, periodontal disease and infection is usually painless. A person could have mild to significant disease and be completely unaware of the problem. The signs that you could look for include red or swollen gums, bad breath or a bad taste in the mouth, bleeding gums when brushing or flossing, or teeth that are loose or seem to have moved4.
The Bottom Line:
- Daily flossing is your best home defense against developing gum disease.
- Few people will have healthy gums without regular dental office care. Why? Because you cannot reach all of the places and spaces that must be cleaned.
- An important part of diabetes management includes consistent dental care.
As diabetes educators, we tend to focus on preventing infections and controlling blood sugars, but that’s not the only thing that matters. Healthy teeth and gums will allow you to bite, chew, and enjoy a full range of foods; meet your nutritional needs; and smile with confidence. Show us those pearly whites!
- Mealey BL. Periodontal disease and diabetes. A two-way street. J Am Dent Assoc 2006;137 Suppl:26S-31S.
- Madianos PN, Koromantzos PA. An update of the evidence on the potential impact of periodontal therapy on diabetes outcomes. J Clin Periodontol 2018;45(2):188-95.