Individual checking Insulin Levels

At Smile Generation, we know that it is important to you that you keep your teeth. We know that you do the things we advise you to do; dedicated brushing, flossing, keeping your recommended dental appointments, and even avoiding the occasional sweet treat are all excellent efforts. Most of you even implement specialized gadgets like a water flosser or electric toothbrush, which is very commendable.

However, perhaps you are someone who adheres to these standards and still has problematic dental concerns. Are you aware of the other factors that may be greatly contributing to your oral health? Let’s review a well addressed metabolic disease that affects approximately one hundred million Americans; diabetes mellitus.

What Is Diabetes Mellitus?

Diabetes mellitus, or diabetes, is a systemic disorder that causes elevated levels of glucose in the body. It is classified into four types.1

  • Prediabetes: A diagnostic blood test called hemoglobin A1c (HbA1c) measures the amount of blood sugar attached to hemoglobin. 1 A normal range is between 4% and 5.6%. Prediabetes is determined by someone who has a higher HbA1C than normal but is not high enough to be classified as diabetes and treated with medication (5.7%-6.5%).
  • Type 1: Previously known as juvenile diabetes, as it develops in a short period of time and generally early in life, this type is an insulin-dependent form of diabetes due to the pancreas' inability to produce insulin for the body.
  • Type 2: This is the most common type, with approximately 90-95% of diabetics being classified as type 2 according to the Center for Disease Control (CDC).2 The body can initially produce insulin, but the cells do not respond to insulin as needed, creating insulin resistance. This type generally develops slowly and later in life and is typically in relation to obesity and lack of physical activity.
  • Gestational: This is when diabetes is developed during pregnancy. Individuals with gestational diabetes are at a greater risk of developing type 2 diabetes.

Untreated Diabetes and the Effects on Your Oral Health

All types of diabetes have negative effects on various bodily systems. There are many signs, symptoms, and complications to look for. Examples include weight loss/gain, fatigue, kidney disorders, circulation issues, nerve damage, and diabetic retinopathy (blindness). In addition, there’s a range of effects that occur in the mouth to the gums, teeth, and surrounding tissues that is important to be aware of. You may initially notice: 

  • Puffiness of the gums
  • Burning sensation in the mouth 
  • Reoccurrence of mouth sores
  • Reduced salivary gland function 
  • Altered taste

Oral Health Impact on Gum Disease

Due to generalized impaired wound healing of diabetic disorders, mouth ulcerations and gingival trauma are slower to recover. Gingival tissues may appear inflammatory, and this hyperplasia of gums can trap excess bacteria in the pockets. This can lead to or contribute to periodontal disease. Patients with poorly controlled type 2 diabetes are at greater risk for periodontal disease progression than patients with well-controlled type 2 diabetes.3

Periodontal disease refers to two specific conditions; gingivitis and periodontitis. Gingivitis is classified by bleeding gums and is generally reversible with good home care. Periodontitis is classified by bone loss and gum recession which can eventually lead to tooth loss. This condition is chronic and must be overseen at regular intervals by your dental team. Both diabetes and periodontitis can stimulate the chronic release of proinflammatory cytokines that have a deleterious effect on periodontal tissues. 3  Initial observations may include bleeding gums when brushing or flossing, tooth mobility, and/or gum recession.

Prevention and Detection at the Dental Office

The mouth is the gateway to the body, and systemic health is closely tied to your oral cavity, especially if you have diabetes. Oral manifestations more detectable by a peer or clinician include a specific odor on the breath, which has been described as fruity or acetone-like due to high ketone levels in the body.1 Observing this nail polish essence on the breath could indicate a dangerous level of ketones, putting the body at risk for diabetic ketoacidosis (DKA). Another side effect affecting breath odor is xerostomia or dry mouth. Dry mouth contributes to an unpleasant odor, known as halitosis, and is a key factor in dental decay. Diabetics are at a higher risk for dental decay due to high levels of glucose in their blood and saliva combined with dry mouth.1

It’s helpful to understand that the relationship between diabetes and periodontitis is considered a bidirectional one2. This is to say that people diagnosed with both diabetes and periodontal disease have two chronic conditions, each of which may affect the other. Both require frequent professional evaluations, in-depth patient education, and consistent educational reinforcement by health care providers.2  Exacerbation of periodontal disease is considered a complication of diabetes when other factors such as poor home care, smoking, or genetics can’t be attributed.

