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Prevent diabetes problems: Keep your mouth healthy

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How can diabetes affect my mouth?
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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

Drawing of a woman’s facial profile with the jaw labeled. Inset shows teeth, gums, roof of the mouth, bottom of the mouth, tongue, and inside of cheek.

Glucose is present in your salivathe 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.

Image stating that high glucose levels equal an increase in plaque.

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.

*See the Pronunciation Guide for tips on how to say the words in bold type.

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What happens if I have plaque?
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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.

Drawing of a close-up view of teeth and healthy gums, and a drawing of a close-up view of teeth and gums with periodontitis.
Healthy gums                                       Periodontitis

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

 

Problem What It Is Symptoms Treatment

gingivitis

  • unhealthy or inflamed gums
  • red, swollen, and bleeding gums
  • daily brushing and flossing
  • regular cleanings at the dentist

periodontitis

  • gum disease, which can change from mild to severe
  • red, swollen, and bleeding gums
  • gums that have pulled away from the teeth
  • long-lasting infection between the teeth and gums
  • bad breath that won’t go away
  • permanent teeth that are loose or moving away from one another
  • changes in the way your teeth fit together when you bite
  • sometimes pus between the teeth and gums
  • changes in the fit of dentures, which are teeth you can remove
  • deep cleaning at your dentist
  • medicine that your dentist prescribes
  • gum surgery in severe cases

thrush, called candidiasis

  • the growth of a naturally occurring fungus that the body is unable to control
  • sore, white—or sometimes red—patches on your gums, tongue, cheeks, or the roof of your mouth
  • patches that have turned into open sores
  • medicine that your doctor or dentist prescribes to kill the fungus
  • cleaning dentures
  • removing dentures for part of the day or night, and soaking them in medicine that your doctor or dentist prescribes

dry mouth, called xerostomia

  • a lack of saliva in your mouth, which raises your risk for tooth decay and gum disease
  • dry feeling in your mouth, often or all of the time
  • dry, rough tongue
  • pain in the mouth
  • cracked lips
  • mouth sores or infection
  • problems chewing, eating, swallowing, or talking
  • taking medicine to keep your mouth wet that your doctor or dentist prescribes
  • rinsing with a fluoride mouth rinse to prevent cavities
  • using sugarless gum or mints to increase saliva flow
  • taking frequent sips of water
  • avoiding tobacco, caffeine, and alcoholic beverages
  • using a humidifier, a device that raises the level of moisture in your home, at night
  • avoiding spicy or salty foods that may cause pain in a dry mouth

oral burning

  • a burning sensation inside the mouth caused by uncontrolled blood glucose levels
  • burning feeling in the mouth
  • dry mouth
  • bitter taste
  • symptoms may worsen throughout the day
  • seeing your doctor, who may change your diabetes medicine
  • once your blood glucose is under control, the oral burning will go away


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

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How will I know if I have mouth problems from diabetes?
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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.

Drawing of a man checking the inside of his mouth in the bathroom mirror for signs of problems from diabetes.
Check your mouth for signs of problems from diabetes.

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How can I prepare for a visit to my dentist?
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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.

Drawing of a male patient seated in a dental chair and talking with his male dentist.
If you feel nervous about visiting the dentist, tell your dentist and the staff about your feelings.

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What if my mouth is sore after my dental work?
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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

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How does smoking affect my mouth?
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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.

No-smoking symbol. A lit cigarette inside a circle is crossed out by a heavy line.

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How can I keep my mouth healthy?
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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.

Drawing of a toothbrush, toothpaste, and dental floss.

  • 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

Drawing of a woman flossing her lower teeth.

  • 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.

Drawing of a female dentist examining a male patient’s teeth.
See your dentist twice a year for a cleaning and checkup.

  • 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.

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Pronunciation Guide
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amputation (AM-pyoo-TAY-shuhn)

candidiasis (can-dih-DY-uh-siss)

cholesterol (ko-LESS-tur-ol)

circulation (SUR-kyoo-LAY-shuhn)

fluoride (FLOR-eyed)

gingivitis (JIN-jih-VY-tiss)

glucose (GLOO-kohss)

humidifier (hyoo-MID-ih-FY-ur)

hypoglycemia (HY-poh-gly-SEE-mee-uh)

insulin (IN-suh-lin)

periodontist (PAIR-ee-oh-DON-tist)

periodontitis (PAIR-ee-oh-don-TY-tiss)

plaque (plak)

saliva (suh-LY-vuh)

xerostomia (ZEE-roh-STOH-mee-uh)

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For More Information
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To find diabetes teachers (nurses, dietitians, pharmacists, and other health care providers), contact

American Association of Diabetes Educators
200 West Madison Street, Suite 800
Chicago, IL 60606
Phone: 1–800–338–3633
Internet: www.diabeteseducator.org leaving site icon

To find dietitians, contact

Academy of Nutrition and Dietetics
Internet: www.eatright.org leaving site icon
Click on “Find a Registered Dietitian.”

