The Connection Between Diabetes and Periodontal Disease

Periodontal disease, also known as gum disease, is a leading causes of tooth loss among adults. It develops when the gum tissue, particularly the deep supporting tissue and potentially the bone surrounding teeth, becomes infected and inflamed. It can be a result of poor diabetes control and has also been linked to heart disease and stroke.

In the early stage, gum disease is called gingivitis and is reversible. Once bone loss occurs, however, treatment is considerably more challenging. Gum disease can be prevented with good oral hygiene and regular professional dental care.

Verywell / Alex Dos Diaz


Gum disease starts with plaque, a sticky white substance that coats teeth. It's formed when bacteria in the mouth mixes with saliva and the residue from starchy foods and sugar in your diet.

If plaque isn't properly removed from teeth by brushing and flossing, it can accumulate underneath the gum line and harden into a substance called tartar. Tartar is more difficult to get rid of than plaque and usually requires professional removal by a dental professional.

If tartar is not removed, periodontal disease can develop, causing any of an array of telltale signs and symptoms:

  • Bad breath that won’t go away
  • Red or swollen gums
  • Tender or bleeding gums
  • Painful chewing
  • Loose teeth
  • Sensitive teeth
  • Receding gums or longer appearing teeth


The primary cause of gum disease is a build up of plaque and tartar that eventually leads to inflammation and infection. Studies show that people with diabetes who do not have sufficient blood sugar control seem to develop gum disease more frequently and more severely than those who have good management over their diabetes.

Factors that contribute to the increased risk and severity of periodontal disease in people with diabetes include:

  • Diabetes slows circulation, which can render gum tissue susceptible to infection.
  • Diabetes lowers the body’s resistance to infection, which increases the probability of gums becoming infected.
  • High glucose levels in saliva promote the growth of bacteria that cause gum disease.
  • People with diabetes who smoke are far more likely to develop gum disease than people who smoke and do not have diabetes.
  • Poor oral hygiene is a major factor in gum disease for everyone, but it is even more so for a person with diabetes.


Gum disease at any stage is diagnosed during standard dental cleanings and exam, during which the hygienist and/or dentist will be on the lookout for early signs and symptoms.

They will also measure the depth of the "pockets" around individual teeth. Pocket depth greater than 3 millimeters may suggest periodontal disease.

Your dentist may also take X-rays to look for bone loss.

Treatment and Prevention

If your dentist detects gum disease, they likely will recommend dental procedures beyond the standard cleaning you receive at check-ups. These may include scaling to thoroughly remove plaque and tartar beneath gums, root planing, or oral antibiotics to control bacteria. They also may refer you to a periodontist, who specializes in gum disease.

Lifestyle factors can also lower your risk of having periodontal disease. When you have diabetes, one of the number one tips is to maintain good control over your blood sugar levels.

Here are some other helpful tips to prevent gum disease:

  • Do not smoke. Whether you have diabetes or not, smoking even less than half a pack of cigarettes a day makes you three times as likely to get periodontal disease.
  • Maintain good oral hygiene and get regular dental check-ups. Brush at least twice a day and floss your teeth once a day (preferably before sleep). Regular dental cleanings will help to remove built-up tartar and treat advanced gum disease.  
  • An electric toothbrush, while expensive, can remove plaque from teeth more effectively than a manual brush, making dental check-ups easier. Water flossing or tools designed to clean between your teeth, such as a dental pick, may also be helpful.
  • For at-home care, dentists often recommend a simple saline (salt) rinse to help reduce oral bacteria that can exacerbate gum disease. Once a day, or after brushing teeth before bedtime, add a spoonful of salt to a mug of warm water. (Any salt, such as table salt, will do.) Stir to dissolve, then use the mixture to rinse your teeth for a minute or so. You can use this rinse up to three or four times a week. Over time, saline can erode tooth enamel, so finish by swishing plain water in your mouth and spitting it out.
  • Eat a healthy and well-balanced diet.

A Word From Verywell

Keeping up with good oral hygiene, along with maintaining consistent blood sugar levels, are the best things you can do for your gum health and teeth if you have diabetes. Since you know your teeth, you'll be able to tell when something feels off—don't ignore warning signs. Make an appointment for a dental cleaning and check-up if you notice pain or unusual bleeding in your gums, or any of the symptoms above. Dental professionals often catch warning signs early on, when they're much easier to treat—and that's something you can smile about..

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. The National Institute of Health. Periodontal (Gum) Disease.

  2. Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and preventionInt J Health Sci (Qassim). 2017;11(2):72-80.

  3. The National Institute of Health. Periodontal Disease.

  4. Cedars-Sinai. Diabetes and Gum (Periodontal) Disease.

  5. Kim SH, Kang SR, Park HJ, Kim JM, Yi WJ, Kim TI. Improved accuracy in periodontal pocket depth measurement using optical coherence tomographyJournal of Periodontal and Implant Science. 2017;47(1):13-19. doi: 10.5051/jpis.2017.47.1.13

By Tammy Davenport
Tammy Davenport is a dental assistant with experience on the clinical and administrative side.