Gum Disease

Gum disease is a lesser known complication of diabetes
Gum disease is a lesser-known complication of diabetes

Gum disease is one of the lesser-known complications that can affect people with diabetes.

It is estimated that one in three people with diabetes suffer from gum disease, known as periodontitis, at some point in their life.

What is gum disease?

Gum disease is a very common infection that develops when dental plaque builds in the mouth and sits of the surface of the tooth.

Dental plaque is a sticky white coating formed by food, bacteria and saliva, which builds up throughout the day. The aim of brushing your teeth is to remove plaque, but if plaque is not removed this can create toxins which irritate the gums.

Regular brushing is essential to prevent plaque build-up, otherwise a gum inflammation called gingivitis may develop, eventually leading to gum disease.

If you have bleeding when brushing your teeth, bad breath, red swollen gums, painful gums, receding gums or loose teeth, this could be indicative of gum disease.

Untreated gum disease can lead to difficulty eating, loose teeth and ultimately tooth loss.

What does gum disease have to do with diabetes?

Poorly managed blood sugar levels can lead to or accelerate the development of periodontal diseases in both children and adults by causing elevated levels of glucose in the saliva. This then creates a breeding ground for bacteria, increasing the risk of gum disease and dental decay.

Periodontitis can also work the other way: severe gum disease can negatively affect your long-term blood sugar control and raise your chances of suffering from other common long-term complications of diabetes.

The European Foundation of Periodontology recommends that following a diagnosis of diabetes you should inform your dentist and undergo a comprehensive dental check up.

People with diabetes should have annual dental check-ups, including a review of your gum health. If your dentist or hygienist detects gum disease, they can help you with your initial management.

What are the symptoms of gum disease?

The symptoms of gum disease include:

  • Bleeding in the mouth stimulated by brushing and/or flossing
  • Swollen, red or tender gums
  • Receding gums
  • Loose teeth
  • Presence of pus between teeth/gums
  • Painful jaws
  • Persistent bad breath

To obtain an accurate diagnosis you should consult a dental health expert.

The three stages of gum disease

Gum disease is classified on the severity of its development. There are three stages of gum disease.


If regular brushing fails to remove excess plaque over time, the gums become irritated by toxins released by bacteria leading to localized swelling and inflammation. This is known as gingivitis.

Symptoms of gingivitis can include:

  • Red and swollen gums
  • Bleeding whilst brushing or flossing
  • Gum disease will stem from untreated gingivitis, and in turn the teeth will begin to decay.

Luckily, gingivitis is reversible, and by improving plaque removal from your teeth you can reverse the initial stages of gum inflammation.

Periodontitis (mild)

If plaque removal does not improve and/or because a patient is susceptible to the bacteria in the plaque, gingivitis can progress to periodontitis, which is more destructive to the tissues that surround and support the teeth.

Prompt medical care is required at this stage because the bone around the tooth will begin to erode.

Periodontitis (severe)

Severe periodontitis occurs when plaque migrates below the gum margin, leading to pockets forming between the inflamed gum and the tooth and root surface.

Over time the plaque bacteria travel further down the root surface into these gum pockets, and the supporting tissues and bone that hold the teeth in place are destroyed by the body’s response to the toxins produced by the harmful bacteria.

Risk factors for gum disease

The following factors raise the risk of developing gum disease:

  • Frequently high blood glucose levels
  • Poor oral hygiene
  • Smoking
  • Viral infections
  • Certain medications - including some blood pressure medications
  • Having a condition that affects immunity - such as Addison’s disease or HIV

Diagnosis of gum disease

If you have symptoms of gum disease, your dentist can provide you with a diagnosis and advice on treating gum disease.

Developed forms of gum disease such as periodontitis will require a dental examination to assess the scale of the problem. X-rays may be required to assess damage to the jaw or to the parts of teeth below the gum line.

How is gum disease treated?

If gum disease is diagnosed, the initial treatment can be carried out by a dentist or dental hygienist. They will review your general oral health and teach you how to effectively remove the plaque from your teeth. They will often perform professional cleaning of the teeth above and below the gum level.

Your treatment will depend upon the extent of your gum disease, diabetes control and current medication. Consequently a variety of techniques may be employed.

Treatment will involve maintaining strong oral hygiene. Brushing your twice a day in the morning and evening and flossing your teeth daily can help to keep your teeth clean. Mouthwash may also be recommended by your dentist and you may need to visit a dental hygienist.

It is also important to keep your blood sugar levels well controlled. This can be achieved by joining a diabetes education course and using blood glucose testing to inform meal choices.

Quitting smoking is also highly recommended to limit further damage.

If there is no improvement after treatment with your dentist or hygienist, you may be referred to a periodontist, or gum disease specialist.

Antibiotics or painkillers may be prescribed for treating acute necrotising ulcerative gingivitis, and severe periodontitis might require surgery to remove or replace gum tissue.

How do I prevent gum disease and oral problems?

There are several ways you can prevent gum disease from developing, including:

  • Daily removal of plaque from your teeth (through brushing and flossing), especially at the junction where the gum meets the tooth surface
  • Keep your blood glucose levels within a normal range
  • Maintain a healthy lifestyle and stop bad habits such as smoking
  • Attend regular dental check-ups with your dentist, including screening for gum disease, at least once a year

What other oral problems may be caused by diabetes?

Unfortunately, the scope of diabetes to cause other oral problems is not limited to gum disease. Diabetes may also cause oral thrush through high glucose levels in the mouth, as well as problems with dry mouth.

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