On Oral Health and Finding a Dentist with Type 1 Diabetes

Unfortunately, diabetes can negatively affect dental health in a variety of ways. People with diabetes are more susceptible to infections, and persistent high blood sugars (and extra sugar from snacks needed to treat lows) can lead to not only dental caries (cavities), but bigger issues like gum disease (gingivitis and periodontitis) and tooth loss later on down the line as well.

According to the American Dental Association, 1 in 5 cases of total tooth loss are due to diabetes.

Research shows that people with T1D are also at a greater risk of developing both the gum disease gingivitis and tooth loss, especially in youth.

This is because people with diabetes have a greater inflammatory response to the bacteria in their mouths than people who don’t have diabetes. This, combined with high blood sugars and more difficulty fighting off infections, can lead to trouble.

If gingivitis is left untreated, it can lead to deterioration of the jaw bone, periodontitis. This can lead to damaged gums and tooth loss, if it’s not addressed.

All of this is cyclical. If someone is struggling with advanced periodontitis, it makes blood sugars harder to control, which in turn can worsen dental health even more.

Dr. Michael Raizen, is a staff dentist at Denver Health (and spouse of a longtime T1D) in Denver, Colorado. He says, “The most common oral health issue we see in patients with diabetes [at my practice] is periodontal disease. This is true for both type 1 and type 2 diabetes. Both diabetes and periodontitis are chronic diseases, and the two have a complex interrelationship. Poor glycemic control can lead to higher blood glucose levels in the mouth, which can lead to the growth of bacteria that can cause gum disease. On the other hand, infections from untreated periodontal disease can cause the blood sugar to rise and make it harder to control diabetes.”

“Another common issue we see in diabetics is poor wound healing in general, but we see it in the mouth too,” Raizen added. “Oral surgical procedures heal more slowly and with more postoperative complications. Even deep dental cleaning, which is the most common nonsurgical treatment of periodontal disease, exhibits slower healing and increased risk of continued bacterial infection (in people with diabetes). The slower healing is common whether a patient has good glycemic control or not.”

In fact, periodontal disease is the most common mouth ailment affecting people with diabetes, touching nearly 22 percent of those with the disease.

People with diabetes may also suffer from dry mouth, or xerostomia, which is exacerbated not only by high blood sugars but by reduced production of saliva. Persistent dry mouth can lead to sores, ulcers, gum disease, and tooth loss, as saliva produces crucial enzymes that attack dangerous mouth bacteria.

Although rare, people with diabetes are also more likely to suffer from thrush. Thrush is a fungal infection caused by the yeast Candida albicans. Symptoms of this treatable condition include painful yellow or white patches of bumps in your mouth and on your tongue. Brushing and flossing daily can help prevent thrush in people with diabetes.

Juggling not only diabetes management, but the cost of the disease can also negatively affect oral health as well because people tend to put off expensive dental treatments.

Quinn Leighton, from Helena, Montana, sums it up by saying, “I’ve always deprioritized my dental care in regard to my diabetes, due to the high cost of everything. My teeth always came last.”

All hope is not lost, however! There are simple ways that you can help prevent the onset of dental health complications if you live with diabetes. Follow these steps to make sure you’re taking the very best care of yourself.

See a dentist regularly

First and foremost, you should get regular dental cleanings from a professional. The Centers for Disease Control and Prevention (CDC) recommends that people see a dentist at least once a year for cleanings, X-rays, and checkups. Also, make sure that your dentist knows you live with diabetes, so they can be on the lookout for any early oral health issues that affect our population disproportionately.

Seeing a dentist for a professional cleaning was not always easy during the COVID-19 pandemic shutdowns. In fact, in August 2020, the World Health Organization (WHO) issued a statement recommending that people postpone routine dental visits, but many dentists disagreed. In response, the American Dental Association released a statement saying it “strongly disagrees” with the WHO’s advice here. You’ll have to make your own decisions about safety concerns around visiting the dentist during the lingering COVID-19 pandemic, but do keep in mind what the American Dental Association’s president Dr. Chad P. Gehani stated: “Dentistry is essential healthcare because of its role in evaluating, diagnosing, preventing or treating oral diseases, which can affect systemic health.”

Brush and floss after meals

Dr. Raizen urges people with diabetes to be diligent about preventive care. “I recommend scrupulous home care (as well as regular professional care). That includes using a fluoride-containing toothpaste, especially one that contains stannous fluoride. Stannous fluoride has an antibacterial effect as well as an anti-cavity effect, as opposed to sodium fluoride, which only has an anti-cavity effect. If you use a mouthwash, use one that does not contain alcohol, such as Crest Pro-Health or Listerine Zero Alcohol. Alcohol is irritating to oral tissues that are already inflamed. Always brush twice a day for 2 minutes using a soft toothbrush, and floss at least once a day.”

