Diabetes and oral health

Diabetes, teeth and gums

Diabetes can lead to multiple complications in the mouth. These complications can increase in severity when a person with diabetes has poor control of their blood glucose levels. This is because they have lowered resistance to infection and may not heal as easily.

If you are living with diabetes, you need to pay particular attention to your oral health and dental care, as well as keeping your blood glucose levels in the target range. Visit your dentist every 6 to 12 months for advice about how to keep your teeth and gums healthy.

Diabetes is a common condition in Australia, affecting around 1.8 million people (around 7% of the population). The first signs and symptoms of diabetes can occur in the mouth, so paying attention to your oral health and speaking to your doctor or dental practitioner about any changes can also lead to earlier diagnosis and treatment.

Diabetes and common oral health problems

The most common oral health problems affecting people with diabetes are:

• periodontal (gum) disease
• tooth decay
• oral thrush fungal infections, such as thrush (also known as candidiasis)
• taste disturbances
• dry mouth due to low saliva levels.

Diabetes and periodontal (gum) disease

Periodontal (gum) disease is a chronic disease caused by inflammation. The inflammation slowly destroys the bone surrounding and supporting your teeth. This bone holds your teeth into your jawbone and allows you to chew comfortably. Bacteria and food debris called dental plaque contribute to gum disease.

If left on teeth and gums, plaque hardens to form calculus or tartar. The plaque and calculus irritate the gums around teeth, which can look red, swollen and bleed. As gum disease progresses, the gums may recede (or shrink) and teeth may become loose, fall out or need to be removed.

Gum disease is more common and more severe in people with suboptimal blood glucose levels. This is because they generally have lower resistance to infection and reduced healing capacity.

It is important to look after your oral health and control your blood glucose levels to prevent gum disease. Treating gum disease may also help to improve blood glucose levels in people living with diabetes. In general, people with blood glucose levels in the target range respond very well to dental treatment.

Smoking increases the risk of developing gum disease or the disease worsening for all people, whether they have diabetes or not. Quitting smoking can help to prevent the development of gum disease and improve healing for people having treatment for gum disease.

Symptoms of gum disease

Please see your dentist immediately if you notice any signs and symptoms of gum disease, including:

• red, swollen, tender or bleeding gums
• a persistent discharge (pus) coming from the gums
• gums that are loose and pull away from the teeth
• a bad taste or bad breath
• loose teeth – this can change the ‘feel’ of your bite when your teeth are placed together or may make dentures fit differently
• spaces opening up between your teeth.

Diabetes and tooth decay

With increased blood glucose levels, people living with diabetes may have more glucose in their saliva and very dry mouths. These conditions allow dental plaque to build up on teeth, which can lead to tooth decay and cavities.

Tooth decay can occur more easily on the root of the tooth. This area is usually covered by the gums, however, in people with periodontitis (gum disease), the shrinking gums may expose the tooth root. Shrinking gums may also result in larger gaps between teeth which trap food and plaque.

Dental plaque can be removed by cleaning your teeth and gums twice daily with a toothbrush and fluoride toothpaste. Be gentle when brushing over the gums where they meet the teeth as bushing them too hard can cause some gum loss. Use interdental cleaners or dental floss daily to clean between your teeth. Taking good care of your teeth prevents cavities and gum disease.

Diabetes and oral fungal infections

Oral thrush (candidiasis) is a fungal infection occurring in or around the mouth. It is caused by an overgrowth of the yeast, Candida albicans, which lives in the mouth. Some conditions caused by diabetes such as high glucose in saliva, lowered resistance to infection and dry mouth (low saliva levels) can encourage the overgrowth of these fungi, leading to oral thrush.

Symptoms of oral thrush can include white patches of plaque on soft tissues in the mouth, such as the tongue. The white patch can often be wiped off and will leave behind red areas that may bleed slightly.

Good mouth hygiene and blood glucose levels in the target range can help to treat oral thrush. Your dentist can treat this condition by prescribing antifungal medications if needed.

Altered taste

The ability to taste foods and drinks can be affected in people with diabetes. The underlying cause for this is not clear. It may be related to the taste receptors in the mouth renewing at a slower rate or is suggested to be associated with the presence of diabetic neuropathies.

Caring for your teeth and gums

If you are a person living with diabetes, it is recommended that you:

• Follow your doctor’s advice about diet and medication to keep your blood glucose levels as close to the target levels as possible.
• Clean your teeth and gums twice a day with toothpaste that contains fluoride. Fluoride helps to strengthen the enamel on your teeth and prevent decay.
• Use dental floss or interdental brushes once a day to clean between your teeth.
• Visit your dentist every 6 to 12 months so that they can check your mouth, teeth and gums for any signs of oral conditions, professionally clean your teeth and give advice about caring for your teeth and gums at home. Talk to your dentist about your blood glucose levels and what medications you are taking.
• Avoid having a dry mouth – drink plenty of water and chew sugar-free gum to stimulate saliva flow.
• Don’t smoke – speak to your doctor or dentist, or call Quitline if you would like some support to quit. Tel. 13 78 48 for guidance and support.

Where to get help

• Your GP (doctor)
• Your dentist
• Diabetes educator
• Diabetes Victoria Tel. 1300 437 386
• Australian Dental Association – ‘Find a dentist’ Tel. (03) 8825 4600
• Dental Health Services Victoria – provides public dental services through the Royal Dental Hospital of Melbourne and community dental clinics, for eligible people Tel. (03) 9341 1000 or 1800 833 039 outside Melbourne metro
• Quitline Tel. 13 78 48