You know that the sugar in candy is bad for your teeth, but did you know that sugar (glucose) in your blood may also pose dental dangers?

Fact #1: Diabetes predisposes people to periodontal disease—infection or inflammation of the gums—with severe cases spreading to the bones and ligaments that support the teeth.

Fact #2: Periodontal disease aggravates diabetes.

Fact #3: Diabetes interferes with wound healing.

These three facts portray how diabetes may worsen gum disease and vice versa.

The sixth complication

Periodontal disease has been called the sixth complication of diabetes, along with nerve disease, kidney disease, eye disease, heart attack, and stroke. Chronically high blood glucose (sugar) levels provoke inflammation in the gums. The mouth is home to untold numbers of bacteria and other germs, some of which may invade the inflamed gums. Pockets of infection may then develop, and tooth loss is possible. Other microbes attack the teeth and cause cavities.

Diabetes may also lead to dysfunction of the salivary glands, causing xerostomia, a reduction or absence of saliva in the mouth. Xerostomia, or dry mouth, is associated with enlarged parotid glands—one pair of the major salivary glands—and occurs in 25% of people with moderate to severe diabetes. It also causes widespread tooth decay that can lead to more infection if left untreated.

Starts with plaque

Plaque is a sticky, soft film of bacteria that continuously forms on the teeth and gums. If it’s not flossed and brushed away, gingivitis (inflammation of the gums) develops. It is the first and most treatable stage of periodontal disease. Signs of gingivitis include red, swollen, tender gums that may bleed during brushing. The plaque and calculus, a harder substance that forms (also called tartar), together harbor harmful bacteria and other destructive agents.

Untreated gingivitis often progresses to full-blown periodontal disease. Periodontal disease causes pockets to form between the teeth and gums due to the breakdown of both gum structure and bone. Gums may also pull back from the teeth, making the teeth look longer. People may require oral surgery, antibiotics, and/or pain management measures. Those who have uncontrolled diabetes may need higher dosages of antibiotics for a longer period of time because their immune system is weakened and infections may take longer than normal to heal.

Common disease bonds

If you have diseased gums that bleed and pull away from your teeth, germs in the mouth can slip into the bloodstream and gain access to your entire body. Cytokines—inflammatory chemicals of the immune system—are produced as the result of a gum infection. And, they may contribute to insulin resistance, the hallmark of type 2 diabetes.

In addition, cytokines may alter the function of beta cells in the pancreas, which normally produce insulin. As type 2 diabetes progresses, beta cells increasingly lose their ability to produce insulin. Some research indicates that cytokines may hasten this process.

Dental infection has also been linked with coronary artery disease, a danger for people with type 2 diabetes.

Many studies have shown that controlling a gum infection helps improve blood glucose control.

Take care of your teeth

In general, people can protect themselves from periodontal disease by

• brushing their teeth twice a day and using a new toothbrush every 3 to 4 months
• flossing their teeth once a day
• rinsing with a mouthwash that bears the seal of the American Dental Association’s Council on Dental Therapeutics to fight gingivitis, plaque, and other oral problems
• getting a professional dental cleaning every 6 months or as the dentist advises.

Individuals with diabetes may need an even more intensive regimen.

From Clinical Diabetes