High blood sugar can allow bacteria to grow in your mouth. These bacteria, along with food particles, form plaque. Plaque is a thin film that can build up on your teeth. It can then lead to tooth decay and other oral health problems.

It can cause bleeding and swollen gums. It may even result in tooth loss. People with diabetes may be more likely to lose their teeth, especially as they grow older.

That, in turn, can lower quality of life. Like any infection, gum inflammation also makes it harder to manage your diabetes. Women with diabetes during pregnancy are at a very high risk for gum disease. Thrush, a type of fungus that causes painful white patches to grow inside the mouth.

You can prevent many oral health problems. First, see your dentist for regular checkups. Every 6 or less months is best. But your dentist may want to see you more often if needed. The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes.

The trials look to find new ways to prevent, detect, or treat disease and improve quality of life. Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of diabetes and gum disease, such as how certain genes may play a role in diabetes, gum disease, heart disease, and bone loss. Find out if clinical studies are right for you.

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. You can find clinical studies on diabetes and gum disease at www.

In addition to searching for federally funded studies, you can expand or narrow your search to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe.

Always talk with your health care provider before you participate in a clinical study. This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases NIDDK , part of the National Institutes of Health.

NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public.

Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts. The NIDDK would like to thank: Timothy Iafolla, D.

English English Español. On this page: How can diabetes affect my mouth? What are the most common mouth problems from diabetes? How will I know if I have mouth problems from diabetes?

What should I do if I have mouth problems from diabetes? How can I prepare for dental work? Diabetes is associated with gum disease periodontal disease. Gum disease can be more severe and take longer to heal if you have diabetes.

Having gum disease can also make your blood glucose hard to control. Gum disease may increase the risk of type 2 diabetes. Uncontrolled diabetes can also show up as tooth-related abscesses in the mouth. Infection in the mouth can be linked to poor insulin regulation.

How Your Dentist Can Help You Fight Diabetes. Regular dental visits, at least twice per year, are important. If you wait until you notice a problem, serious damage may have already occurred.

Your best defense is to regularly get an exam and check-up to stop a problem before it gets too far. Treating gum disease can help improve blood sugar control in patients living with diabetes, decreasing the progression of the disease.

Treatment of gum disease in people with type II diabetes can lower blood sugar over time. Treatment of gum disease can reduce your chance of having other problems from diabetes, such as heart and kidney disease. Oral Health Action Plan for the Diabetic Patient.

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However, the consistency of our findings suggests they are reliable and future research is not likely to change them. In summary, currently there is moderate-certainty evidence to support gum disease treatment known as subgingival instrumentation for controlling blood sugar levels in people with periodontitis gum disease and diabetes up to 12 months after the start of the periodontal treatment.

Our update of this review has doubled the number of included studies and participants, which has led to a change in our conclusions about the primary outcome of glycaemic control and in our level of certainty in this conclusion.

We now have moderate-certainty evidence that periodontal treatment using subgingival instrumentation improves glycaemic control in people with both periodontitis and diabetes by a clinically significant amount when compared to no treatment or usual care.

Glycaemic control is a key component in diabetes mellitus diabetes management. Periodontitis is the inflammation and destruction of the underlying supporting tissues of the teeth.

Some studies have suggested a bidirectional relationship between glycaemic control and periodontitis. Treatment for periodontitis involves subgingival instrumentation, which is the professional removal of plaque, calculus, and debris from below the gumline using hand or ultrasonic instruments.

This is known variously as scaling and root planing, mechanical debridement, or non-surgical periodontal treatment. Subgingival instrumentation is sometimes accompanied by local or systemic antimicrobials, and occasionally by surgical intervention to cut away gum tissue when periodontitis is severe.

This review is part one of an update of a review published in and first updated in , and evaluates periodontal treatment versus no intervention or usual care.

To investigate the effects of periodontal treatment on glycaemic control in people with diabetes mellitus and periodontitis. An information specialist searched six bibliographic databases up to 7 September and additional search methods were used to identify published, unpublished, and ongoing studies.

To be included, the RCTs had to have lasted at least 3 months and have measured HbA1c glycated haemoglobin. At least two review authors independently examined the titles and abstracts retrieved by the search, selected the included trials, extracted data from included trials, and assessed included trials for risk of bias.

Where necessary and possible, we attempted to contact study authors. Our secondary outcomes included adverse effects, periodontal indices bleeding on probing, clinical attachment level, gingival index, plaque index, and probing pocket depth , quality of life, cost implications, and diabetic complications.

We included 35 studies, which randomised participants to periodontal treatment or control. All studies used a parallel-RCT design and followed up participants for between 3 and 12 months.

