Diabetes and oral health

 

How does diabetes affect oral health?

Having diabetes means you have a higher-than-average risk of developing other health conditions such as problems with your heart, your kidneys, your eyesight and your nerves. However, you may not realise that diabetes increases your risk of developing complications with your mouth, teeth and gums too. In fact, Diabetes UK claims oral health is an important aspect of diabetes care that’s often overlooked (i).
 

Does having diabetes affect oral health?

Oral health problems such as gum disease are common. But they’re even more common in people with diabetes:
 

• People with type 2 diabetes are around three times more likely to develop dental problems than those who don’t have diabetes (ii).

• People with type 1 diabetes are also more at risk of having dental problems than the rest of the population (ii).

 
However, a study published in the journal BMC Oral Health suggests some people with diabetes are thought to have a higher risk of developing oral health problems than othes. The paper investigated the link between type 2 diabetes and oral problems including gum disease, missing teeth and dental bleeding (iii).
 
Results of the study showed that the longer you have diabetes, the higher your fasting blood sugar level and the higher your HbA1c level (your average blood sugar levels for the past two to three months), thus increasing your chances of having gum disease and dental bleeding.
 
The study also discovered that the participants who didn’t manage their diabetes carefully were more likely to have missing teeth than those who kept their blood glucose under good control. 
 

Can diabetes cause oral cancer?

Having diabetes has also been linked with a higher risk of oral cancer, especially if you’re a woman, says a review of studies published in the journal Diabetologia (iv). The researchers suggest women have a 13 per cent higher chance of developing oral cancer if they have diabetes, though this figure is lower than that for all types of cancer (women were found to have a 27 per cent higher risk of developing any form of cancer if they had diabetes, compared to a 19 per cent higher risk for men).

 

How does diabetes affect your teeth and gums?

There are a few reasons why diabetes may be linked with oral health problems. According to Diabetes UK, one of the most common causes of oral problems among diabetics is having high blood sugar levels for a long period of time (ii). Too much sugar in your blood can lead to excessive sugar in your saliva, which causes the ideal breeding ground for oral bacteria, the charity’s experts claim (ii).
 
These bacteria form a soft, sticky film on the surface of your teeth called dental plaque. If plaque isn’t removed regularly by brushing your teeth it can damage your gums and cause the symptoms of early gum disease (gingivitis). 

Having diabetes can also make you more susceptible to oral infections because high blood sugar levels can damage your blood vessels, which reduces blood supply to your mouth and gums . In fact, having diabetes makes you vulnerable to all types of infections, which may also be difficult to treat. This is due to poorly controlled blood sugar, which can affect your immune system and make healing much slower. 
 

Can poor oral health increase diabetes risk?

It’s also thought that if your oral health is poor, your chances of developing type 2 diabetes become higher too. Indeed, according to Patient UK, poor oral hygiene may be a trigger for diabetes to develop and may increase your chances of developing other diabetes complications (v). In other words, while having type 2 diabetes increases your risk of gum disease, having gum disease increases your risk of type 2 diabetes too.
 

Type 2 Diabates and Oral Health

There’s also some research that suggests people with type 2 diabetes could manage their blood sugar levels more effectively if they practiced good oral hygiene (vi).
 
In this study, people who had deep cleaning treatments called scaling and root planing – which remove plaque from the teeth and below the gums – had significant improvements in their blood sugar levels after six months, when compared to others who had other treatments that didn’t give their mouth such a deep clean (or no treatments at all). 
 

What common oral health problems are associated with diabetes?

 

Diabetes and Gum Disease

Gum disease is one of the most common oral health problems that affects people with diabetes. At first, the symptoms of gingivitis can be hard to spot. But if it’s allowed to develop you may notice things like swelling and redness in your gums. When gum disease becomes more severe, however, it can cause bleeding and slight discomfort when you brush your teeth.
 
Once this happens you’re at risk of developing periodontitis, which is an even more serious type of gum disease that can lead to tooth loss. If periodontitis is allowed to develop, you’ll need specialist treatment to save your teeth.
 

