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

Meal Planning Optimizes Oral Health in People with Diabetes

For people who are managing diabetes, their diet goes way beyond glucose control and weight management; it will also has a significant impact on their oral health.

There are several reasons that put people with diabetes are at greater risk for oral diseases. Blood sugar control plays a large role in controlling the risk for periodontal disease.1,2 When someone’s blood sugar is high, it has a systemic impact. In particular, elevated blood sugar stimulates bacterial growth, which may lead to gingivitis and periodontal disease. It is essential for patients with diabetes to have good blood sugar control to reduce the risk of oral diseases.

periodontal disease, progressive graphic

It has been determined that periodontal disease can lead to diabetes and worsen blood sugar levels, too. While many associated behavioral risk factors can increase the risk of oral diseases, including poor oral hygiene, tobacco use, and beverage intake, it is the diet that has the potential to improve or reduce oral health. Dry mouth, in particular, can increase risks of disease because a sufficient level of saliva is necessary to help keep bacteria at bay and the mouth at its healthiest.

Impact of Food Choice On Oral Health
When it comes to the of diet and diabetes, there are several important factors to consider: cardiovascular heart health, blood pressure, risk of cancers, and stroke. However, when people with diabetes are introduced to meal planning, the focus is usually on achieving blood sugar control.

Carbohydrates are the primary foods that affect blood sugar, so the bottom line is to include plenty of dietary fiber (ie, choose whole grains) to maintain some consistency in the amount that is consumed at one time in order for the body to process it correctly and not cause the blood sugars to rise. The amount of carbs that can be consumed is different for every individual, but the first step in meal planning is to moderate the amount of added carbohydrates and avoid all white flour-based foods, and foods whose first ingredient is a sugar since these foods cause a spike in blood sugar that may promote undesirable weight gain, while not contributing any nutritional benefit.

healthy foods, glucometer

Foods That Should Be Avoided?
There are foods that people with diabetes should be instructed to avoid both for oral health and overall healths. The foods known to increase the risk of periodontal disease, include:3

  • Sugar-sweetened liquids, such as carbonated beverages, fruit drinks, energy drinks and sweetened coffees and teas
  • Sticky foods like raisins
  • Slow dissolving candies
  • Sugary starchy snacks, like cookies, cakes and pastries
  • Simple sugars, such as granulated sugar, honey, molasses, syrups

In addition, some eating patterns are associated with increased risk:

  • Frequent and prolonged intake of foods high in simple sugars
  • Eating sticky foods alone (such as a stand alone snack)
  • Sipping sugar-sweetened beverages for prolonged periods

Foods Choices That Can Reduce Oral Diseases    

The following eating habits have been found to reduce risk:3

  • Sugar-free chewing gum, mints and candies
  • Fresh fruits and vegetables
  • High-quality protein foods, such as meat, eggs, cheese, fish and beans
  • Whole-grain, low-sugar breads and cereals
  • Brown rice (vs white)
  • Space the frequency of food and beverage intake at least two hours apart
  • Select fresh, less processed food to stimulate salivary output
  • Chew sugarless gum for a brief period immediately after a meal or snack, if brushing is not possible

When it comes to beverages, how do they fit in?
In the absence of diabetes, it has been shown that sweetened beverages increase the risk of periodontal disease in young adults.4 This includes all juices, as well as sodas and other bottled beverages whose first ingredient is sugar, high fructose corn syrup, honey or agave. The body doesn't distinguish the source of the sugar. Since sugar-sweetened beverages deliver concentrated amounts of simple carbohydrates quickly, it is the best first step to recommend that patients eliminate sweetened beverages to improve their oral health in addition to their impact on serum glucose.

Water is best. Fruit, mint and herbal flavored teas are another excellent option to recommend.  While non-nutritive (artificial) sweeteners are often considered reasonable alternatives, this decision should be made with the understanding that some research suggests that diet beverages may stimulate hunger, leading to a greater desire to eat to achieve satiety. This is particularly true for people who tend to gain weight easily and/or are overweight.

What is The Bottom Line?
You can guide your patients with diabetes best by offering the following recommendations:

  • Choose foods that will not increase your risk of periodontal disease and fits into your carb-counting food plan
  • Avoid any and all sweetened beverages
  • Get into the habit of brushing your teeth each meal to reduce the risk of oral diseases; or, chew sugarless gum if brushing is not possible during the day.
  • Work with your healthcare professional to create a food plan that allows you to protect your oral health while maintaining your stable blood sugars and promotes a healthy weight.

Diabetes Self-Management to Individualize Care

The goal of diabetes self-management and medical nutrition therapy for diabetes is to individualize a patient's diet so that their lifestyle, cultural desires, food preferences and overall health concerns are all addressed. Every person is different. Patients with diabetes are strongly encouraged to see a certified diabetes educator who is a registered dietitian/nutritionist (RDN). An RDN can help your patient individualize a meal planning to help improve and/or maintain blood sugars to reduce their risk for periodontal disease.

Visit to find certified diabetes educators in your area so you might suggest someone who is conveniently located near your patient's work or home.

Continue Reading:
Regular Dental Care Not Optional for People with Diabetes
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