Here’s a little-known fact few dentists like to share: even when you stay on top of your oral health care at home, you can still have oral health issues. That’s because other factors might be contributing to the problem.
Research indicates that a number of systemic conditions have a relationship with oral health. Here at Smile Generation, we call this association the Mouth-Body Connection®.
The Mouth-Body Connection refers to the effects of gum disease on your overall health, and vice versa. For example, the inflammation typical of gum disease is associated with conditions like heart disease, respiratory illness, stroke, Alzheimer’s, and cancer, among other serious diseases.
One of the most researched systemic conditions for connections with gum disease is diabetes mellitus. Per the Mayo clinic, people who have diabetes frequently have gum disease, too. The connection could be how diabetes reduces the body’s ability to fight off infection, which leads to gum infections.[i]
What is Diabetes Mellitus?
Let’s take a closer look at, 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.[ii]
- Prediabetes: A diagnostic blood test called hemoglobin A1c (HbA1c) measures the amount of blood sugar attached to hemoglobin. [iii] A normal range is between 4% and 5.6%. Prediabetes is 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 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).[iv] 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 type develops during pregnancy. Individuals with gestational diabetes are at a greater risk of developing type 2 diabetes.
What is Gum Disease?
Poor oral health leads to periodontal disease or gum disease. There are many contributing factors to poor oral health, but among them is diabetes.
Periodontal disease refers to two specific conditions: Gingivitis and periodontitis. Gingivitis is classified by red, swollen, or bleeding gums and is reversible with appropriate home care. Periodontitis is a more serious condition, typified by bone loss and gum recession which can lead to tooth loss. Periodontitis is chronic and should be treated at regular intervals by your dental team.[v]
Gum Disease and Diabetes is a Two-Way Street
It’s helpful to understand that the relationship between diabetes and periodontitis and even gingivitis and diabetes is considered a bidirectional one.[vi] 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.[vii]
All types of diabetes have negative effects on various bodily systems, especially when the condition is not managed or remains untreated. There are many signs, symptoms, and complications associated with your overall health that include weight loss/gain, fatigue, kidney disorders, circulation issues, nerve damage, and diabetic retinopathy (blindness).
In addition to the impacts on your overall health, there’s a range of oral complications from diabetes that affect the gums, teeth, and surrounding tissues, including:
- Puffiness or swollen gums
- Bleeding gums
- Burning sensation in the mouth
- Reoccurrence of mouth sores
- Reduced salivary gland function
- Altered taste
Another oral manifestation of diabetes your dental team might notice is bad breath. Bad breath and diabetes are common companions, particularly breath that smells fruity or acetone-like.[x] This nail-polish essence on the breath could indicate a dangerous level of ketones, putting the body at risk for diabetic ketoacidosis (DKA).
Also, xerostomia, or dry mouth, another side effect of diabetes, can cause bad breath. Saliva helps control the bacteria growth in your mouth. When salivary production is lowered, it allows the bacteria to grow, which contributes to an unpleasant odor, known as halitosis. In addition, dry mouth increases the risk of tooth decay for patients with diabetes. Furthermore, diabetics are already at a higher risk for dental decay due to high levels of glucose in their blood. When combined with dry mouth, the risk tooth decay with diabetes only grows higher. [xi]
Can Diabetes Cause Tooth Loss?
Loss of teeth and diabetes have a relationship, too, albeit an indirect one. In the relationship between the two conditions, diabetes can inhibit the gum tissue to recover from inflammation and repair itself. This chronic inflammation from diabetes gums degrades the bone and gums, which can lead to gum recession, bone loss, and eventually, tooth loss. Also, leaving poorly compromised teeth in your mouth can increase diabetic complications and introduce harmful bacteria into the bloodstream.1 In these instances, surgical intervention or removal of hopeless teeth may benefit adjacent teeth and surrounding tissues.
Can Gum Disease Cause Diabetes?
The mouth is the gateway to the body, and systemic health is closely tied to your oral cavity, especially if you have diabetes. If you have plaque and bacteria in your mouth because of your gum disease, it will travel to the other parts of your body, too. When the infection from your gum disease travels and settles down somewhere else, it can trigger other chronic conditions, like diabetes.[xii]
Research indicates that patients that have gum disease have a more challenging time controlling their blood sugar levels.[xiii] One explanation is the inflammatory response to the plaque in the oral tissues makes it more difficult to control glucose levels. [xiv]
This conclusion stems from the HbA1c present in your blood. HbA1c is a glycated hemoglobin (which are the proteins in your blood that carry oxygen to the body). Medical teams use the A1c test to check for elevated levels to determine if patient’s diabetes is under control.[xv] According to a 2018 systemic review, an increased HbA1c level promotes complications in periodontal disease, including tooth loss. Moreover, those on the cusp with prediabetes and diagnosed with periodontal disease are at a significantly increased risk for developing type 2 diabetes.[xvi] People that have severe gum disease may also have elevated HbA1c levels, reinforcing that the disease can go both ways: Gum disease affects blood sugar control, which aggravates current or developing diabetes.
