Diabetes-Oral Health Connection: Elevating Awareness on the Neglected Link

Diabetes Mellitus presents a spectrum of clinical complications and is recognised as the major systemic risk factor for multiple oral disorders.
A poorly controlled blood glucose level in diabetic patients can contribute to serious oral/dental issues in addition to other health problems. (Representational image: Pixabay)
A poorly controlled blood glucose level in diabetic patients can contribute to serious oral/dental issues in addition to other health problems. (Representational image: Pixabay)

Diabetes Mellitus ( DM) is a growing public health problem that is primarily associated with elevated blood glucose levels (hyperglycemia). According to the International Diabetes Federation, one in ten adults had DM in 2021 highlighting the global burden of the disease. The multifaceted metabolic disease presents diverse complications in various regions of the body, including the oral cavity. People with diabetes are likely to have higher than normal risk of oral health problems. This is attributed to various mechanisms such as impaired neutrophil function, increased collagenase activity, and a reduction in collagen synthesis, microangiopathy, and neuropathy. The severity of diabetic complications is usually proportional to the degree and duration of hyperglycemia.


The pathologic conditions that underlie the complications of DM, particularly the role of excessive inflammation and generation of reactive oxygen species (the damaging effect of molecular oxygen on cells) exert harmful effects on blood vessel cells and nerve cells. This accounts for the changes seen in tissues that are richly innervated and vascularised.

The oral cavity is also highly vascularised and highly innervated, thus exhibiting numerous alterations associated with DM-

1. Gum disease (Periodontitis): Red, swollen or bleeding gums are initial signs that may progress to advanced stages expressed as bone loss and loosening of teeth. People with diabetes are more susceptible to gum infections due to high levels of blood glucose. Unfortunately, there is also a reciprocal link to it as the inflammation from periodontitis can complicate glycemic control. Interestingly, periodontitis is an early sign of diabetes mellitus and may be a useful risk indicator for the screening of early diabetes.

What's new?
A recent study at Pusan National University provides the first immunological explanation about mechanisms underlying the intricate association between periodontitis and diabetes. The findings suggest that both gum disease and diabetes can alter the body’s immune cell function and identifies periodontitis as a precursor to diabetes.

2. Dry mouth (Xerostomia): The experience of a dry mouth due to decreased saliva production is one of the most frequently mentioned oral complaints by patients with diabetes. Especially poor glycemic control negatively impacts both the prevalence and severity of dry mouth. This can lead to numerous problems such as difficulty in eating, swallowing, and speaking. Other variables include the use of medications with the side effect of dry mouth.

Xerostomia is a common complaint in individuals with DM characterised by dry mouth due to decreased saliva. (Representational image: Wikimedia Commons)
Xerostomia is a common complaint in individuals with DM characterised by dry mouth due to decreased saliva. (Representational image: Wikimedia Commons)

3. Oral infections: Decreased salivary flow rate and the absence of its antimicrobial effects can trigger fungal infections, particularly oral thrush (candidiasis). In addition, an impaired defense mechanism and poor metabolic control may play an important role in the development of infections.

4. Poor wound healing: The healing of any sores or wounds in the oral cavity is delayed due to factors like compromised innate immunity and diminished blood flow. This can pose challenges particularly when planning oral surgeries.

5. Dental caries:  Saliva renders protection against tooth decay due its cleansing and buffering capacity. It can neutralize the tooth-damaging acidic by-products released from bacterial fermentation of carbohydrates. Therefore, the diminished saliva production in diabetic patients makes them more prone to tooth decay. Moreover, the high levels of glucose in the saliva of such individuals can increase the population of decay-causing bacteria.

Oral complications in diabetic patients can be debilitating and impact their quality of life. There is evidence that chronic oral complications in these patients have negative effects on blood glucose control, so prevention and management of the oral complications are pivotal.


Many patients are unaware of the relationship between diabetes and oral health, leading to a lack of understanding about the significance of oral health maintenance among diabetic individuals. Reportedly, more than 90% of diabetic patients had oral manifestations due to lack of periodic dental check-ups.

A few practices for managing oral health complications in diabetic individuals -

  • Regular visits to the dentist at least biannually for check-ups. Inform your dentist about your diabetes diagnosis and the related medications to ensure tailored care for your specific needs.

  • Reinforcement of good oral hygiene habits such as brushing twice a day with fluoride toothpaste and flossing daily. Consider an antimicrobial mouthwash to reduce the risk of infections.

  •  The patients with dentures are advised to remove them at night and keep them completely clean.

  • Blood glucose control through increased physical activity, eating a balanced diet and making necessary lifestyle adjustments are critical to evade serious complications.

  • Quit smoking as the habit can aggravate gum disease and also worsen diabetes control. 

Regular self and professional oral care can benefit patients with diabetes. Those patients, particularly with a history of poor glycemic control, require more frequent recall visits and quick attention to any emerging acute oral infections.
Dr. Radhika.S, BDS, MDS, Consultant Periodontist


The indubitable relationship of diabetes and oral disease has assumed great importance, as is clear from the review of past and recent literature. Once the diagnosis of DM is made, oral health care should become a routine part of patient management. This encompasses both regular professional care and a special emphasis on self-care practices to tackle the associated oral health challenges. Given the substantial impact of oral complications on one’s quality of life, raising awareness to alleviate crises in diabetic patients is crucial.


1. Verhulst MJL, Loos BG, Gerdes VEA, Teeuw WJ. Evaluating All Potential Oral Complications of Diabetes Mellitus. Front Endocrinol (Lausanne). 2019 Feb 18;10:56. doi: 10.3389/fendo.2019.00056. PMID: 30962800; PMCID: PMC6439528.

2. Rohani B. Oral manifestations in patients with diabetes mellitus. World J Diabetes. 2019 Sep 15;10(9):485-489. doi: 10.4239/wjd.v10.i9.485. PMID: 31558983; PMCID: PMC6748880.

3. Teeuw WJ, Kosho MX, Poland DC, Gerdes VE, Loos BG. Periodontitis as a possible early sign of diabetes mellitus. BMJ Open Diabetes Res Care. 2017 Jan 19;5(1):e000326. doi: 10.1136/bmjdrc-2016-000326. PMID: 28316794; PMCID: PMC5337701.

4. Nazir MA, AlGhamdi L, AlKadi M, AlBeajan N, AlRashoudi L, AlHussan M. The burden of Diabetes, Its Oral Complications and Their Prevention and Management. Open Access Maced J Med Sci. 2018 Aug 15;6(8):1545-1553. doi: 10.3889/oamjms.2018.294. PMID: 30159091; PMCID: PMC6108795.

5. Hansong Lee et al, Immunological link between periodontitis and type 2 diabetes deciphered by single‐cell RNA analysis, Clinical and Translational Medicine (2023). DOI: 10.1002/ctm2.1503

(Original/ Dr. Vineesha V)

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