Diabetes Forecast

Keys to Keeping Your Mouth Healthy

By Kimberly Goad ,

Eric Hinders/Mittera

Your mouth doesn’t lie. Swollen, bleeding, or receding gums; loose or missing teeth; and persistent bad breath are all signs of gum disease. If you have diabetes, you’re at higher risk for both gingivitis (early-stage gum disease) and what’s known as periodontitis (advanced gum disease).

Both start with plaque, a soft, sticky substance that accumulates on your teeth as you eat and is made up mostly of bacteria. More than 500 types of bacteria can be found in plaque; some are good for your mouth and some aren’t. “The bacteria in a person with diabetes is no different than that of a person who doesn’t have diabetes,” says Ira Lamster, DDS, MMSc, professor of health policy and management at the Columbia University Mailman School of Public Health and dean emeritus of the Columbia University College of Dental Medicine.

The difference is in the nature and intensity of the body’s inflammatory response to the bacteria. “A person with diabetes—especially someone whose blood glucose levels are poorly controlled—will have a more robust, more aggressive inflammatory response,” Lamster says. “The consequence of that response is loss of supporting tissue for the teeth. Eventually, the tooth becomes loose and has to be removed.”

Now for the good news: None of this happens overnight, says Lamster. And there’s plenty you can do to prevent gum disease. “If you control your diabetes and your oral health, too—by getting regular checkups with a dentist or periodontist—you reduce your risk dramatically,” says Sally Cram, DDS, a practicing periodontist in Washington, D.C., and spokesperson for the American Dental Association. “So much of your diabetes and oral health can be controlled just by doing simple preventive things.”

Here are three essential steps to maintaining a healthy smile:

  • Brush twice a day. The American Dental Association recommends brushing for two minutes, twice a day, with a fluoride toothpaste. Place your toothbrush at a 45-degree angle to the gums and gently move the brush back and forth along the outer, inner, and chewing surfaces of your teeth. Be sure to clean each surface thoroughly. Whether you use a manual or electric brush doesn’t matter, but the size and shape of your brush should make it easy to reach all areas. And be sure to use soft bristles. Research shows that firm bristles tend to wear away the enamel on your teeth.

  • Floss once a day. If you don’t, plaque and food particles build up between teeth and along the gum line, setting you up for tooth decay and gum disease. To floss, wind an 18-inch piece around your middle fingers, leaving an inch or two to work with. Holding the floss between your thumbs and index fingers, curve it around each tooth in a C shape and gently slide it up and down the tooth and beneath the gum line. Not a fan of flossing? Try an interdental device. The tiny brush is designed to reach places a regular toothbrush can’t.

  • See your dentist twice a year. Depending on the health of your gums, he or she may recommend cleanings every three months. “Removing the bacteria more frequently might make a difference,” says Cram. If not, your dentist may suggest an antibacterial mouth rinse or antibiotics. Be sure to let your dentist know of any changes in your health or medications because both can affect your oral health. Dry mouth, for instance, may be more common among people with diabetes. It may be a result of aging or medications, but it could also be a complication of the disease, says Cram. Whatever the cause, the lack of saliva means food debris, sugar, acid, and bacteria don’t get washed away as easily.

Check It Out

The dentist’s office may be a good place for a prediabetes or type 2 diabetes screening. A study published recently in BMJ Open Diabetes Research & Care found that nearly 1 in 5 people with severe gum disease had type 2 diabetes and didn’t know it.

Know Before You Go

4 ways to get the most out of your dental appointment

  1. Find a dentist who is aware of the needs of people with diabetes.

  2. Be honest with your dentist. “Knowing the link between diabetes and periodontal disease, I need to know if your diabetes is under control,” says Sally Cram, DDS, a Washington, D.C., periodontist. “I need to know what your blood sugar runs and if you’re checking it periodically. These things affect how you’ll respond to treatment.”

  3. Be sure to eat normally prior to your appointment and take your usual meds on schedule.

  4. Be proactive. When you go in for a cleaning, ask: How do my gums look? Was there a lot of bleeding? Is there anything more I should be doing? “You have to be your own best advocate,” says Cram.


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