People living with diabetes are at a higher risk of developing a range of dental issues. The most well-known is periodontitis, or advanced gum disease, but other complications include:

• Tooth decay (dental caries)
• Dry mouth (xerostomia) due to reduced saliva
• Oral thrush, a fungal infection
• Delayed healing of mouth wounds
• Changes in taste perception

Let’s explore these in more detail.

Gum problems: a two-way street

Periodontitis is a chronic gum condition that damages the tissues and bone supporting the teeth. It happens when the gums pull away from the teeth, and the bone underneath starts to break down. This can lead to lose teeth or even tooth loss.

People with diabetes are more likely to get gum disease, especially if their blood glucose levels are frequently high. Gum disease can also make it harder to manage blood glucose, increasing the risk of developing prediabetes or diabetes.

Studies show that people with high blood glucose levels tend to lose more teeth. This can happen even in younger adults. Keeping your glucose levels in range may help protect your teeth, especially the ones in the back of your mouth.

Recent research also shows that, if you have diabetes and are also overweight, your risk of gum disease goes up. This is because extra weight can cause more inflammation in the body, which affects your gums too.

Maintaining blood glucose levels within the recommended range (4–7 mmol/L) can reduce the risk of periodontitis to that of someone without diabetes. And treating gum disease can lead to modest improvements in blood glucose levels, although these effects may be short-term.

Tooth decay and dry mouth (xerostomia)

Diabetes can cause your gums to pull back, exposing the softer root of the tooth. This part of the tooth is more likely to get cavities.

Also, many people with diabetes have dry mouth due to decreased saliva production. This is also known as Xerostomia, and is especially common in people with diabetic neuropathy. Saliva helps protect your teeth, so without it, you’re more likely to get tooth decay.

Hence, a dry mouth can increase the risk of tooth decay, gum disease, and oral infections.

In addition, people with diabetes often have changes in the bacteria in their mouth. Good brushing and flossing habits, along with regular dental care, can help reduce harmful bacteria and improve overall mouth health.

Oral thrush, delayed healing, and altered taste

Oral thrush, or candidiasis, is a yeast infection that can show up as white patches in your mouth. It’s more common in people with diabetes because of higher glucose levels in saliva and a weaker immune system.

Diabetes can also slow down healing. If you get a sore or ulcer in your mouth, it might take longer to get better.

Some people with diabetes notice that food tastes different. This might be due to nerve damage or slower renewal of taste buds.

Even if it doesn’t always show up in tests, diabetes can make your mouth feel sore, uncomfortable, or hard to use. This can make it harder to eat, talk, or smile, and may even affect how you feel about yourself.

Even if you have dentures, you could develop mouth issues such as pressure spots.

How do I know if I have oral health issues?

You might not feel pain, even if something is wrong. Pain may only appear in advanced stages, when treatment options are limited—so early detection is key. Look out for:

• Bleeding gums
• Bad breath
• Loose or sensitive teeth
• Gums pulling away from teeth
• Food getting stuck between teeth

If you notice any of these signs, see your dentist.

How to keep your mouth healthy

Here are practical steps to maintain a healthy mouth:

• Brush twice daily with a soft toothbrush and fluoride toothpaste
  • Fluoride combines with the white enamel surface of the teeth to strengthen the tooth structure and prevent tooth decay
• Clean between teeth with floss or interdental brushes
• Limit sugar intake and eat a balanced diet
• Drink fluoridated tap water, rather than bottled water, where available
• Chew sugar-free gum to stimulate saliva production
• Visit your dentist regularly for check-ups and tailored advice, at least once per year
• Avoid smoking, which increases the risk of gum disease
• Rinse your mouth with water after treating a hypo (also known as hypoglycaemia, or a low blood glucose level) with sugary foods or drinks, once you feel well again. This helps rinse the sugar and acids from your mouth. If you want to brush your teeth it is recommended to wait 60 minutes before brushing.

Who can help?

Your dentist is your first stop for oral care. If you have serious gum problems, they may refer you to a periodontist (a gum specialist).

Make sure your dentist knows:

• That you have diabetes
• How well your blood glucose is managed
• What medications you take
• If you smoke or used to smoke

Your dentist will advise you on how often you should have check-ups and treatment. This may be more often if you have any of the above mouth problems and diabetes.

For more information

The Australian Dental Association website Teeth is a great resource. You may also like to take a look at this information on teeth and gum health.

For more diabetes specific information, you can call the NDSS Helpline on 1800 637 700 and ask to speak to a health professional.

If you are looking to find a local dentist, click here.

By Carolien Koreneff, Credentialled Diabetes Educator