Gum disease, also known as periodontitis, is the 6th most common disease in the world.

What is gum disease?

Gum disease affects the gums and bone supporting the teeth and eventually leads to tooth loss. If treated early gum disease is preventable and can be easily treated in the early stages.

What does gum disease have to do with diabetes?

People with diabetes have an increased risk of developing gum disease. In the same way that poorly managed blood sugar levels can cause damage to nerves, blood vessels, the heart, the kidneys, the eyes and the feet, the gums can also be affected.

Because high blood sugar levels damage blood vessels, reducing the supply of oxygen and nourishment to the gums. This can lead to infections of the gums and bones.

Diabetics have more than 4 times more glucose in their saliva than non-Diabetics.9.10  These excess levels of glucose in saliva provides the perfect environment for bacteria to thrive, compounding the risk of gum disease and dental decay.

Severe gum disease can also make it harder to control blood sugar which increase the likelihood of other common long-term complications associated with diabetes. Toxins which occurs in inflamed gums can escapes into the bloodstream. This disturbs the body’s natural defence mechanisms which, in turn, affects blood sugar control. In other words, gum disease and diabetes are linked in both directions.

So, diabetes is associated with an increased prevalence and severity of periodontitis, and, severe periodontitis is associated with compromised glycaemic control.7   This has been named the ‘see-saw effect’.


This relationship between diabetes and periodontal diseases has been the subject of more than 200 articles published in English during the past 50 years.

Evidence demonstrates that having diabetes can cause a five-fold increase in the risk of oral health problems, such as gum disease,1 and a four-fold risk of progressive alveolar bone loss – the bony tissue into which the teeth are anchored.3,4

A risk analysis in 1990 showed that subjects with type 2 diabetes had approximately threefold increased odds of having periodontitis compared with subjects without diabetes.3,4

In a case-control study it was demonstrated that loss of tooth attachment is more prevalent in children with diabetes than in children without diabetes.2 In addition, epidemiologic research confirms an increased prevalence and severity of attachment loss and bone loss in adults with diabetes.3,4

A review of studies conducted before 1996 that included more than 3,500 adults with diabetes, Papapanou 5 found a significant association between diabetes and periodontitis.

Diabetics may also have an increased risk of experiencing ongoing periodontal destruction over time. As an example, a two-year longitudinal study demonstrated a fourfold increased risk of progressive alveolar bone loss in adults with type 2 diabetes compared with that in adults who did not have diabetes.6

The clinical implications, therefore, are that diabetics who have periodontal disease have two chronic conditions, each of which may affect the other, and both of which require frequent professional evaluations, in-depth patient education and consistent educational reinforcement by healthcare providers.8

Moreover, control of oral hygiene in diabetes is important not only for oral health but also to protect the whole body. A number of studies have shown that people with gum disease may have a higher risk of heart disease. Bacteria and inflammation in the gums can escape into the blood system and cause blockages in the blood vessels, which reduce blood flow to the heart. Diabetes can also lead to excess cholesterol building up in the bloodstream, raising the risk of heart disease. Research is ongoing to further investigate the effect of gum disease on the heart.

The European Federation of Periodontology recommends that following a diagnosis of diabetes, a patient should arrange a comprehensive dental check-up and, with his dentist, implement a mouthcare Treatment Plan.

Diabetics need an intensive course of treatment and more regular follow-up dental visits compared to those who do not have gum disease.  It is important to be aware that high blood sugar levels can affect the time the gums take to heal, for example, after a tooth extraction.


Research indicates that people with diabetes have a higher risk of oral health problems, including gum disease, thrush and dry mouth.

It is important for people living with diabetes to maintain excellent plaque removal every day through specialist products, brushing regularly and using floss or small brushes for cleaning in-between the teeth.

Keeping good control of blood glucose levels, eating a healthy diet and quitting smoking can all help reduce the risk of dental health problems.

A diabetic should ensure his dentist knows about his diabetes and that should attend regular dental appointments.

Good oral health can contribute to good general health.


1. Cianciola L, Park B, Bruck E, Mosovich L, Genco R. Prevalence of periodontal disease in insulin-dependent diabetes mellitus (juvenile diabetes). JADA 1982;104(5):653-60.
2. Lalla E, Cheng B, Lal S, Tucker S, et al. Periodontal changes in children and adolescents with diabetes: a case-control study. Diabetes Care 2006;29(2):295-9.
3. Shlossman M, Knowler WC, Pettitt DJ, Genco RJ. Type 2 diabetes mellitus and periodontal disease. JADA 1990;121(4):532-6.
4. Emrich LJ, Shlossman M, Genco RJ. Periodontal disease in noninsulin dependent diabetes mellitus. J Periodontol 1991;62(2): 123-31.
5.  Papapanou PN. Periodontal diseases: epidemiology. Ann Periodontol 1996:1(1):1-36.
6. Taylor GW, Burt BA, Becker MP, et al. Non-insulin dependent diabetes mellitus and alveolar bone loss progression over 2 years. J Periodontol 1998;69(1):76-83.
7.  Diabetes and periodontal disease: a two-way relationship L. Casanova, F. J. Hughes & P. M. Preshaw
8. Periodontal Disease & Diabetes. Brian L Mealey, IADA Vol 37. P265. Oct 2006
9. Glucose estimation in the salivary secretion of diabetes mellitus patients.  Abikshyeet P1, Ramesh V, Oza N. Diabetes Metab Syndr Obes. 2012;5:149-54.
10. Salivary glucose concentration and excretion in normal and diabetic subjects. Jurysta C1, Bulur N, Oguzhan B, Satman I, Yilmaz TM, Malaisse WJ, Sener A.  J Biomed Biotechnol. 2009:430426.