Imagine that you are trying to enjoy your favorite meal, but realize that your gums are sore, your mouth is dry, and chewing has become uncomfortable. For people with diabetes, this can be a daily reality that often goes unnoticed.
Diabetes treatment generally focuses on the heart, feet, eyes, liver, and kidneys. However, the mouth is often neglected, even though oral health affects and is affected by diabetes in important ways.
One in nine adults worldwide has diabetes, and more than four in ten do not know they have the disease. Global projections indicate that by 2050, one in eight adults, or about 853 million people, will be affected, an increase of 46%.
Therefore, understanding the bidirectional relationship between diabetes and oral health is essential. It’s not about achieving a Hollywood smile. Keeping diabetes under control contributes to overall oral health and thus helps improve overall health.
Diabetes affects the way the body processes sugar. When blood sugar levels remain high for long periods, they damage blood vessels and nerves, slow healing, and impair the body’s ability to fight infection.
The mouth, with its soft and hard tissues and naturally diverse bacterial community, is particularly vulnerable. Oral health complications associated with diabetes include dry mouth caused by decreased saliva, a higher risk of tooth decay, gum disease that involves inflammation and loss of bone around the teeth, mouth infections such as oral thrush, mouth ulcers, difficulty wearing dentures, changes in taste, and eventually tooth loss.
These issues can affect nutrition, self-confidence, and even blood sugar control. My recent study showed a clear relationship between type 2 diabetes and severe tooth decay. High blood sugar levels, along with changes in the quantity and quality of saliva, can contribute to this progression.
Many people don’t realize this connection, which creates a vicious cycle. However, dry mouth and subsequent tooth decay can often be prevented if there is greater awareness among the public and healthcare professionals.
Gum disease and diabetes
People with diabetes are more likely to develop gum disease, and the relationship is reciprocal. Diabetes increases the risk of gum disease because high blood sugar leads to a high concentration of sugar in saliva. Bacteria in the mouth feed on sugar and produce acids that irritate and damage the gums.
Once the gums are injured, the bone that supports the teeth can undergo resorption. With bone loss, teeth can become loose or fall out. Keeping your blood sugar within a healthy range and maintaining good oral hygiene greatly reduces this risk.
Dry mouth is another common problem in people with diabetes. About 20% of the general population suffers from dry mouth, with higher numbers observed in women and the elderly. Some medications used to treat blood pressure, depression, or nerve pain can make dehydration worse.
Saliva is the natural protection of the mouth. It removes food particles, neutralizes acids and helps prevent infections. Without enough saliva, the mouth becomes more acidic and the teeth lose minerals, increasing the risk of cavities.
Dentists can offer personalized prevention plans for people who are most at risk. These plans may include fluoride varnishes, specific mouthwashes, or high-fluoride toothpaste.
Saliva also plays a vital role for those who wear dentures. It supports the gums, stabilizes the prosthesis and reduces irritation. When the mouth is dry, dentures can cause friction, discomfort, ulcers, and infections such as oral thrush.
Good oral hygiene can greatly improve comfort, nutrition, and overall health, including cleaning dentures daily, removing them at night, cleaning the gums and tongue, using appropriate cleaning solutions instead of hot water, and making regular dental appointments to ensure a correct fit.
Dental implants are another option for replacing missing teeth, but diabetes must be well controlled before they are considered, as high blood sugar slows the healing process, increases the risk of infection, and makes it difficult for the bone to properly fuse with the implant.
Healthy gums, stable bone levels, and good oral hygiene are essential for the success of the implant. Dentists need to evaluate each person’s condition to determine whether dental implants are suitable.
Good oral hygiene can make eating easier, help control blood sugar and improve quality of life. Staying informed, developing healthy daily habits and attending regular dentist appointments helps manage oral health complications associated with diabetes.
*Aileen Bessan, Professor of Minimally Invasive Dentistry, Queen Mary University of London