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Connecting the Dots… Diabetes and Gum Disease

April 28, 2010

Learn More About Oral Health and Diabetes at Upcoming Seminar

People with diabetes generally have a lower resistance to infections throughout their bodies – and that includes the mouth. According to the National Institutes of Health, gum infections (gingivitis and periodontal disease) are much more common in people who have diabetes:

  • Among young adults, those with diabetes have about twice the risk of those without diabetes.
  • People with poorly controlled diabetes—A1C greater than 9 percent—were nearly three times more likely to have severe periodontitis than those without diabetes.
  • Almost one-third of people with diabetes have severe periodontal disease with significant loss of attachment of the gums to the teeth.

"People with diabetes who don’t have good control of their blood glucose levels have been shown to develop gum disease more often and more severely than other people," says Ruchi Nijjar-Sahota, D.D.S., a family dentistry specialist. "Uncontrolled diabetes not only makes you less resistant to infections, it also can result in slower healing of infections, as well as after oral surgery or other dental procedures."

Gum disease can result when a sticky film called plaque builds up on the teeth, Dr. Nijjar-Sahota explains.

"Plaque is full of bacteria, and high blood glucose helps that bacteria to grow," she says. "When the plaque builds up, it hardens and turns to deposits of tartar – also called calculus. As tartar builds up along the gum lines, it can cause swollen gums and infections. The tartar and bacteria can also cause the bone beneath the teeth to deteriorate, resulting in tooth loss – otherwise known as periodontal disease."

Symptoms of gum disease can include:

  • Red, sore or swollen gums
  • Bleeding gums
  • Gums that pull away from the teeth
  • Loose or sensitive teeth
  • Dentures (false teeth) that don’t fit properly

In addition to gum disease, diabetes can contribute to or complicate a number of other oral health problems. To help people in the community learn more about oral health problems associated with diabetes, Washington Hospital is sponsoring a free "Diabetes Matters" class, featuring a lecture by Dr. Nijjar-Sahota. A question-and-answer session will follow the lecture. The class is scheduled for Thursday, May 6 from 7 to 8 p.m. in the Conrad E. Anderson, M.D. Auditorium in the Washington West Building at 2500 Mowry Avenue in Fremont. The support group session runs from 8 to 9 p.m. following the lecture.

Other Oral Health Problems Related to Diabetes

"Tooth decay can also be common among people with diabetes," Dr. Nijjar-Sahota says. "All of us have plaque that builds up on our teeth. Foods and beverages that contain sugar – or other carbohydrates – cause the bacteria in plaque to release acid, which decays the teeth. If your blood glucose is high because of uncontrolled diabetes, you also will have more glucose in your saliva, which will increase the growth rate of bacteria producing the acid that causes tooth decay."

Another common oral health problem among people with diabetes is a decrease in the flow of saliva in the mouth, resulting in "dry mouth" (xerostomia).

"Dry mouth is a common complaint among people with diabetes," Dr. Nijjar-Sahota says. "The condition may be a significant problem, because it can lead to mouth sores, tooth decay and gum disease. Alcohol and caffeine can contribute to dry mouth, as can some mouthwashes containing alcohol. There are some non-prescription mouthwashes such as Biotene, though, that can help relieve dry mouth."

Ways To Reduce Your Risks

To help reduce the risks for gum disease and other oral health problems, people with diabetes should take extra care with their oral hygiene. Dr. Nijjar-Sahota offers a number of recommendations:

  • Brush your teeth at least twice a day, preferably after each meal and snack.
  • Use dental floss twice a day to help prevent the buildup of plaque.
  • If you wear false teeth, keep them clean.
  • Be sure to inform your dentist that you have diabetes, or if there is any other change in your medical history (for example, if you have been diagnosed with pre-diabetes).
  • Get your teeth cleaned and your gums checked by your dentist twice a year.

Call your dentist right away if you have any problems such as sore or bleeding gums, gums that are pulling away from your teeth, a sore tooth that could be infected, loose teeth or problems with the fit of your dentures.

"People with diabetes who are planning any dental procedures, gum treatments, root canals or oral surgery should speak with their dentist, periodontist, endodontist or oral surgeon to discuss ways to minimize the risk of infections," she cautions. "In some cases, we might want to prescribe antibiotics either before or right after the procedure to prevent possible infection. In any case, it’s important to have your blood glucose levels under control prior to a major dental procedure."

For more information about Diabetes Matters and other diabetes services offered through Washington Hospital, call (510) 745-6556 or visit us online at