The Connection Between Diabetes and Periodontal Disease

Periodontal disease, also known as gum disease, is one of the leading causes of tooth loss among adults. In gum disease, your gums, the deeper supporting tissue, and potentially the bone surrounding teeth become infected and inflamed. It can be a result of poor diabetes control and has also been linked to heart disease and strokes.

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

If plaque isn't properly removed from teeth by brushing and flossing, it accumulates and hardens underneath the gum line into tartar.

Once tartar builds up, it's much more difficult to remove than plaque and usually requires professional removal by a dentist. Over time, it can lead to inflamed gums or gingivitis.

As periodontal disease develops and progresses, there are noticeable signs and symptoms, which may include:

• Red and swollen gums
• Painful areas in the gum tissue around teeth
• Receding gums or longer-looking teeth
• Gums that tend to bleed easily
• Gums separating from the teeth
• Loose teeth
• Frequent bad breath
• Change in the way your teeth fit together or movement in teeth
• Change in the way partials or dentures fit

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.

There are two major stages of periodontal disease: gingivitis and periodontitis. People with diabetes tend to develop gum disease more frequently than others. However, if it is diagnosed in the early stage (gingivitis), gum disease can be reversed. If you don't get treatment for periodontal disease, it might progress to a more serious and advanced stage (periodontitis), which involves bone loss and is irreversible.

Studies show that people with insufficient blood sugar control seem to develop gum disease more frequently and more severely than people who have good management over their diabetes.

• Diabetes slows circulation, which can also make the gum tissues more susceptible to infections.
• Diabetes reduces the body’s resistance to infection, which increases the probability of the 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.

If you smoke or have diabetes, be sure to tell your dentist and hygienist so they can help. They'll likely notice signs of gum disease, such as inflamed or receding gums before you will.

In a standard cleaning and exam, the dentist or hygienist will measure the depth of pockets around your teeth. Pocket depth greater than 3 millimeters may suggest periodontal disease.

Your dentist may also take x-rays to look for bone loss, as well as refer you to a periodontist, who specializes in gum disease, if necessary.

If your dentist detects gum disease, they are likely to 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 topical or oral antibiotics to control bacteria.

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. Smoking 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. You should brush at least twice a day and floss your teeth once a day (preferably before sleep). Regular dental cleanings will help to remove the build-up of 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 always finish by rinsing your mouth with plain, unsalted water to remove saline.
• Eat a healthy and well-balanced diet.

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. While they can seem minor compared to other health issues you may be dealing with, the small actions of daily dental care will add up to healthy teeth for a lifetime—and that's something you can smile about.