Diabetes and Oral Health By Oral Health Therapist Glenys Shelton

Diabetes and Oral Health

Our April 2014 Dentistry in Focus Article is about diabetes and dentistry and is written by Dental Oral Health Therapist & Hygienist Glenys Shelton.

Diabetes & Dentistry

General Information

Diabetes is an endocrine disorder where enough insulin is either not produced or not utilized well by the body.

There are 3 types of diabetes:- Type 1, Type 2 and gestational.
Type 1 has an early onset and severe symptoms while Type 2 is mostly lifestyle related and has milder symptoms.
Gestational or pregnancy diabetes goes away after pregnancy, but may be prone to type 2 later in life.

Diabetes has many microvascular (small blood vessels) and macrovascular (large blood vessels) implications but along with these it also affects the oral tissues as well.
Patients are often unaware of their underlying diabetic problem and thus their condition is uncontrolled and unmanaged.

Oral Implications

Patients of uncontrolled diabetes present with a wide range of oral signs and symptoms and it’s not uncommon for dentists and dental hygienists/therapists to be the first people to warn patients about it.

Signs (Dental):-

  • Dry mouth and reduced saliva,
  • Increased risk of decay,
  • Increased risk of gum disease with more rapid attachment loss, deeper pockets, bleeding of gums and quicker bone loss leading to weak mobile teeth,
  • Poor wound healing.

If you suffer from any of these conditions it is recommended to check with your General Medical Practitioner (Doctor/GP).


Diabetes promotes gum disease and decay because;

  1. Reduced Host Immunity:-
    the immunity of patients of uncontrolled diabetes is highly reduced and the polymorphonuclear leukocytic (the body’s defense) function is poor. Therefor leading to poor response to bacteria and impaired defense.
  2. Changes in Oral Flora:-
    Due to excessive glucose in blood and crevicular fluid (saliva), the oral flora experiences massive change and the bacteria responsible for gum disease (periodontitis and gingivitis) and decayed teeth rise in number.
  3. Tissue Changes:-
    In uncontrolled diabetes the activity of collagenase (collagen/tissue protein eating enzyme) is very high and production of collagen is fairly low, thus leading to a net loss of collagen. This promotes easier tissue breakdown in response to bacterial assault.
  • On the other hand, periodontitis can contribute to poor metabolic control in people with diabetes which can place them at a higher risk for diabetic complications. A long term study has shown that those with severe periodontitis had three times the risk of death from ischemic heart disease or diabetic nephropathy (kidney disease) than those with moderate, mild or no periodontitis.

Patients who have diabetes under good control respond to all infections and disease causing bacteria in a similar manner to non-diabetics. This emphasizes the need for good management.

Precautions before seeing the dentist

If you are a known diabetic and your condition is being well managed, the following steps will help with a good dental experience:

  1. Always check your blood glucose levels before any invasive procedures and long appointments,
  2. Take your normal dose of medications at the usual times,
  3. Don’t skip meals beforehand,
  4. If you feel unwell advise us.

About the Author

Dental Oral Health Therapist & Hygienist Glenys Shelton has worked at Robertson Dental Innovations for over 5 years. She enjoys watching her patients oral health improve with each visit.

Posted in Dentistry In Focus Articles, OHT Shelton