Symptoms of Gum Disease

Signs to look out for that suggest you have one of the more serious stages of gum disease include:
 

• Bleeding gums when brushing or flossing

• Gums that look red and inflamed and feel tender

• Gum abscesses

• Receding gums

• Sensitivity in your teeth 

• Loose teeth 

• A bad or metallic taste in your mouth 

 
Other oral health problems that can affect people living with diabetes include:
 

• Fungal infections (oral thrush is common in people with diabetes, thanks to the extra sugar in their saliva causing an overgrowth of sugar-loving fungi called Candida – read our guide to oral thrush symptoms, causes and treatments for further details).

• Recurring mouth ulcers that are slow to heal (discover more about mouth ulcers in our guide to mouth ulcers symptoms and signs) 

• Problems with tasting your food

• Dry mouth (also called xerostomia this is caused by a lack of saliva in your mouth and can be caused by having diabetes, especially if you’re older. Find out more about this condition by reading our guide to understanding dry mouth causes, symptoms and prevention) 

• Burning mouth syndrome (this can be caused by diabetes, dry mouth and oral thrush, among other things, and is often described as the feeling you get when you scald your mouth after eating or drinking something very hot – there’s more information on this condition in our guide to burning mouth syndrome causes and treatments).

 

Why is oral care important for diabetes?

If you have diabetes, keeping your blood sugar at as healthy a level as possible is important, not just for your oral health but for many other aspects of your health too. Keep your dentists informed about your blood sugar status, as it could help them to keep a closer eye on your oral health if your blood sugar isn’t as well controlled as it could be. 

Meanwhile if your dentist has scheduled treatment for gum disease for you, speak to your doctor or a member of your diabetes care team before your appointment, as you may need to take antibiotics to reduce your risk of infection afterwards. If you take insulin, you may be advised to change your mealtimes or your insulin dose/timing that day too. And if your blood sugar isn’t under good control, your doctor may advise you to put off having any non-emergency dental treatment until things improve. 

 

How can poor oral health be prevented?

On a day-to-day basis there are also many things people with diabetes can do to protect their teeth and gums, including:

• Avoid smoking, since the negative effect smoking has on your immune system can make it harder for you to fight an oral infection (plus it can make it more difficult for your gums to heal if you already have gum disease). For tips on giving up, read our guide to stop smoking. 

• Follow a healthy, nutritious, balanced diet that’s low in sugar. Check food labels for sugar levels, as many processed foods can contain surprisingly high amounts of ‘hidden’ sugars (ingredients that end in ‘ose’ such as sucrose, fructose and glucose are all types of sugars). Also avoid sugary drinks such as colas and even fruit juice (limit yourself to 150ml of juice a day: you can make it healthier and go further by watering it down – try one quarter juice to three quarters water). 

• Brush your teeth twice a day for at least two minutes each time (this should happen last thing at night before bed and at one other time but not within an hour of eating).

• Use a toothbrush with a small to medium-sized brush head with soft, multi-tufted, round-ended nylon bristles (it should be small enough to reach all parts of your mouth, including the back).

• Replace your toothbrush every two or three months, or sooner if the bristles look worn or splayed.

• Use a toothpaste that contains the right amount of fluoride, as it helps protect against tooth decay: adults and children over the age of three should use a toothpaste containing 1,350 - 1,500 parts per million (ppm) fluoride) and younger children should use a smear of toothpaste with a fluoride level of 1,000ppm.

• After brushing, spit out the toothpaste in your mouth rather than rinsing your mouth with water. This helps to keep some of the fluoride on your teeth, which means your teeth are protected for longer.

• Clean between your teeth every day using dental floss, dental tape or interdental brushes. Your dentist or hygienist can show you how to use floss or interdental brushes, as well as recommend the best type for you (interdental brushes come in different sizes, so you need to know which size – or combination of sizes – is suitable). According to the National Institute of Health and Care Excellence (NICE), interdental brushes are more effective than dental floss or tape for most people with gum disease (vii).

