April 01, 2021 Diabetes and your teeth

The tools needed to keep your teeth and gums healthy are basic: a toothbrush, toothpaste, floss…and, if you have diabetes, a blood glucose monitor.

“If you have diabetes, good oral health depends on good blood sugar control,” says Joanne Lewis, director for healthcare provider education and engagement at Diabetes Canada. She explains that high blood sugar can damage gums and teeth in the same way that it can damage the heart, eyes, and nerves. As a result, people with diabetes are at higher risk for tooth decay, gum inflammation and disease, and periodontitis (a severe gum infection that destroys the bone supporting your teeth). She adds,

Keeping your blood sugar levels near target—by eating a healthy diet, taking your medications as prescribed, and being active—is the key to good oral health.

The impact of diabetes on oral health can be so significant, says Dr. Kim Hansen, a dentist in private practice in Prescott, Ont., that a dentist can often spot the signs of the disease in a patient before it is diagnosed. “If I notice a patient suddenly has dry mouth, gum disease, or more cavities, especially at the gum line or below, I will ask if they have been tested for diabetes,” says Hansen, who is also president of the Ontario Dental Association.

Here is some important information to know about diabetes and the health of your teeth and gums:

Talk to your dentist

Be sure to tell your dentist if you have diabetes or prediabetes.

Your dentist will want to carefully review your medical history. Since diabetes—especially if you have high blood sugar levels—puts you at higher risk for dental problems, your dentist may recommend more frequent cleanings or check-ups.

Give your dentist a list of all your medications. While diabetes medications do not usually cause any dental issues, other drugs you might be taking (such as blood thinners for heart disease) can cause you to bleed more than usual during dental procedures.

“If a patient has a complex medical history—such as diabetes combined with other conditions and is taking multiple medications—I may consult with their physician before doing a major dental procedure like extracting teeth,” says Hansen.

Infection and slower healing

Diabetes increases the risk of infection and also slows healing, so any dental surgery will take longer to heal. Your dentist may prescribe antibiotics in advance of some procedures to prevent infection.

Sugary saliva

Diabetes raises sugar (glucose) levels not only in your blood but also in your saliva. This can cause a fungal infection known as thrush, which produces a white coating on the tongue. This can lead to bad breath and a burning sensation in your mouth, and change your ability to taste. Talk to your dentist about medications and mouthwashes to treat thrush.

Gum disease

Gum disease can range from gingivitis (slightly inflamed or swollen gums) to periodontitis. People with diabetes are at especially high risk of serious gum disease because the sugar in their saliva helps bacteria grow, and high blood sugar lowers their body’s ability to fight infection. In addition to good diabetes management, it is important to have good brushing and flossing habits.

Dry mouth

High blood sugar levels cause the body to make more urine; as a result, there is less water available in other parts of the body, including the mouth. The result is a dry mouth, which is one reason why excessive thirst is an early sign of diabetes.

“Don’t dismiss the impact of dry mouth, especially if it is combined with high blood sugar levels,” says Lewis. Dry mouth is a risk for poor oral health, including plaque and tooth decay, because there is not enough saliva to wash away any bacteria.

While you can treat the symptoms of dry mouth with sugar-free candies or mouth spray, it is more important to address the root cause, says Lewis. Talk to your diabetes care team for help in improving your blood sugar control.

Prevention

As with all health issues, it is better to prevent dental problems than to treat them later. If you have diabetes, your oral health routine should include:

• Brushing after meals (or at least twice a day) with a fluoride toothpaste

• Flossing daily

• Removing and cleaning dentures daily, if you wear them

• Following a healthy diet

• Limiting added sugar, especially pop and juice

• Quitting (or not starting) smoking

• Managing your diabetes to keep your blood sugar levels at or near target

Dr. Hansen says,

People with diabetes often think about possible long-term complications such as heart disease and nerve damage. But they shouldn’t forget about what’s going on in their mouth. Good dental care and diabetes care have a direct impact on their future ability to chew and smile.

Did you know?

Keeping your blood sugar as close to target as possible will help keep your teeth and gums healthy. Learn more in Managing Your Blood Sugar.

(This article appeared in Diabetes Dialogue, Spring 2020)