Smoking is an additional risk factor for periodontal disease. Engaging in tobacco use may have negative changes to the inflammatory response, the oral microbiome, and in turn, the general health of the periodontium.5 Remember, healing is impaired in smokers and diabetics, and periodontal disease is a chronic inflammatory disorder. Without the ability to heal and repair itself, gingival tissues and bone can degrade to the point of tooth loss. Smile generation can help you with tobacco cessation.

Dentists Role in Diabetes Management

The treatment of periodontitis includes oral hygiene instructions by your dental hygienist/dentist, a nutrition assessment and accompanying information on the role of your diet, and a periodontal cleaning of the teeth and gingival tissues.4 At each cleaning, the pocket depth of your gums should be assessed via probe readings, and the teeth will be cleaned by an ultrasonic device and hand instrumentation. An antibacterial mouth rinse such as chlorhexidine gluconate may be prescribed to control specific bacteria found in periodontal disease.

Surgical or non-surgical intervention may be recommended when indicated during your dental visits. Non-surgical therapy includes scaling and root planing, localized deliverance of antibiotic therapy, and gingival irrigation. Research supports that active therapy such as scaling and root planing significantly reduces HbA1c levels at three months, with even more reduction after six months.1

Can Diabetes Cause Tooth Loss?

In some instances, surgical intervention or removal of hopeless teeth may benefit adjacent teeth and surrounding tissues. Leaving poorly compromised teeth in your mouth can increase diabetic complications and introduce harmful bacteria into the bloodstream.At Smile Generation, we can provide you with comprehensive treatment plans and affordable financing options.

Following active therapy, you may be informed of a periodontal maintenance program in which you have your cleanings performed at three or four-month intervals. The American Dental Association strongly recommends at least three cleanings a year for those diagnosed with diabetes or periodontal disease. You will benefit from the assistance of professional cleanings to keep harmful bacteria controlled. Compliance with recommended treatment will nurture the best outcomes to the longevity of your dentition, as well as your overall health.

What Will Your Dentist Want to Know?

Your dental team at Smile Generation will review your glycemic control with you at each visit, commonly using your most recent HbA1c levels as an indicator, so always knowing your current levels is helpful information for us when assessing your mouth. Ideally, your HbA1c levels will remain lower than 7%. According to a 2018 systemic review, and increased HbA1c level promotes complications in periodontal disease, including tooth loss. Those just on the cusp with prediabetes but are diagnosed with periodontal disease are at a significantly increased risk for developing type 2 diabetes.6

Tips on Managing Your Diabetes

You can take control of your oral health at home too! Good oral hygiene home care will be an important factor in managing your diabetes-associated periodontal condition. Proficient brushing and flossing habits should be practiced daily to reduce the accumulation of biofilm, plaque, and bacteria on the teeth.

Gum pockets will be best accessed by daily c-shaped flossing. You can achieve effective flossing by curving around the tooth and bringing the floss as far in the pocket as it will go, usually up to a four or five-millimeter reach. This will allow the base of the pocket to remain in a healthy state following a dental visit with us. Bleeding occurs when the base of the pocket is ulcerated from stagnant bacteria and other causative agents, such as plaque and calculus accumulation due to insufficient cleaning or flossing.

While periodontitis can only be managed, gingivitis can be eradicated just with your good efforts. Reversing this inflammatory condition is beneficial in controlling your diabetes and vice versa, and your friends at Smile Generation will applaud you. 

Speaking with Your Dentist

Now that you have a better understanding of the link between diabetes and your oral health, feel free to ask your dental team at Smile Generation about any likeness you notice if you are not a diagnosed diabetic or any questions you have if you are. They are very knowledgeable in this topic and would love to share any information with you. Together, we can create healthier, happier smiles.



1. Darby, M. L., Walsh, M. M., Bowen, D. M., & Pieren, J. A. (2020). Dental hygiene: Theory and practice. St. Louis (Missouri): Elsevier/Saunders.

2. Mealey, B. L. (2006). Periodontal disease and diabetes. The Journal of the American Dental Association, 137. doi:10.14219/jada.archive.2006.0404

3.Hallmon, W. W., & Mealey, B. L. (1992). Implications of Diabetes Mellitus and Periodontal Disease. The Diabetes Educator, 18(4), 310-315. doi:10.1177/014572179201800409

4. G. Rutger Persson, DDS, PhD (Odont Dr) Diabetes Spectrum 2011 Nov; 24(4): 195-198.

5. American Diabetes Association. (2018, March 22). Statistics About Diabetes. American Diabetes Association.

6.National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Diabetes Statistics. June 2016.