The studies focused on people with type 2 diabetes, other than one study that included participants with type 1 or type 2 diabetes. Most studies were mixed in terms of whether metabolic control of participants at baseline was good, fair, or poor.

Most studies were carried out in secondary care. We assessed two studies as being at low risk of bias, 14 studies at high risk of bias, and the risk of bias in 19 studies was unclear.

We undertook a sensitivity analysis for our primary outcome based on studies at low risk of bias and this supported the main findings.

Moderate-certainty evidence from 30 studies analysed participants showed an absolute reduction in HbA1c of 0.

Similarly, after 6 months, we found an absolute reduction in HbA1c of 0. Studies that measured adverse effects generally reported that no or only mild harms occurred, and any serious adverse events were similar in intervention and control arms.

However, adverse effects of periodontal treatments were not evaluated in most studies. Language: English Español فارسی Français हिन्दी Hrvatski Bahasa Indonesia 日本語 Bahasa Malaysia Polski Português Русский ภาษาไทย 简体中文 繁體中文. Review question The main question addressed by this review is: how effective is gum disease periodontitis treatment for controlling blood sugar levels known as glycaemic control in people with diabetes, compared to no active treatment or usual care?

Background The aim of treating periodontitis is to reduce swelling and infection and stabilise the condition of the gums and supporting bone. Study characteristics We searched six research databases and found 35 relevant trials where people with diabetes and periodontitis were randomly allocated to an experimental group or a control group.

Key results Evidence from 30 trials results from participants showed that periodontitis treatment reduces blood sugar levels measured by HbA1c in diabetic patients on average by 0. Certainty of the evidence Most of the studies were conducted in a way that meant they were at a high risk of bias or did not provide enough information for us to make a judgement on this.

The autoimmune process can start in infancy, and, although most cases present in children or young adults, the disease can manifest at any age. Insulin is a peptide hormone that plays an important role in blood glucose regulation.

It is secreted rapidly into the blood in response to changes in blood sugar. In diabetic patients, insulin-dependent cells are unable to use available blood glucose as an energy source.

To compensate, the body turns to its stored triglycerides as an alternative fuel source and ketoacidosis may result. As hyperglycemia proceeds, the body will attempt to get rid of excess blood glucose by excreting it in the urine. This explains why polyuria is a classic sign of DM. Increased fluid loss from excessive urination results in dehydration; therefore, polydipsia is another classic sign.

DM is also associated with an increased incidence of microvascular and macrovascular complications. Some possible long-term sequelae include neuropathy, nephropathy and chronic kidney disease and retinopathy with possible loss of vision. Obesity, hypertension, dyslipidemia and atherosclerosis are common in diabetic patients and increase their risk of cardiac events.

The fasting plasma glucose FPG test measures blood glucose level following a period of zero caloric intake for at least 8 h. An FPG level of about 5.

This test, which is reported as a percentage, is used by clinicians to assess control and management of DM. In a healthy, non-diabetic patient, an HbA1C level of 5. Information provided.

Sources: Diabetes Canada Clinical Practice Guidelines Expert Committee et al. At the core of every DM management or treatment plan is an attempt to restore blood glucose levels to as close to normal as possible. Notably, if blood glucose levels can be adequately managed and controlled, progression to complications can be delayed or even prevented.

Thorough patient education, compliance with medication, adherence to lifestyle changes i. Numerous randomized controlled trials have demonstrated beneficial metabolic effects of nutritional recommendations for diabetic patients.

In an attempt to override insulin resistance, physicians may incorporate exogenous insulin into the treatment plans of some T2DM patients as well. Effective duration, h. The major classes of oral hypoglycemic medications include biguanides, sulfonylureas, meglitinides, thiazolidinedione, dipeptidyl peptidase 4 inhibitors, sodium-glucose cotransporter inhibitors and α-glucosidase inhibitors.

Representative agents. The effects of DM on the oral cavity have been studied extensively. Complications, such as periodontal disease, salivary gland dysfunction, halitosis, burning mouth sensation and taste dysfunction, have been associated with DM in scientific literature.

Table 4 23 highlights the influence of glycemic control on the oral manifestations of T2DM. Numerous studies have identified a link between DM and periodontal disease. Although the mechanisms are not entirely understood, increased periodontal tissue destruction in diabetic patients is thought to result from reduced polymorphonuclear leukocyte function that is secondary to the formation of advanced glycation end products and changes in collagen metabolism.

Although effective management of DM can lower susceptibility to periodontitis, evidence suggests that periodontal therapy can improve glycemic control as well.