Dentists’ Role in Diabetes Management Starts with Gum Disease Treatment
Dentists have a significant role in diabetes management stemming from their treatment of your gum disease. [xvii] The treatment of periodontitis includes oral hygiene instructions by your dental hygienist or 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.
In addition to the cleanings, other treatments might be recommended for your gum disease treatment. Surgical or non-surgical intervention may be prescribed. Non-surgical therapy includes scaling and root planing, localized antibiotics, and gum 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.[xviii]
In addition to the health benefits, the dentists’ role in diabetes management has other benefits, too. Diabetic patients who completed periodontal treatment also saved money on annual medical costs. Per United Concordia Dental, a dental wellness company in Pennsylvania, these patients saved $2,840 or 40 percent in annual medical cost savings over patients that did not complete periodontal treatment. In addition, patients who completed gum disease treatment experienced an outpatient drug cost savings of $1,477.
Managing Your Gum Disease and Diabetes with Home Care
Daily and proficient brushing and flossing habits reduce the accumulation of biofilm, plaque, and bacteria on the teeth. We recommend brushing with fluoride toothpaste twice a day for at least two minutes.
Frequent brushing might also lower your risk of getting diabetes. A 2020 study from Diabetologia, the journal published by the European Association for the Study of Diabetes, indicates that tooth brushing three times a day or more is associated with an eight percent lower risk for developing diabetes. Furthermore, not brushing increases your risk for oral health disease, which the study says links to a nine percent increased risk of developing diabetes. That risk increases to 21 percent when gum disease has led to multiple missing teeth (15 or more).[xxii]
Effective flossing requires curving the dental floss around the tooth and as far in the gum pocket as it will go, usually up to a four or five-millimeter reach. If you haven’t been flossing, be aware that your gums may bleed the first few times you floss. Bleeding occurs when the base of the pocket is ulcerated from stagnant bacteria and other causative agents, like plaque and calculus accumulation due to insufficient cleaning or flossing. Keeping up with regular flossing and preventing that accumulation will resolve the bleeding in a short time.
Also, the American Dental Association strongly recommends that patients with gum disease or periodontal disease have at least three cleanings a year instead of the usual two cleanings. Professional cleanings at more frequent intervals control the harmful bacteria present in the oral cavity and provide you the best possible outcomes for your teeth and oral health.
In addition, there are a few other things you can do to improve your oral health and protect yourself against complications in the circular relationship between periodontal disease and diabetes. Replace your toothbrush when the bristles every three or four months, or as soon as the bristles appear worn. Use a medicated mouthwash after brushing and flossing, preferably one with fluoride unless you are told differently, to be the last defense against any additional food particles or bacteria left in the mouth. Limit your sugary foods and drinks and eat a nutrient-rich diet, meaning foods that have more than empty calories. If you smoke, stopping today would be an excellent boost to your oral and overall health.
Speaking with Your Dentist About Gum Disease and Diabetes
Now that you have a better understanding of the link between diabetes and your oral health, feel free to ask your Smile Generation-trusted dental team about your oral and systemic health. You should probably ask if you are at risk for gum disease and if that means you might be at higher risk for diabetes and other systemic conditions. If you recognize any of the oral symptoms described, ask your dentist or hygienist about them, so they can examine the situation and determine if there is a problem.
If you are not a diagnosed diabetic but think you might be or if you have any questions about periodontal disease and diabetes, don’t hesitate to ask. Our team would love to share any information with you.
Patients at a few Smile Generation-trusted offices recently did that and here’s what happened:
A 21-year-old patient with moderate gingivitis was tested and scored a 98. She was a healthy-looking kid with a history of diabetes. She said to the hygienist afterward:
"When my number came back at 98, I visited the doctor and was informed that I was prediabetic. I’m glad that for $29 I took a test that made me reach out to my doc and find this out."
