Too much glucose, also called sugar, in your blood from diabetes can cause pain, infection, and other problems in your mouth. Your mouth includes

• your teeth
• your gums
• your jaw
• tissues such as your tongue, the roof and bottom of your mouth, and the inside of your cheeks

Glucose is present in your saliva—the fluid in your mouth that makes it wet. When diabetes is not controlled, high glucose levels in your saliva help harmful bacteria grow. These bacteria combine with food to form a soft, sticky film called plaque. Plaque also comes from eating foods that contain sugars or starches. Some types of plaque cause tooth decay or cavities. Other types of plaque cause gum disease and bad breath.

Gum disease can be more severe and take longer to heal if you have diabetes. In turn, having gum disease can make your blood glucose hard to control.

Plaque that is not removed hardens over time into tartar and collects above your gum line. Tartar makes it more difficult to brush and clean between your teeth. Your gums become red and swollen, and bleed easily—signs of unhealthy or inflamed gums, called gingivitis.

When gingivitis is not treated, it can advance to gum disease called periodontitis. In periodontitis, the gums pull away from the teeth and form spaces, called pockets, which slowly become infected. This infection can last a long time. Your body fights the bacteria as the plaque spreads and grows below the gum line. Both the bacteria and your body’s response to this infection start to break down the bone and the tissue that hold the teeth in place. If periodontitis is not treated, the gums, bones, and tissue that support the teeth are destroyed. Teeth may become loose and might need to be removed. If you have periodontitis, your dentist may send you to a periodontist, an expert in treating gum disease.

The following chart shows the most common mouth problems from diabetes.

More symptoms of a problem in your mouth are

• a sore, or an ulcer, that does not heal
• dark spots or holes in your teeth
• pain in your mouth, face, or jaw that doesn’t go away
• loose teeth
• pain when chewing
• a changed sense of taste or a bad taste in your mouth
• bad breath that doesn’t go away when you brush your teeth

Check your mouth for signs of problems from diabetes. If you notice any problems, see your dentist right away. Some of the first signs of gum disease are swollen, tender, or bleeding gums. Sometimes you won’t have any signs of gum disease. You may not know you have it until you have serious damage. Your best defense is to see your dentist twice a year for a cleaning and checkup.

Plan ahead. Talk with your doctor and dentist before the visit about the best way to take care of your blood glucose during dental work.

You may be taking a diabetes medicine that can cause low blood glucose, also called hypoglycemia. If you take insulin or other diabetes medicines, take them and eat as usual before visiting the dentist. You may need to bring your diabetes medicines and your snacks or meal with you to the dentist’s office.

You may need to postpone any nonemergency dental work if your blood glucose is not under control.

If you feel nervous about visiting the dentist, tell your dentist and the staff about your feelings. Your dentist can adapt the treatment to your needs. Don’t let your nerves stop you from having regular checkups. Waiting too long to take care of your mouth may make things worse.

A sore mouth is common after dental work. If this happens, you might not be able to eat or chew the foods you normally eat for several hours or days. For guidance on how to adjust your usual routine while your mouth is healing, ask your doctor

• what foods and drinks you should have
• if you should change the time when you take your diabetes medicines
• if you should change the dose of your diabetes medicines
• how often you should check your blood glucose

Smoking makes problems with your mouth worse. Smoking raises your chances of getting gum disease, oral and throat cancers, and oral fungal infections. Smoking also discolors your teeth and makes your breath smell bad.

Smoking and diabetes are a dangerous mix. Smoking raises your risk for many diabetes problems. If you quit smoking,

• you will lower your risk for heart attack, stroke, nerve disease, kidney disease, and amputation
• your cholesterol and blood pressure levels might improve
• your blood circulation will improve

If you smoke, stop smoking. Ask for help so that you don’t have to do it alone. You can start by calling 1–800–QUITNOW or 1–800–784–8669.

We now know that smoking is one cause of type 2 diabetes. In fact, people who smoke cigarettes are 30%–40% more likely to develop type 2 diabetes than people who don’t smoke. And people with diabetes who smoke are more likely than those who don’t smoke to have trouble with insulin dosing and with managing their condition.The more cigarettes you smoke, the higher your risk for type 2 diabetes.