Salivary gland dysfunction is another widely reported oral manifestation of DM. Several authors have reported that diabetic patients are susceptible to fungal and bacterial infections. This can be attributed to impaired host defense mechanisms associated with poor glycemic control.

Further, oral soft tissue regeneration and osseous healing processes are compromised in a diabetic patient. This is thought to result from delayed vascularization, reduced blood flow, decreased growth factor production, weakened innate immunity and psychological stress.

Especially during invasive procedures, dentists should take extra precautions to avoid the need for profound wound-healing processes. Before initiating treatment of a diabetic patient, dentists must appreciate important dental management considerations see Box 1. In doing so, dentists can help to minimize the risk of an intraoperative diabetic emergency and reduce the likelihood of an oral complication of the disease.

Box 1: Dental management considerations for the diabetic patient. Effective management of a diabetic patient begins with the dentist taking a thorough medical history and carrying out a review of systems. Also, the dentist should review the current DM management plan, including doses and times of administration of all medications, as well as any lifestyle modifications, such as exercise or nutritional changes.

Of note, a variety of medications that are taken for reasons other than DM may interact with and potentiate the effect of oral hypoglycemic agents. Cortisol is an endogenous hormone that increases blood glucose levels. Because cortisol levels are typically higher in the morning and during times of stress e.

For patients receiving exogenous insulin therapy, appointment scheduling should avoid the time of peak insulin activity when the risk of hypoglycemia is highest. If these patients require surgery or invasive procedures, the dentist should consult their physician regarding possible adjustment of insulin doses.

At the beginning of each appointment, the dentist should make sure that the diabetic patient has eaten and taken their medications as usual. If not, the patient may be at risk of a hypoglycemic episode.

In some cases, the dentist may need to measure and record blood glucose level before initiating treatment. If blood glucose is low, the patient should consume a source of oral carbohydrates before treatment is initiated. If blood glucose is high, treatment should be postponed, and the dentist should refer the patient to their physician to re-asses glycemic control.

Electronic blood glucose monitors are relatively inexpensive and quite accurate. The most common intraoperative complication of DM is a hypoglycemic episode. Initial signs and symptoms of hypoglycemia include hunger, fatigue, sweating, nausea, shaking, irritability and tachycardia.

If the patient is unconscious or cannot swallow, the dentist should seek medical assistance. Emergency management. Because of the prolonged onset of symptoms, diabetic ketoacidosis and hyperosmolar hyperglycemic state are unlikely to present as acute emergencies in the dental office.

Following treatment, the dentist must remember that diabetic patients are prone to infections and delayed wound healing.

This is especially true for a diabetic patient whose condition is uncontrolled. Therefore, depending on the dental procedure, some consideration should be given to providing antibiotic coverage. Notably, salicylates are known to potentiate the effect of oral hypoglycemic agents by increasing insulin secretion and sensitivity.

Recent estimates suggest that million people are living with DM worldwide. Given the numerous possible oral manifestations of DM and the risk of an intraoperative diabetic emergency, it is important for dentists to recognize and appreciate the impact of the disorder on dental care.

With a thorough understanding of DM and its dental management considerations, the dental health care team can work together effectively to provide excellent oral health care to diabetic patients.

Miller is a 4th-year dental student in the faculty of dentistry, University of Toronto. Correspondence to: Dr. Aviv Ouanounou. Toronto ON M5G 1G6. Email: aviv. ouanounou dentistry. The authors have no declared financial interests. This article has been peer reviewed. Skip to main content. Diagnosis, Management, and Dental Considerations for the Diabetic Patient Share on.

Cite this as: J Can Dent Assoc ;k8. April 7, oral conditions. systemic disease. Abstract Current epidemiological data suggest that the prevalence of diabetes in Canada is increasing. Test Information provided Normal value Diabetes value Sources: Diabetes Canada Clinical Practice Guidelines Expert Committee et al.

Table 2: Commonly used insulin preparations and their properties. Source: Adapted from Donner and Sarkar. Table 3: Common classes of oral hypoglycemic medications. Class Representative agents Mechanism of action Source: Adapted from Chaudhury et al. Table 4: Prevalence of oral manifestations in controlled vs.

uncontrolled diabetes. Table 5: Target values for most patients with diabetics. Table 6: Management of an intraoperative hypoglycemic emergency.

Signs and symptoms Emergency management Source: Adapted from McKenna. ca The authors have no declared financial interests. References Diabetes Canada Clinical Practice Guidelines Expert Committee, Punthakee Z, Goldenberg R, Katz P.

Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Can J Diabetes. Diabetes Canada Clinical Practice Guidelines Expert Committee, Houlden RL.