Diabetes and Your Mouth

Diabetes and oral care: the merry-go-round that never ends, and one that many patients don’t understand. 

How many times have we seen patients with a disconnect between oral and systemic disorders? That’s when we whip out our super-dental cape and spend just as much time educating as we do treating patients, all in hopes they will listen and learn.

Diabetes comes in different forms and may present itself orally prior to a symptomatic patient being diagnosed by a medical doctor. Diabetes mellitus – whether type I, II or a combination type – increases the risk of periodontal disease, and diminishes the healing response.

What to look for
You may see increased bleeding in the absence of plaque and calculus, or a sudden change in tissue appearance and pocket depths from a previous visit. It may also present as a history of subtle changes in oral tissue, pockets not responding to treatment for example.

I treated a diabetic patient for periodontal disease and he was the “dream” patient, was at every three-month periomaintenance appointment and used all the homecare recommendations as directed. For years, he maintained well with the tissue showing he was doing his job at home, until one visit it was different.

This patient had double the bleeding points, deeper pockets and tissue was red and inflamed. After discussion, we discovered that a week before he was told his HbA1c was incredibly high (10.2) and medications were added in response. Fast forward 3 months, and we again saw improvement in gingival tissue, which got even better after six months when his glucose levels were in better control.

Common complications
One of the most common complications of diabetes is the destruction of small blood vessels throughout the body, including the oral cavity. Healing from procedures may take longer than anticipated, and the patient is more prone to infection.



Diabetes may also be a contributing factor in salivary dysfunction, altered taste, candidiasis, lichen planus, recurrent aphthous stomatitis and an increased caries risk. Salivary dysfunction may go hand-in-hand with neuropathy, in turn increasing caries risk not only from the lack of saliva, but also because diabetics have been documented to have higher percentage of streptococcus mutans than non-diabetics.

Increased perio, increased caries, xerostomia, diminished healing and immune response, all on top of limiting great-tasting breads and treats are just a few commonalities in the life of a diabetic.

What if your patient is showing diabetic symptoms?
What if you suspect your patient may be one of the millions of non-diagnosed diabetics? You can refer them to their physician for a full examination; however, many patients who come in for dental visits regularly cannot remember the last time they had a physical.

A billable CDT code D0411 allows dental offices to provide on-point testing of HbA1c, the marker that’s used to test blood glucose levels over a three-month period and is often the test administered to diagnose diabetes.

These are small test kits that utilize only a pin-prick worth of blood and give necessary information as to why a patient may be exhibiting symptoms. While you can’t make a diagnosis of diabetes in the office, it can help you eliminate a cause of unresolved treatments or give the patient a cause to see a physician.

Armed with the knowledge, making a referral may end up saving a life.  

Solving the puzzle of the link between oral care and diabetes, and debunking the thinking that the mouth is not affected by other disease processes in the body can be a challenging concept for our patients to understand.

There have been patients over the years that I’ve referred to their physician because of a suspicion of one disease process or another, and some have proved false, while others have returned to thank me for detecting a disease that may have gone unnoticed for much longer.

One life saved and helped is worth the vigilance, and by donning a super-dental cape by providing education, we are more than just teeth-cleaners!