Another patient from another office had this to say about the experience:
“I had a PerioFitness test done, and my score came back at 91 (High). It caused me to question things bit more because while I did have some things going on with my teeth, nothing major was occurring. My dentist recommended that I speak to my primary doctor. After having blood tests done, I found out that I was prediabetic. I never would have made that appointment if my numbers wouldn’t have come back that high. Six months later, after diet changes and a new electric toothbrush, air flosser, and perio treatment, my numbers were in the 50s and I have prevented myself from getting diabetes.”
Should you need periodontal disease treatment, you can find a dentist near you with comprehensive treatment plans and affordable dental plan options, such as the Smile Generation Dental Plan+ which offers special benefits for those with diabetes and prediabetes, and more at SmileGeneration.com.
[i] Oral health: A window to your overall health. MayoClinic.org. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475. Published 2021. Accessed March 29, 2022.
[ii] Darby, M. L., Walsh, M. M., Bowen, D. M., & Pieren, J. A. (2020). Dental hygiene: Theory and practice. St. Louis (Missouri): Elsevier/Saunders.
[iii] Darby, M. L., Walsh, M. M., Bowen, D. M., & Pieren, J. A. (2020). Dental hygiene: Theory and practice. St. Louis (Missouri): Elsevier/Saunders.
[iv] Mealey, B. L. (2006). Periodontal disease and diabetes. The Journal of the American Dental Association, 137. doi:10.14219/jada.archive.2006.0404
[v] THE MOUTH: The Missing Piece To Overall Wellness And Lower Medical Costs. United Concordia; 2014. https://www.unitedconcordia.com/docs/united%20concordia%20oral%20health%20whitepaper.pdf. Accessed March 29, 2022.
[vi] Mealey, B. L. (2006). Periodontal disease and diabetes. The Journal of the American Dental Association, 137. doi:10.14219/jada.archive.2006.0404
[vii] Mealey, B. L. (2006). Periodontal disease and diabetes. The Journal of the American Dental Association, 137. doi:10.14219/jada.archive.2006.0404
[viii] 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
[ix] 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
[x] Darby, M. L., Walsh, M. M., Bowen, D. M., & Pieren, J. A. (2020). Dental hygiene: Theory and practice. St. Louis (Missouri): Elsevier/Saunders.
[xi] Darby, M. L., Walsh, M. M., Bowen, D. M., & Pieren, J. A. (2020). Dental hygiene: Theory and practice. St. Louis (Missouri): Elsevier/Saunders.
[xii] THE MOUTH: The Missing Piece To Overall Wellness And Lower Medical Costs. United Concordia; 2014. https://www.unitedconcordia.com/docs/united%20concordia%20oral%20health%20whitepaper.pdf. Accessed March 29, 2022.
[xiii] Oral health: A window to your overall health. MayoClinic.org. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475. Published 2021. Accessed March 29, 2022.
[xiv] Hall K, Sanjai Sinha M. What Gum Disease Can Mean for Your Overall Health. EverydayHealth.com. https://www.everydayhealth.com/periodontal-disease/what-gum-disease-can-mean-your-overall-health/. Published 2018. Accessed March 30, 2022.
[xv] Dansinger, MD M. The Hemoglobin A1c Test & Chart. WebMD.com. https://www.webmd.com/diabetes/guide/glycated-hemoglobin-test-hba1c. Published 2020. Accessed March 30, 2022.
[xvi] National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Diabetes Statistics. June 2016.
[xvii] Oral health: A window to your overall health. MayoClinic.org. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475. Published 2021. Accessed March 29, 2022.
[xviii] Darby, M. L., Walsh, M. M., Bowen, D. M., & Pieren, J. A. (2020). Dental hygiene: Theory and practice. St. Louis (Missouri): Elsevier/Saunders.
[xix] THE MOUTH: The Missing Piece To Overall Wellness And Lower Medical Costs. United Concordia; 2014. https://www.unitedconcordia.com/docs/united%20concordia%20oral%20health%20whitepaper.pdf. Accessed March 29, 2022.
[xx] THE MOUTH: The Missing Piece To Overall Wellness And Lower Medical Costs. United Concordia; 2014. https://www.unitedconcordia.com/docs/united%20concordia%20oral%20health%20whitepaper.pdf. Accessed March 29, 2022.
[xxi] American Diabetes Association. (2018, March 22). Statistics About Diabetes. American Diabetes Association. http://www.diabetes.org/diabetes-basics/statistics/
[xxii] Chang, Y., Lee, J.S., Lee, KJ. et al. Improved oral hygiene is associated with decreased risk of new-onset diabetes: a nationwide population-based cohort study. Diabetologia 63, 924–933 (2020). https://doi.org/10.1007/s00125-020-05112-9