No matter what type of diabetes you have, smoking makes your diabetes harder to manage. If you have diabetes and you smoke, you are more likely to have serious health problems from diabetes, including:

• Heart disease
• Kidney disease
• Poor blood flow in the legs and feet that can lead to infections, ulcers, and possible amputation (removal of a body part by surgery, such as toes or feet)
• Retinopathy (an eye disease that can cause blindness)
• Peripheral neuropathy (damaged nerves to the arms and legs that cause numbness, pain, weakness, and poor coordination)

If you have diabetes and you smoke, quitting smoking will benefit your health right away. People with diabetes who quit are better able to manage their blood sugar levels.

You can keep your mouth healthy by taking these steps:

• Keep your blood glucose numbers as close to your target as possible. Your doctor will help you set your target blood glucose numbers and teach you what to do if your numbers are too high or too low.
• Eat healthy meals and follow the meal plan that you and your doctor or dietitian have worked out.
• Brush your teeth at least twice a day with fluoride toothpaste. Fluoride protects against tooth decay.
  • Aim for brushing first thing in the morning, before going to bed, and after each meal and sugary or starchy snack.
  • Use a soft toothbrush.
  • Gently brush your teeth with the toothbrush angled towards the gum line.
  • Use small, circular motions.
  • Brush the front, back, and top of each tooth. Brush your tongue, too.
  • Change your toothbrush every 3 months or sooner if the toothbrush looks worn or the bristles spread out. A new toothbrush removes more plaque.

• Drink water that contains added fluoride or ask your dentist about using a fluoride mouth rinse to prevent tooth decay.
• Ask your dentist about using an anti-plaque or anti-gingivitis mouth rinse to control plaque or prevent gum disease.
• Use dental floss to clean between your teeth at least once a day. Flossing helps prevent plaque from building up on your teeth. When flossing,
  • slide the floss up and down and then curve it around the base of each tooth under the gums
  • use clean sections of floss as you move from tooth to tooth

• Another way of removing plaque between teeth is to use a dental pick or brush—thin tools designed to clean between the teeth. You can buy these picks at drug stores or grocery stores.
• If you wear dentures, keep them clean and take them out at night. Have them adjusted if they become loose or uncomfortable.
• Call your dentist right away if you have any symptoms of mouth problems.
• See your dentist twice a year for a cleaning and checkup. Your dentist may suggest more visits if you need them.

• Follow your dentist’s advice.
  • If your dentist tells you about a problem, take care of it right away.
  • Follow any steps or treatments from your dentist to keep your mouth healthy.
• Tell your dentist that you have diabetes.
  • Tell your dentist about any changes in your health or medicines.
  • Share the results of some of your diabetes blood tests, such as the A1C test or the fasting blood glucose test.
  • Ask if you need antibiotics before and after dental treatment if your diabetes is uncontrolled.
• If you smoke, stop smoking.

Diabetes can cause serious problems in your mouth. You can do something about it.

If you have diabetes, make sure you take care of your mouth. People with diabetes are at risk for mouth infections, especially periodontal (gum) disease. Periodontal disease can damage the gum and bone that hold your teeth in place and may lead to painful chewing problems. Some people with serious gum disease lose their teeth. Periodontal disease may also make it hard to control your blood glucose (blood sugar).

Other problems diabetes can cause are dry mouth and a fungal infection called thrush. Dry mouth happens when you do not have enough saliva—the fluid that keeps your mouth wet. Diabetes may also cause the glucose level in your saliva to increase. Together, these problems may lead to thrush, which causes painful white patches in your mouth.

If your diabetes is not under control, you are more likely to develop problems in your mouth. The good news is you can keep your teeth and gums healthy. By controlling your blood glucose, brushing and flossing every day, and visiting a dentist regularly, you can help prevent serious problems in your mouth.

Take steps to keep your mouth healthy. Call your dentist when you notice a problem.

If you have diabetes, follow these steps:

• Control your blood glucose.
• Brush and floss every day.
• Visit your dentist regularly. Be sure to tell your dentist that you have diabetes.
• Tell your dentist if your dentures (false teeth) do not fit right, or if your gums are sore.
• Quit smoking. Smoking makes gum disease worse. Your physician or dentist can help you quit.

Take time to check your mouth regularly for any problems. Sometimes people notice that their gums bleed when they brush and floss. Others notice dryness, soreness, white patches, or a bad taste in the mouth. All of these are reasons to visit your dentist.

Remember, good blood glucose control can help prevent mouth problems.