• Consider using a fluoride mouthwash too, as it can help prevent tooth decay. You may want to use it in the middle of the day rather than straight after brushing and flossing in the morning, as this can help remove any plaque that has built up since then – plus it gives you another ‘hit’ of fluoride. If you need help with controlling plaque or reducing gingivitis, you may need an antibacterial mouthwash – ask your dentist or dental hygienist for advice.

 
* If you wear dentures, keep them as clean as possible by removing them and cleaning them every day to prevent the bacteria build-up that can cause oral thrush.
 

• See your dentist for check-ups regularly, as often as they advise (at least once every one or two years). If you notice any of the signs of gum disease or other oral health problems, see your dentist as soon as possible

 

Natural ways to keep your blood sugar healthy

There are lots of things you can do to manage your diabetes effectively and keep your blood sugar levels at a healthy level, from following the lifestyle advice your doctor or diabetes care team suggests to taking your medication (if you have been prescribed any) correctly and having regular check-ups as often as recommended.
For more advice and tips on eating, exercising and other lifestyle changes you can make, read our guide to diabetes: diet and lifestyle.
 

Best supplements for lowering blood sugar

You may also want to consider taking a supplement that’s been shown to help lower blood sugar – though please note, supplements should never be used as an alternative to the advice and medicines your GP or specialist gives you. If you are taking any medication for diabetes, it’s also important to speak to your doctor before taking these or any other supplements, since some supplements could make your blood sugar too low (see our guide to diabetes for more about hypoglycaemia, which is a diabetes complication you may have heard of called hypos). 

The first supplement you may want to think about taking is a good-quality multivitamin and mineral, as it can help make sure your body’s getting all the nutrients it needs to stay healthy. To find out more about multivitamin supplements and the variety of different formulations available, take a look at our guide to multivitamins and daily requirements. 

Meanwhile you may also want to consider one or more of the following:
 

Cinnamon

A natural remedy that’s been used in traditional Chinese medicine for centuries, cinnamon is a spice that’s also often recommended by natural therapists for people with type 2 diabetes, as there’s some evidence it may help improve blood sugar levels (viii).
 

Alpha lipoic acid

There’s also evidence to suggest this fatty acid and powerful antioxidant could help control blood sugar levels (ix) as well as improve insulin sensitivity in people with type 2 diabetes (x). However, if you have diabetes always consult your GP before taking alpha lipoic acid as it may enhance insulin activity. 
 

Magnesium

Some researchers have found that people who have diabetes may have low magnesium levels (xi), possibly because having diabetes or taking the medicines used to treat it may cause magnesium deficiency. Others have also discovered magnesium may even help with blood sugar control (xii). 
 

Turmeric

The curry spice turmeric contains a compound called curcumin that’s thought to have a number of potential health benefits, including the ability to reduce blood sugar levels (though to date most studies have been carried out in animals rather than humans, meaning the available evidence isn’t as strong as it could be). However, one study has found that curcumin may help improve blood sugar level control after investigating its effects in people with diabetic foot ulcers (xiii).
 

High-strength fish oils

Omega-3 fatty acids – particularly two called EPA and DHA found in oily fish such as salmon, trout, sardines and mackerel – are widely considered helpful for general health and wellbeing. There’s also evidence to suggest adding omega-3 fatty acids to your diet may help prevent and treat gum disease (xiv). 

According to the NHS, a healthy, balanced diet should include at least two portions of fish a week, including one of oily fish (xv). But if you can’t or don’t like eating fish, a high-strength fish oil supplement may be a good option – or an omega oil supplement derived from marine algae instead of fish if you’re a vegetarian or vegan.
 

 

Fenugreek

Fenugreek seeds have a long tradition of use in some parts of the world, including in Ayurvedic medicine. These days herbal practitioners often recommend fenugreek seeds to people with diabetes, as they may help the body to produce insulin. There’s also some evidence fenugreek seeds may be helpful in controlling type 2 diabetes and reducing insulin resistance, though supporting studies to date are small in scale (xvi). However, don’t take fenugreek if you’re pregnant or breastfeeding. 
 

