Clinicians' Guide to Diabetes and Oral Health
Diabetes, Oral Health, Hygiene and Prevention

Common Diabetes-Related Oral Health Problems

Chapter 2: Exploring the complicated world of the oral cavity and how changes can influence diabetes outcomes.

A healthy oral cavity is essential to overall health. Besides the lips, the oral cavity includes the cheeks, teeth, gums, tongue, floor of the mouth under the tongue, and the hard palate. Similar to a bacterial biofilm, different types of bacteria colonize and coat the oral structures, which have plenty of places to adhere—such as, pits, crevices and papillated surfaces. Common types of oral bacterium include Gemella, Granulicatella, Streptococcus, and Veillonella.

oral cavity of the human mouth

In people with diabetes, the balance between healthy and disease-promoting bacterium can be affected by glucose management, meal planning, and good oral hygiene. For example, fermentable carbohydrates (eg, cookies) can affect the pH balance in the oral space leading to bacterial formation (Streptococcus mutans) of dental plaque. A byproduct of plaque is an acid that can demineralize the surface of teeth leading to cavities (caries). Formation of dental plaque can cause periodontal or gum disease too.

dental plaque formation; clean teeth after cleaningLeft side: Dental plaque formation. Right side: After dental cleaning, plaque gone.

Besides tooth decay and periodontal disease, other types of oral health problems are associated with diabetes. A brief discussion of these disorders demonstrates the importance in educating patients about proper habits of oral hygiene to help avoid tooth loss, infection, difficulty chewing, pain, and potential for serious health problems (eg, cardiovascular disease).

  • Gingivitis (mild gum disease)

periodontal disease; progression from gingivitis

  • Salivary gland dysfunction (eg, dry mouth, gland infection)
  • Oral candida (eg, fungal infection). Candida is a fungus/yeast that often grows out of control and is problematic when there is a chronic presence of high-sugar levels in the mouth or body. Candida infection may present orally in the commissures of the mouth or hard palate. Candidiasis can be exacerbated by wearing dentures, smoking, high glucose levels, high-sugar diet and antibiotics.
  • Lichen planus often presents as an itchy body rash with bumps that become dry scaly patches. About 50% of people who acquire lichen planus also develop it in the mouth; sometimes causing painful oral sores that can affect eating and drinking.
  • Delayed healing. Patients with poorly managed diabetes often show delayed healing after scaling and root planing (eg, deep dental cleaning), tooth extractions and implant placement that can result in failure of dental implants.
  • Taste impairment

Red Flags of Dental Disease

  • Gums that easily bleed
  • Gums that are red, swollen, tender
  • Gums that have pulled away from teeth
  • Heavy build-up or coating of calculus on teeth
  • Pus between teeth and gums when the gums are pressed
  • Persistent bad breath (halitosis)
  • Persistent bad taste in the mouth
  • Permanent teeth that are loose or separating
  • Change in bite
  • Change in the fit of dentures or partials
  • Thick white coating on tongue
Continue Reading:
Meal Planning Optimizes Oral Health in People with Diabetes
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