Diabetes, Oral Health, and How to Prevent Tooth and Gum Problems

Did you know that people with diabetes are more likely to develop oral and dental health issues? Living with diabetes means taking care of your oral health is even more important than it is for the average person.

Oral Health Problems Common in Diabetes

Most mouth problems associated with diabetes have one thing in common: they all ultimately stem from hyperglycemia (high blood sugar). 

Gingivitis and periodontitis

Gingivitis is inflammation of the gums – it usually precedes the development of periodontitis (gum disease). These are among the most common oral complications for people living with diabetes. As many as 22% of people living with diabetes have some measure of periodontitis. 

The high blood sugar characteristic of diabetes prevents the immune system from functioning properly. It can also cause our blood vessels to thicken. This thickening restricts the supply nutrients to the teeth and gums, and interrupts the healthy removal of waste. Additionally, bacteria thrive on the increased amount of sugar in the body, including saliva, so they multiply more quickly in the mouth of a patient with diabetes.

These issues can sneak up on you – examine your mouth for red, puffy, swollen gums, and take note if brushing or flossing causes much bleeding. If not treated early, the gums can begin to recede from the teeth, a more serious situation.

Dry mouth

Diabetes can cause dry mouth in several ways.

If you’ve experienced acute hyperglycemia, perhaps in the days or weeks before your diagnosis, you know that uncontrolled high blood sugars can lead to a seemingly unquenchable thirst. This symptom is a serious warning sign of immediate danger, but luckily it can usually be resolved quickly with the use of insulin or other glucose-lowering medications.

But dry mouth can occur in less critical conditions, too. A small study in Diabetes Care found that 43% of diabetes patients complained of dry mouth (and the condition was significantly more common in women). The condition was “xerostomia,” which indicates that the mouth is creating an abnormally low amount of saliva. The study suggests that most or all patients with diabetes have lower salivary flow than healthy peers. The condition gets significantly worse as A1C rises.

Xerostomia is also a common side effect of many medications, including some of those used to treat diabetes.

Poor healing of sores and cuts

High blood sugar affects our ability to heal, so some may experience a longer healing time and stubborn sores that won’t go away. Infections in the mouth are slower to heal for the same reason as infections in the legs, feet, and elsewhere — high blood sugars inhibit the ability of the body’s immune system to fight off viruses and bacteria.


Thrush is a yeast infection, caused by a fungus named candida that is normally innocuous — small, harmless amounts are found in the mouths of many perfectly healthy people. The large amounts of sugar in the saliva, however, allow candida to grow more quickly, and it may begin to cause problems; a weakened immune system is not as good at fighting it off, either.

Thrush can cause dry mouth, discomfort, and pain. It can affect the tongue, cheeks, roof of the mouth, or lips. It may result in white patches or spots. Antibiotics can also increase the risk of infection.

Tooth decay

Diabetes contributes to tooth decay (and tooth loss!) in several ways. Higher levels of glucose in our saliva can erode the teeth just like a sugary diet can. The poor blood circulation that contributes to gum disease also reduces the body’s ability to care for the teeth, resulting in cavities and decay.


The good news is there are multiple preventative measures we can take to avoid these complications:

5 Things You Can Do to Prevent Oral Health Problems

Get your blood sugar in check!

The problems above all have one thing in common: high blood sugar. If you can bring your blood glucose levels back down to a healthy range, it’s a great first step towards preventing the oral and dental health problems associated with diabetes, not to mention far more dangerous complications.

What’s a normal blood sugar?

In a healthy person without diabetes or prediabetes, blood sugars tend to stay mostly between 70 and 100 mg/dL (3.8 and 5.5 mmol). After a meal, and depending on the composition of the meal, blood sugars can rise up to 120-140 mg/dL or 6.7-7.8 mmol/L. It will typically fall back into the normal range within two hours.

You should determine your optimal range with the help of your medical team. Many experts consider 180 mg/dL a more reasonable upper blood sugar limit for most patients with diabetes, but certain individuals may feel empowered to target a more restrictive upper limit.

Brush (and floss!!) regularly

Okay, you already know this is good advice, but now you understand why regular tooth care is even more important for people with diabetes. Every time you brush or floss, you’re scraping and washing away untold numbers of the nasty bacteria and fungi that cause so many oral health issues.

Get into a good routine both morning and night, and make sure to floss daily. Also, if you wear dentures, please clean them as often as you’ve been advised – pathogens love to hide there.

Make regular appointments for cleaning

We don’t mean to be nags – you surely already know that you’re supposed to see the dentist (or a dental hygienist) every 6 months.

Here’s something you didn’t know: visiting the dentist regularly may actually improve your blood sugar control. A fascinating study in The Lancet found that patients with diabetes and gum disease enjoyed huge improvements in A1C after submitting to intensive dental care. The authors concluded that “routine oral health assessment and treatment of periodontitis could be important for effective management of type 2 diabetes.”

It is important to get regular cleanings and it’s easy to let this fall off our radars. Make sure to schedule your next appointment before you leave your cleaning so that it is already set up and you don’t have to add it to your to-do list.

Avoid smoking

Tobacco and diabetes are a double whammy for overall health — and smoking makes just about every aspect of oral health worse. People living with diabetes who smoke are up to 20 times more likely than non-smokers to develop thrush and periodontal disease. Smoking, just like high blood sugar, affects our circulation and can negatively affect our gums and tissues; it can also delay wound healing, compounding the problems caused by diabetes.

Patients with high blood sugars who smoke have a hugely increased likelihood of losing teeth. In a study published in Diabetology International patients were over 3.5 times more likely to have fewer than 24 teeth than nonsmoking adults with normal blood sugars.

Stick with a healthy diet

Good news: the foods that cause poor tooth health are mostly the same foods that are so challenging for people with diabetes — sugary drinks and junk food. Sugar not only spikes your blood sugar, and it also creates plaque build-up and causes tooth decay. Just another good reason to limit the sweets in your diet.


While people living with diabetes are at greater risk for oral health problems, there is plenty we can do to prevent these issues from happening. Creating good habits, sticking to a healthy routine, and quitting smoking can help you achieve great oral health!

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