Diabetes and gum health: a link not to ignore

A link that works both ways

The gums and the bone around the teeth form the periodontium. When bacterial plaque builds up, it first causes superficial inflammation (gingivitis) and then, if nothing is done, gradual destruction of the supporting tissues: this is periodontitis.

The World Health Organization describes a two-way relationship between diabetes and periodontal disease:

• diabetes, especially when poorly controlled, encourages periodontitis and can make it more severe;
• established periodontitis maintains chronic inflammation in the body, which can make blood sugar harder to control.

This link applies to both type 1 and type 2 diabetes. It is not inevitable: with well-managed diabetes and careful oral hygiene, gums can stay healthy.

Why diabetes makes gums more vulnerable

Several mechanisms explain this vulnerability:

• an amplified inflammatory response: faced with the same bacteria, the tissues react more strongly;
• slower healing, particularly when blood sugar stays high;
• weaker defences against infection;
• a drier mouth in some people with diabetes: saliva, which cleans and protects the teeth, is reduced, which also encourages decay and some oral fungal infections.

Smoking, stress and irregular oral hygiene add to these factors and raise the risk further. This is why your dentist will always ask whether you have diabetes, what treatment you take and how well it is controlled.

Warning signs to look out for

Periodontitis often progresses without pain. It can become advanced before you notice anything. See a dentist if you notice:

• red, swollen or tender gums;
• bleeding when brushing or eating;
• persistent bad breath or a bad taste;
• receding gums, teeth that look longer;
• gaps appearing between the teeth;
• a loose tooth or a change in the way your teeth fit together;
• an abscess or discharge from the gum.

Bleeding gums are never normal, even if common and painless: they are often the first sign of inflammation. Avoiding brushing the area that bleeds makes things worse, because plaque builds up there even more. If you have diabetes, these signs call for an appointment without delay, and are worth mentioning to your doctor at your next review.

Diabetes control and oral hygiene: the two pillars

Protecting your gums relies on two complementary efforts.

On the diabetes side, follow the treatment and monitoring set by your doctor. Well-controlled diabetes is associated with better periodontal health and better healing. Some studies also suggest that treating periodontitis may help improve blood sugar control, but this treatment never replaces the medical management of diabetes.

On the mouth side, adopt a regular routine:

• brush twice a day with a soft brush and fluoride toothpaste;
• clean between your teeth every day, with floss or suitable interdental brushes, as advised by your dentist;
• avoid tobacco;
• drink enough water if your mouth is dry;
• have regular check-ups, with a professional scale and polish as often as your dentist recommends.

When periodontitis is established, gum treatment cleans the pockets around the teeth in depth, followed by suitable maintenance.

Dental care and implants if you have diabetes

Having diabetes does not prevent you from receiving dental care. A few simple precautions make appointments safer:

• tell the dentist about your diabetes and list your medicines;
• take your usual treatment and meal, unless your doctor advises otherwise;
• bring something to correct a possible hypo, and tell the team if you feel unwell;
• bring your latest test results if the dentist asks for them.

To replace a missing tooth, a dental implant may be considered for people with diabetes, particularly when the diabetes is well controlled. Poorly controlled diabetes, on the other hand, is a risk factor for healing and for the health of the tissues around the implant. The decision is made case by case, after a full examination, prior gum treatment if needed and, often, a discussion with your doctor.

Working with your doctor

Oral health is part of diabetes care. It helps when your doctor and your dentist have the same information:

• let your doctor know if periodontitis is diagnosed or treated;
• tell your dentist about any change in treatment or recent loss of control;
• always follow your doctor's instructions about your medicines, including before a procedure.

At German Dental Clinic in Agdal, a gum assessment includes examining the gums, measuring the pockets and, if needed, X-rays. If you have diabetes and live in or near Rabat, book an appointment to have your gums checked.

Sources

• World Health Organization: oral health
• CDC: about periodontal (gum) disease
• American Dental Association (MouthHealthy): diabetes and dental health