For The Dental Patient. Diabetes and oral health JADA, Vol. 133, September 2002 1299

Diabetes affects millions of Americans each year. If you have been diagnosed with diabetes, you may know that the disease can cause problems with your eyes, nerves, kidneys and heart, as well as other parts of your body. Diabetes can lower your resistance to infection and can slow the healing process.

The most common oral health problems associated with diabetes are

  • tooth decay;
  • periodontal (gum) disease;
  • salivary gland dysfunction;
  • fungal infections;
  • lichen planus and lichenoid reactions (inflammatory skin disease);
  • infection and delayed healing;
  • taste impairment.

It’s important to keep your medical records up to date. Let your dentist know the following:

  • if you have been diagnosed with diabetes;
  • if the disease is under control;
  • if there has been any other change in your medical history;
  • the names of all prescription and over-the-counter drugs you are taking.


When diabetes is not controlled properly, high glucose levels in saliva may help bacteria thrive. Brushing twice a day with fluoride toothpaste and cleaning once a day between your teeth with floss or an interdental cleaner helps remove decay-causing plaque.

Plaque that is not removed can eventually harden (calcify) into calculus, or tartar. When tartar collects above the gumline, it becomes more difficult to thoroughly brush and clean between teeth. This can create conditions that lead to chronic inflammation and infection in the mouth.

Because diabetes reduces the body’s resistance to infection, the gums are among the tissues likely to be affected. Periodontal diseases are infections of the gum and bone that hold your teeth in place.

Periodontal disease often is linked to the control of diabetes. For example, patients with inadequate blood sugar control appear to develop periodontal disease more often and more severely, and they lose more teeth than do people who have good control of their diabetes.

See your dentist immediately if you notice any of the following:

  • gums that bleed easily;
  • red, swollen or tender gums;
  • gums that have pulled away from the teeth;
  • pus between the teeth and gums when the gums are pressed;
  • persistent bad breath or bad taste in the mouth;
  • permanent teeth that are loose or separating;
  • any change in the way your teeth fit together when you bite;
  • any change in the fit of partial dentures.


Bacteria, viruses and fungi occur naturally in the mouth. The body’s natural defenses and regular oral hygiene generally keep them in check. However, under some situations, they may proliferate and impede or defeat the body’s defenses.

Oral candidiasis, a fungal infection in the mouth, appears to occur more frequently among people with diabetes, including those who wear dentures. If you smoke, have high blood glucose levels or often are required to take antibiotics, you are more likely to have a problem with fungal infections in your mouth.

Diminished salivary flow and an increase in salivary glucose levels create an attractive environment for fungal infections such as thrush. Thrush produces white (or sometimes red) patches in the mouth that may be sore or may become ulcers. It may attack the tongue, causing a painful, burning sensation. It also can cause difficulty in swallowing and compromise your ability to taste. Your dentist may prescribe antifungal medications to treat this condition. Good oral hygiene is critical.


Preventive oral health care, including professional cleanings at the dental office, is important if you are to control the progression of periodontal disease and other oral health problems. Regular dental checkups and periodontal screenings are important for evaluating overall dental health and for treating dental problems in their initial stages. Your dentist may recommend more frequent evaluations and preventive procedures, such as teeth cleaning, to maintain good oral health. Choose oral care products that display the American Dental Association’s Seal of Acceptance, an important symbol of a dental product’s safety and effectiveness when the products are used as directed.

In addition to brushing twice a day and flossing or using an interdental cleaner once a day, your dentist may suggest using an antimicrobial mouthrinse or toothpaste to control gingivitis.

Watch for signs and symptoms of oral disease and contact the dental office immediately when a problem arises. Practice good oral hygiene at home, follow your physician’s instructions regarding diet and medications, and schedule regular dental checkups to maintain a healthy smile.

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