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Bleeding gums and diabetes? Here’s what you need to know.

People with diabetes are more likely to have gum disease and other dental health issues — and that can make their diabetes worse. This science-backed advice can help.

Hallie Levine By Hallie Levine

If you’re dealing with a diabetes diagnosis, making a dental appointment may be the furthest thing from your mind. But it absolutely should be on your radar.

“Gum disease spreads more rapidly in people with diabetes,” says Mark S. Wolff, DDS, PhD. He’s a professor at the University of Pennsylvania School of Dental Medicine in Philadelphia. People with diabetes are also about 50 percent more likely to have severe tooth loss, a recent study finds. Yet a third of them haven’t seen a dentist in over a year.1

Here’s why diabetes and dental issues tend to go hand in hand. Plus, learn simple steps you can take to keep your smile healthy and happy.

The diabetes-dental health connection

Your saliva naturally has glucose, or sugar. But when diabetes isn’t well controlled, high glucose levels help harmful bacteria grow. These bacteria combine with the sugary or starchy food you eat to form soft, sticky plaque on your teeth and gums. Over time, plaque buildup leads to red and swollen gums that bleed easily. If left untreated, the gums pull away from the teeth. Pockets can form that become infected.

In fact, your gum disease may even worsen your diabetes. “Some of the bacteria may actually leak into your bloodstream, which causes inflammation that raises your blood sugar,” Dr. Wolff says. It also raises the chances of developing heart disease, he adds. A recent study in the Journal of Periodontology found that people with gum disease have a significantly higher risk of having a heart attack or stroke.2

One more reason that gum disease may worsen diabetes: If you have severe tooth loss, it’s harder to eat healthy foods such as crunchy veggies and chewy lean proteins. That means you’ll miss out on foods that can help you control your diabetes, says Dr. Wolff.

How to keep your teeth healthy

The first signs of gum disease are often swollen, tender or bleeding gums. But sometimes you won’t have any signs at all, says Dr. Wolff. That’s why you need to see your dentist at least twice a year. They’ll do a preventive cleaning and checkup to spot early warning signs that the rest of us don’t see. If you do notice bleeding, see your dentist even earlier.

Beyond regular visits to the dentist, following these steps can also help people with diabetes save their smile.

1. Keep your diabetes under good control

Work to keep your blood glucose numbers as close to your target range as possible. “If you get your blood sugars close to normal, it will help reduce the gum disease, allowing better healing with dental care,” says Dr. Wolff.

2. Brush regularly

Because you’re at higher risk for gum disease, you need to brush your teeth more than the usual two times a day:

  • First thing in the morning
  • Before you go to bed
  • After each meal and any sugary or starchy snacks

But it’s not just how often you brush — it’s also how you brush, stresses Dr. Wolff. Start with a soft toothbrush and angle it toward your gumline with small, circular motions. For guidance, it’s also a good idea to have your dentist or hygienist give you a mini tutorial in their office. “Sometimes just seeing your dentist do it in a mirror can make it easier for you to understand how to do it properly,” says Dr. Wolff.

If possible, use an electric or sonic toothbrush instead of a manual one. They appear to work better at reducing dental plaque and gum inflammation. A powered toothbrush may also help if you have arthritis in your hand or wrist. That that can make it harder to brush thoroughly, Dr. Wolff adds.

What about toothpaste and mouthwash? There are many toothpastes and rinses that are touted to improve gum health. But the most important thing is to use toothpaste with fluoride. “All the mouthwash in the world won’t make a difference if you don’t brush the right way,” says Dr. Wolff.

3. Don’t forget to floss

It’s easy to want to skip flossing when you’re tired and just ready to crawl into bed. But it’s important to floss daily to remove plaque that may have gotten stuck between your teeth. If hand or wrist arthritis makes it difficult to use floss, Dr. Wolff suggests trying an interdental brush, which is easier to hold.

4. Quit using tobacco

Smokers have twice the risk of gum disease compared to nonsmokers.3 The habit weakens your immune system. That makes it harder for your body to fight off a gum infection. And once your gums are damaged, smoking makes it harder for them to heal. It doesn’t matter whether it’s cigarettes, pipes or spit tobacco — they all raise your risk for gum disease.

5. Eat the right foods

Foods you should reach for: fruits, vegetables and lean proteins such as chicken and fish. Dental problems such as tooth loss, dry mouth and gum disease in older age may be diet related. These issues have been associated with a diet low in fruits and veggies and high in saturated and trans fats and processed meats. That’s according to a recent British Journal of Nutrition study.4

6. Ask for help if you need it

If your health isn’t so great, you may be less mobile. That can make it harder for you to get to the dentist’s office. Don’t be afraid to reach out to a friend or family member for help. If you’re an Aetna D-SNP member, you may be able to get a ride to and from your dentist’s office and other medical locations at no extra cost to you. To arrange transportation, simply call your care team. They’re there to make it easier to get the care you need.

1Patel N, Fils-Aime R, Li C, et al. Prevalence of past-year dental visit among US adults aged 50 years or older, with selected chronic diseases, 2018. Preventing Chronic Disease. April 29, 2021; 18: 200576.

2Van Dyke TE, Kholy KE, Ishai A, et al. Inflammation of the periodontium associates with risk of future cardiovascular events. Journal of Periodontology. March 2021; 92(3): 348-358.

3Centers for Disease Control and Prevention. Smoking, gum disease, and tooth loss. May 5, 2022. Accessed June 13, 2022.

4Kotronia E, Brown H, Papacosta AO, et al. Poor oral health and the association with diet quality and intake in older people in two studies in the UK and USA. British Journal of Nutrition. January 20, 2021; 126(1).


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