Vitamin D

This is probably best known for helping the body to absorb calcium. However vitamin D is also thought to have both anti-inflammatory and antimicrobial activity (xvii), which could make it a useful supplement for people with diabetes who want to avoid oral health problems. Researchers have also found that periodontitis (severe gum disease) and vitamin D deficiency may both increase the risk of type 2 diabetes – though when the two are combined the risk is even higher (xvii).
 
Vitamin D deficiency is common, including in the UK. Indeed, Public Health England advises adults and children over the age of one year old to consider taking a daily supplement containing 10mcg of vitamin D, particularly during autumn and winter (xviii).
 
However if your skin is rarely exposed to the sun – if you spend most of your time indoors, for instance, or if your skin is always covered when you’re out and about – you may need to take vitamin D throughout the year. People with dark skin from African, Afro-Caribbean and South Asian backgrounds should consider taking vitamin D all year round too, PHE advises.

The recommended form of vitamin D is vitamin D3 or cholecalciferol, as it’s the natural form of vitamin D that the body makes when it’s exposed to sunlight. Vitamin D3 supplements are available in tablet form, and now you can get them in veggie-friendly drops too. However most vitamin D3 supplements are made from the fat of lamb’s wool, which means they’re unsuitable for vegans. The good news is that vegan Vitamin D3 supplements sourced from lichen are now more widely available.
 

High-strength anthocyanidins

The damage to blood vessels caused over time by consistently high blood sugar levels are thought to make you more susceptible to oral infections. Supplements that contain plant substances called anthocyanidins, however, help support blood vessel health. That’s because anthocyanidins – which are found in dark-skinned fruits such as blueberries, cranberries, raspberries, blackberries and red grapes as well as vegetables such as red cabbage, red onions and aubergines – protect collagen in the body (collagen is a structural protein that gives blood vessels their strength).
 
If you want to try an anthocyanidins supplement, look for one that also contains vitamin C,
as vitamin C supports the body’s ability to produce collagen.
 
 
Having a healthy smile is good for all-round health, and this may apply to people who have diabetes even more so. It’s important to be aware of the damage you could be doing to your mouth, teeth and gums if your diabetes isn’t well-controlled, and to take steps to controlling it more effectively if necessary. This guide aims to show why it’s essential to practice good oral hygiene, as well as the steps you can take to make your oral hygiene routine more effective. In the meantime, there’s lots more advice and information on a wide range of conditions – including oral health and diabetes – in our pharmacy health library?

 

References:

(i) Available online; https://www.diabetes.org.uk/resources-s3/2019-02/FactFileOralHealth.pdf
 
(ii) Available online: https://www.diabetes.org.uk/guide-to-diabetes/complications/gum-disease
 
(iii) Eun-Kyong Kim et al. Association between diabetes-related factors and clinical periodontal parameters in type-2 diabetes mellitus. BMC Oral Health 13, Article number: 64 (2013). Available online: https://bmcoralhealth.biomedcentral.com/articles/10.1186/1472-6831-13-64
 
(iv) Ohkuma T., Peters S, Woodward M. Sex differences in the association between diabetes and cancer: a systematic review and meta-analysis of 121 cohorts including 20 million individuals and one million events. Diabetologia 2018; 61(10: 2140-2154. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133170/
 
(v) Available online: https://patient.info/oral-dental-care/toothache/oral-hygiene
 
(vi) Mauri-Obradors E et al. Benefits of non-surgical periodontal treatment in patients with type 2 diabetes mellitus and chronic periodontitis: A randomized controlled trial. J Clin Periodontol. 2018 Mar;45(3):345-353. Available online: https://onlinelibrary.wiley.com/doi/10.1111/jcpe.12858
 
(vii) Available online: https://cks.nice.org.uk/topics/gingivitis-periodontitis/management/gingivitis-periodontitis/
 
(viii) Mang. B, Wolters. M, Schmitt. B, et al. Effects of a cinnamon extract on plasma glucose, HbA, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest. 2006;36:340-344. Available online: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2362.2006.01629.x

