Gum, teeth and mouth problems

(Adapted from material kindly supplied by the American Diabetes Association)

Key points

  • People with diabetes are prone to get problems affecting their gums, teeth and mouth.
  • Gum disease is the most common mouth problem for people with diabetes.
  • Gum disease can start at any age.
  • There's a lot you can do to fight gum disease (such as brushing your teeth twice daily, flossing once every day, looking for early signs of gum disease, and visiting your dentist at least twice a year).

Gum disease starts with plaque

Gum disease is when you have germs that are working to destroy the gums and bone around your teeth. It all starts with plaque.

Plaque is a sticky film of saliva, food and germs. Plaque loves to settle in at the gum line. There, germs get busy making your gums red, tender, and likely to bleed.

The goal of daily tooth brushing and flossing is to clean away plaque. When plaque stays put, it hardens into tartar. Tartar builds up under the gum line. More plaque forms over the tartar. Only your dentist or dental hygienist (dental nurse) can get tartar off your teeth.

If plaque and tartar are not cleaned away, even gentle brushing can cause your gums to bleed. This is called gingivitis. It is the first stage of gum disease. You can prevent gingivitis with:

  • daily good brushing and flossing habits.
  • getting your teeth professionally cleaned at least twice a year at your dentist.

If you ignore gingivitis, the gum disease gets worse. The more severe form of gum disease is called periodontitis. If untreated this can lead to you losing your teeth.

Diabetes causes its own problems

Plaque is the “bad guy” of gum disease. But things are not helped by your diabetes. This is because:

  • Diabetes can weaken your mouth's germ fighting powers.
  • High blood glucose levels can make gum disease worse.
  • Diabetes may cause damage to the blood vessels supplying your gums.

If you have an infection from gum disease this can make your diabetes harder to control (usually causing your blood glucose levels to go up)

Warning signs of gum disease

Because gum disease is often painless, you may not know you have a problem until you have some serious damage. Regular check-ups at your dentist are your best weapon, but you can also help prevent it from happening by looking out for the early warning signs of gum disease. These are:

  • Bleeding gums when you brush or floss. Bleeding from your gums is not normal. Even if your gums don't hurt, get them checked.
  • Red, swollen, or tender gums.
  • Gums that have pulled away from your teeth. Part of the tooth's root may show, or your teeth may look longer.
  • Pus between your teeth and gums (when you press on the gums).
  • Bad breath.
  • Adult teeth that are loose or moving away from each other.
  • Changes in the way your teeth fit when you bite.
  • Changes in the fit of partial dentures or bridges.

If you have any of the above, visit your dentist as soon as possible.

Brush and floss

The three main steps to fight gum disease are brushing, flossing, and seeing your dentist regularly. Brush twice a day and floss at least once a day. Ask your dentist to show you the correct way to brush and floss. Here are some tips.

Brushing

A toothbrush can only clean one or two teeth at a time. Allow about 3 minutes of brushing to clean all your teeth well.

  • Use a brush with soft bristles and rounded ends. Soft bristles are less likely to hurt your gums.
  • Angle the brush to the gum line, where teeth and gums meet.
  • Move the brush back and forth with short strokes. Use a gentle, scrubbing motion
  • Brush the outside surfaces of the teeth. Do the same for the backs of teeth and chewing surfaces.
  • Lightly brush the rough surface of your tongue to remove germs and freshen your breath.
  • Brush your gums too.
  • Get a new toothbrush when the bristles are worn or bent (about every 3 to 4 months).

Flossing

Few people really enjoy flossing. But if you don't floss, you're only doing half the job of cleaning your teeth and gums. Flossing cleans away plaque and bits of food from between your teeth and below the gum line. It gets places your brush can't reach. Floss once a day.

  • Break off about 18 inches of floss and wind most of it around one of your middle fingers. Wind the rest around the same finger of the other hand.
  • Hold the floss tightly between your thumbs and index fingers. Leave about an inch of floss between them.
  • Use a gentle sawing motion to get the floss between your teeth. Never snap the floss into the gums (this can cut your gums).
  • When you get the floss to the gum line, curve it into a C-shape against one tooth. Scrape up and down on the sides of each tooth to remove plaque.
  • As floss gets worn and dirty, move to a clean section and continue. Don't forget the backsides of your rear teeth.
  • When you're finished brushing and flossing, rinse your mouth with water.
  • If you have arthritis in your hands, trouble moving your fingers, or if you have bridgework in your mouth, a floss holder might help. Ask your dentist about ways to make flossing easier for you.

Visiting your dentist

When you visit the dentist tell him or her that you have diabetes. Also let them know about any problems with infections or trouble keeping your blood glucose levels under control.

Eat before you go to see your dentist. The best time for dental work is when your blood glucose level is in a normal range. Remember that the visit may delay you eating. Don't book a visit when your diabetes medicine is peaking if it means that food will be delayed. If you take insulin, a morning visit after a normal breakfast is best.

Take your usual medicines before your dentist visit, unless your dentist or doctor tells you to change your dose for dental surgery.

Stick to your normal meal plan after dental work. If you can't chew well, plan how to get the calories you need. You may need to use a meal plan that uses more soft or liquid foods.

If your diabetes is in poor control wait to have dental surgery until it is better controlled. If your dental needs are urgent (pain or swelling), talk to your dentist and doctor about having dental treatment in a hospital or special clinic where you can be checked during and after surgery.

Other mouth problems

The most common problem affecting gums and teeth for people with diabetes is gum disease. But diabetes also makes you prone to other mouth problems.

Oral infections

An oral infection is a cluster of germs causing problems in an area of your mouth. Here are some warning signs:

  • Swelling or pus around your teeth or gums or any place in your mouth. Swelling can be large, or as small as a pimple.
  • Pain in the mouth or sinus area that doesn't go away.
  • White or red patches on your gums, tongue, cheeks or the roof of your mouth.
  • Pain when chewing.
  • Teeth that hurt when you eat something cold, hot or sweet, or when you chew.
  • Dark spots or holes on your teeth.

Infections can make your blood glucose hard to control. Making a plan of action with your dentist and doctor or diabetes nurse will prepare you for any adjustments you might need to make.

Fungal infections

Diabetes makes you more prone to fungal infections such as thrush. If you tend to have high blood glucose levels or if you take antibiotics often, you are even more likely to have this problem. Thrush makes white (or sometimes red) patches in areas of your mouth. These can get sore or turn into ulcers.

Thrush likes moist spots that may be chafed or sore, for example, under poorly fitting dentures (false teeth). Smoking and wearing dentures all day and night can increase the risk of thrush. Stopping smoking and limiting how long you wear dentures can reduce the risk of getting thrush. If you think you have thrush, talk to your dentist or doctor.

Poor healing. If your diabetes is poorly controlled, you heal more slowly and your chance of getting an infection after dental surgery is increased. To give yourself the best shot at healing well, keep your blood glucose under control before, during and after surgery.

Dry mouth

Some people with diabetes complain of dry mouth. High blood glucose can cause you to have a dry mouth. Some medicines can cause your mouth to be dry. Having a dry mouth can increase your risk of cavities because there's less saliva to wash away germs and take care of the acids they create. Dry mouth can sometimes lead to other problems, such as salivary gland infections.

If you have a dry mouth, try drinking more fluids. You can also try chewing sugar-free chewing gum to help keep the saliva flowing.

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