Diabetes and Gum (Periodontal) Disease

What causes gum disease in people with diabetes?

Diabetes causes blood vessel changes. The thickened blood vessels can reduce the flow of nutrients and removal of wastes from body tissues. This reduced blood flow can weaken the gums and bone. This puts them at greater risk for infection.

Diabetes that is not controlled well leads to higher blood sugar (glucose) levels in the mouth fluids. This promotes the growth of bacteria that can cause gum disease. On the other hand, infections from untreated periodontal disease can cause the blood sugar to rise and make it harder to control diabetes.

Another factor, smoking, is harmful to oral health even for people without diabetes. But a person with diabetes who smokes is at a much greater risk for gum disease than a person who doesn't have diabetes.

These diabetes-related factors, together with poor oral hygiene, can lead to periodontal disease. 

What are the symptoms of gum disease?

These are the most common symptoms of gum disease:

• Red, swollen, sore gums
• Bleeding while brushing or flossing
• Receding gums
• Loose or separating teeth
• Persistent bad breath
• Dentures no longer fit
• Pus between the teeth and gums
• A change in bite and jaw alignment

The symptoms of gum disease may seem like other health conditions. See a dentist or other oral health specialist for a diagnosis.

How is gum disease diagnosed?

To diagnose periodontal disease, a dentist will ask about your health history, current medicines, and any other health conditions you may have. It's very important to share your diabetes history with your dentist, especially how well your blood glucose is controlled. In addition to your health history, the dentist will:

• Check your gums for any sign of inflammation
• Measure any pockets around your teeth. A tiny tool called a probe is used to do this.
• Take X-rays to find out if there is bone loss

If you have gum disease, the dentist may refer you to a periodontist. These are dentists who are experts in the diagnosis and treatment of gum disease. A periodontist will evaluate your teeth and gums and give you treatment options for your condition.

The different stages of periodontal disease are often grouped by the level of inflammation and amount of breakdown. They include:

• Gingivitis. Gingivitis is the mildest form of periodontal disease. The gums are likely to be red, swollen, and tender. This makes them bleed easily during daily cleanings and flossing. Treatment by a dentist and correct, regular care at home help to resolve gingivitis.
• Mild to moderate periodontitis. Untreated gingivitis leads to mild to moderate periodontitis. At this stage of gum disease, periodontal pockets start to form. This is when gums pull away from the teeth, causing the small space between the teeth and gums to deepen. It also causes early bone loss around the teeth. Dental care is needed right away to prevent more bone erosion and gum damage.
• Moderate to advanced periodontitis. This is the most advanced stage of gum disease. It causes serious bone and tissue loss, and deepening of periodontal pockets. There may be receding gums around the teeth, heavy bleeding, and bad breath. Teeth may loosen and need to be removed.

How is gum disease treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment may include:

• Tartar and plaque removal beneath the gums. Deep cleaning (also called scaling and root planning) can help remove the plaque and calculus beneath the gums and infected tissues in the early stages of the disease. It also smooths the damaged root surfaces of the teeth. The gums can then reattach to the teeth. This makes the periodontal pocket smaller.
• Medicine. Your dentist may place antibiotics in the periodontal pockets or prescribe a pill.
• Surgery. When the disease is advanced, your dentist will clean the infected areas under the gums, and reshape or replace the tissues. Types of surgeries include pocket reduction, periodontal regeneration, soft tissue graft, or crown lengthening.

What can I do to prevent gum disease? 

Taking care of your teeth and gums correctly can help prevent mouth problems linked to diabetes. These tooth brushing and flossing tips are advised by the American Dental Association:

Brushing	Brush at least twice daily with a soft, nylon brush with rounded bristles and fluoride toothpaste. Use small, circular motions and short back-and-forth motions. Don’t use hard back-and-forth motions. Brush your tongue every time you brush your teeth.
Flossing	Dental floss should be about 18 inches long with each daily use. Don’t use a "sawing" motion in between the teeth. Curve the floss around each tooth and scrape up and down several times, from below the gum to the top of the tooth. Rinse after flossing.

When you have diabetes, you can also keep your teeth and gums healthy if you:

• Control your blood glucose level
• Get regular dental checkups
• Tell your dentist of any changes in your diabetes and any medicine you are taking
• Don’t have any nonemergency dental procedures if your blood sugar is not in good control
• Don’t use tobacco products, including smokeless tobacco
• If you wear dentures, remove and clean them every day
• Eat a healthy, well-balanced diet
• Keep scheduled medical and dental follow-up appointments

Key points about diabetes and gum disease

• Periodontal (gum) diseases are infections of the gums and bone that hold the teeth in place.
• Gum disease is a problem that can happen with diabetes that isn't controlled well. And the body's response to gum infections can also cause blood sugar problems.
• Taking care of your teeth and gums correctly, such as with regular brushing and flossing, can help prevent mouth problems linked to diabetes.
• When you have diabetes, you can also keep your teeth and gums healthy by controlling your blood sugar level and getting regular dental check-ups.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Medical Reviewer: Michael Kapner MD

Medical Reviewer: Rita Sather RN

Medical Reviewer: L Renee Watson MSN RN

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