Akilen. R, Tsiami. A ,Devendra. D, Robinson. N, et al. Glycated haemoglobin and blood pressure-lowering effect of cinnamon in multi-ethnic Type 2 diabetic patients in the UK: a randomized, placebo-controlled, double-blind clinical trial. Diabet Med. 2010;27(10):1159-1167. Available online: https://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2010.03079.x

Pham. AQ, Kourias. H, Pham. DQ. Cinnamon supplementation in patients with type 2 diabetes mellitus. Pharmacotherapy. 2007 Apr;27(4):595-9.Available online: https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1592/phco.27.4.595

Kirkham S, Akilen R, Sharma S, Tsiami A. The potential of cinnamon to reduce blood glucose levels in patients with type 2 diabetes and insulin resistance. Diabetes Obs Metab. 2009 Dec;11(12):1100-13. Available online: https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/j.1463-1326.2009.01094.x
 
(ix) Poh. ZX., Goh KP., A current update on the use of alpha lipoic acid in the management of type 2 diabetes mellitus. Endocr Metab Immune Disord Drug Targets. 2009 Dec;9(4):392-8. Available online: https://www.eurekaselect.com/article/30245
 
(x) Evans JL, Goldfine ID. Alpha-lipoic acid: a multifunctional antioxidant that improves insulin sensitivity in patients with type 2 diabetes. Diabetes Technol ther. Autumn 2000;2(3):401-13. Available online: https://www.liebertpub.com/doi/10.1089/15209150050194279
 
(xi) Elamin. A, Tuvemo. T. Magnesium and insulin-dependent diabetes mellitus. Diabetes Res Clin Pract. 1990;10:203-209. available online: https://www.diabetesresearchclinicalpractice.com/article/0168-8227(90)90062-X/pdf.

Barbagallow M, Dominguez LJ. Magnesium and type 2 diabetes. World J Diabetes 2015 Aug 25; 6(10):1152-57. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549665/
 
(xii) Song. Y, He. K, Levitan. EB. Effects of oral magnesium supplementation on glycaemic control in Type 2 diabetes: a meta-analysis of randomized double-blind controlled trials. Diabet Med. 2006;23:1050-1056. Available online: https://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2006.01852.x
 
(xiii) Mokhtari M., Razzaghi R, Momen-Heravi M. The effects of curcumin intake on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. Phytother Research: PTR (2020) 35(4):2099–107. Available online: https://onlinelibrary.wiley.com/doi/10.1002/ptr.6957
 
(xiv) Nazvi AZ et al. Omega 3 fatty acids and periodontitis in U.S. adults. J Am Diet Assoc. 2010 Nov; 110(11): 1669–1675. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320731/
 
(xv) Available online: https://www.nhs.uk/live-well/eat-well/food-types/fish-and-shellfish-nutrition/
 
(xvi) Yilmaz Z et al. Supplements for Diabetes Mellitus: A Review of the Literature. Pharm Pract 2017 Dec;30(6):631-638. Available online: https://journals.sagepub.com/doi/10.1177/0897190016663070.

Kassaian N et al. Effect of fenugreek seeds on blood glucose and lipid profiles in type 2 diabetic patients. Int J Vitam Nutr Res 2009 Jan;79(1):34-9. Available online: https://econtent.hogrefe.com/doi/10.1024/0300-9831.79.1.34 .

Gupta A, Gupta R, Lal B. Effect of Trigonella foenum-graecum (fenugreek) seeds on glycaemic control and insulin resistance in type 2 diabetes mellitus: a double blind placebo controlled study. Physicians India 2001 Nov;49:1057-61. Available online: https://pubmed.ncbi.nlm.nih.gov/11868855/
 
(xvii) Zuk ZM et al. Joint effects of serum vitamin D insufficiency and periodontitis on insulin resistance, pre-diabetes, and type 2 diabetes: results from the National Health and Nutrition Examination Survey (NHANES) 2009–2010. BMJ Open Diabetes Res Care. 2018 Jul 23;6(1):e000535. Available online: https://drc.bmj.com/content/6/1/e000535
 
(xviii) Available online: https://www.gov.uk/government/news/phe-publishes-new-advice-on-vitamin-d
 

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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