To learn more about mouth problems from diabetes, contact

National Institute of Dental and Craniofacial Research
National Oral Health Information Clearinghouse
1 NOHIC Way
Bethesda, MD 20892–3500
Phone: 1–866–232–4528
Fax: 301–480–4098
Email: nidcrinfo@mail.nih.gov
Internet: www.nidcr.nih.gov/OralHealth

To get more information about taking care of diabetes, contact

National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892–3560
Phone: 1–800–860–8747
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndic@info.niddk.nih.gov
Internet: www.diabetes.niddk.nih.gov

American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1–800–DIABETES (1–800–342–2383)
Email: askADA@diabetes.org
Internet: www.diabetes.org leaving site icon

JDRF
26 Broadway, 14th Floor
New York, NY 10004
Phone: 1–800–533–CURE (1–800–533–2873)
Fax: 212–785–9595
Email: info@jdrf.org
Internet: www.jdrf.org leaving site icon

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More in the Series
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The Prevent Diabetes Problems Series includes seven booklets that can help you learn more about how to prevent diabetes problems:

Image of the seven booklet covers in the Prevent Diabetes Problems Series.

For free single copies of these booklets, write, call, fax, or email the

National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892–3560
Phone: 1–800–860–8747
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndic@info.niddk.nih.gov

These booklets are also available at www.diabetes.niddk.nih.gov.

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Acknowledgments
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Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. The National Diabetes Information Clearinghouse (NDIC) thanks the people who helped review or field-test the original version of this publication:

For the American Association of Diabetes Educators
Lynn Grieger, R.D., C.D.E.
Arlington, VT
Celia Levesque, R.N., C.D.E.
Montgomery, AL
Teresa McMahon, Pharm.D., C.D.E.
Seattle, WA
Barbara Schreiner, R.N., M.N., C.D.E.
Galveston, TX

For the American Diabetes Association
Phyllis Barrier, M.S., R.D., C.D.E.
Alexandria, VA
Linda Haas, Ph.C., R.N., C.D.E.
Seattle, WA
Kathleen Mahoney, M.S.N., R.N., C.D.E.
Drexel Hill, PA
Randi Kington, M.S., R.N., C.S., C.D.E.
Hartford, CT

For the Centers for Medicare & Medicaid Services
Baltimore, MD
Jan Drass, R.N., C.D.E.

For the Diabetes Research and Training Centers
Albert Einstein School of Medicine
Norwalk Hospital
Norwalk, CT
Jill Ely, R.N., C.D.E.
Sam Engel, M.D.
Pam Howard, A.P.R.N., C.D.E.

Indiana University School of Medicine
Indianapolis, IN
Madelyn Wheeler, M.S., R.D., FA.D.A., C.D.E.

VA/JDF Diabetes Research Center
Vanderbilt School of Medicine
Nashville, TN
Ok Chon Allison, M.S.N., R.N.C.S., A.N.P., C.D.E.
Barbara Backer, B.S.
James W. Pichert, Ph.D.
Alvin Powers, M.D.
Melissa E. Schweikhart
Michael B. Smith
Kathleen Wolffe, R.N.

For the Grady Health System Diabetes Clinic
Atlanta, GA
Ernestine Baker, R.N., F.N.P., C.D.E.
Kris Ernst, R.N., C.D.E.
Margaret Fowke, R.D., L.D.
Kay Mann, R.N., C.D.E.

For the Indian Health Service
Albuquerque, NM
Ruth Bear, R.D., C.D.E.
Dorinda Bradley, R.N., C.D.E.
Terry Fisher, R.N.
Lorraine Valdez, R.N., C.D.E.

Red Lake, MN
Charmaine Branchaud, B.S.N., R.N., C.D.E.

For the Medlantic Research Center
Washington, D.C.
Resa Levetan, M.D.

For the Texas Diabetes Council
Texas Department of Health
Austin, TX
Luby Garza-Abijaoude, M.S., R.D., L.D.

Marc Shlossman, D.D.S., M.S.
Chandler, AZ

The NDIC also thanks Timothy J. Iafolla, D.M.D., M.P.H., and Dena J. Fischer, D.D.S., M.S.D., M.S., National Institute of Dental and Craniofacial Research, for reviewing the updated version of this publication.

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National Diabetes Education Program

1 Diabetes Way
Bethesda, MD 20814–9692
Phone: 1–888–693–NDEP (1–888–693–6337)
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndep@mail.nih.gov
Internet: www.ndep.nih.gov
www.yourdiabetesinfo.org

The National Diabetes Education Program is a federally funded program sponsored by the U.S. Department of Health and Human Services’ National Institutes of Health and the Centers for Disease Control and Prevention and includes over 200 partners at the federal, state, and local levels, working together to reduce the morbidity and mortality associated with diabetes.


National Diabetes Information Clearinghouse

1 Information Way
Bethesda, MD 20892–3560
Phone: 1–800–860–8747
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndic@info.niddk.nih.gov
Internet: www.diabetes.niddk.nih.gov

The National Diabetes Information Clearinghouse (NDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1978, the Clearinghouse provides information about diabetes to people with diabetes and to their families, health care professionals, and the public. The NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes.

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.

This publication may contain information about medications and, when taken as prescribed, the conditions they treat. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit www.fda.gov. Consult your health care provider for more information.


NIH Publication No. 14–4280
July 2014

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Page last updated September 10, 2014


The National Diabetes Information Clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892–3560
Phone: 1–800–860–8747
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndic@info.niddk.nih.gov
Internet: www.diabetes.niddk.nih.gov

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