He continues, “Don’t ever think that just because you have never had a cavity that you can put off regular dental care. I have seen many patients with diabetes who have never had a cavity who have had to have all of their teeth extracted by the age of forty because of untreated periodontal disease… whenever I see a new adult patient with gum disease, the first thing I look for in their medical record is an A1C, and/or a diagnosis of diabetes or prediabetes. If I don’t see that they have ever been evaluated for diabetes, I will immediately refer them to their primary care physician for an evaluation. Unfortunately, it’s all too common of a relationship.”

Be sure to brush and floss at least twice a day, but ideally after all meals and snacks. This is true especially if you have to treat low blood sugars in the middle of the night with sugary snacks and are apt to fall immediately back to sleep after eating. It’s also important to use a soft bristle toothbrush only, as medium and hard toothbrushes can cause damage to your gumline, experts say.

Look for early signs of trouble

Be on the lookout for bleeding gums, mouth pain, tooth pain, redness or swelling in the mouth, loose (adult) teeth, or dry mouth. Be aware of any existing or new tooth sensitivity, especially in response to hot or cold foods and/or beverages. Address any persistent issues by going to your dentist early on so they don’t turn into bigger issues at your next scheduled appointment.

Dr. Jess Buxton, of Surrey, United Kingdom, says, “I’ve had four root canals and then eventually lost all of those teeth to T1D since my diagnosis 15 years ago. [Diabetes] does affect dental health, and I just thought it was all the glucose tablets eaten for night time hypos!”

Double down on glucose control

All of us with diabetes know very well that our blood sugar levels affect all parts of our bodies. This is just as true for our teeth! If you’re concerned at all about oral health, it might be a good time to re-commitment to checking your blood sugar regularly, eating a nutritious diet, getting regular exercise, managing stress, and working with your doctor to adjust your insulin or oral diabetes medications as needed.

Improving your diabetes management — by increasing your Time in Range and lowering your A1C — will not only improve your energy level and overall health, but will inevitably result in better oral health as well.

Don’t smoke cigarettes!

Smoking is incredibly damaging not only for one’s oral health, but overall health as well, and those complications are compounded if you live with diabetes. Smoking increases the chances of losing your teeth and developing serious gum disease.

If you don’t smoke, don’t start, and if you need help quitting, check out these resources from the CDC, or talk with your doctor for more resources and advice.

Katie, who lives with T1D in Boulder, Colorado, expresses what many of us feel: “I always dread going to the dentist because I always feel judged.”

It can be challenging to find a provider who understands our plight, but finding a dentist who will serve you best doesn’t have to be difficult or scary.

Here are some ways to find a “diabetes-friendly” dentist:

Ask people you trust

If you have no idea where to start to find a good dentist, talk with your endocrinologist and get their recommendation. They will know of the best dentists for T1Ds in your area and can help you find the right fit.

If you have any friends or family members with diabetes, you can also ask them who their favorite dentist is.

Access will of course depend on your health insurance coverage and if the dentist is in network.

Search a database

To find a dentist who you know is in-network with your health insurance, you can search the insurance company’s patient portal. There are often notes about doctors’ areas of expertise that may help you pick.

You can also conduct some independent research on the American Dental Association’s database of board certified dentists based on where you live, distance you’re willing to drive, their specialty, and several other factors.

Interview for the right fit

Just like you are in the driver’s seat when it comes to choosing your endocrinologist, you are also in control of whom you choose to be your dentist. Before committing to a new dentist and dental practice, call around and get a feel for the various practices’ philosophy and mission.

Then at your first visit, you can see if this practice will be a good fit for you. If something doesn’t feel right, you can always change to another dental practice. Later, you can call and ask to have your X-rays and records transferred, if there are any.

Should you tell your dentist you have diabetes?

Sometimes people are hesitant to bring up the “whole diabetes thing” for fear that a dentist will judge, lecture, or alter treatment based on preconceived ideas.

But in truth, you should tell your dentist right away that you have diabetes, because it is a critical pillar of your health status. Let them know how long you’ve had it, if you suffer from any diabetes complications, and if you’re having any diabetes management issues or concerns.

You can disclose this information over the phone before an initial appointment, while you’re filling out your new patient paperwork, or even when the dentist first walks into the room. You can make this as formal or as casual as you’d like.

All board certified dentists must maintain licensure to practice, and most are well-versed in chronic diseases like diabetes and how it can negatively affect oral health. You may be surprised at how helpful your dentist can be once they learn about your diabetes.

(But if they do judge or lecture, see the section above about choosing a dentist who feels right for you.)

Oral health is a crucial component to overall diabetes health, and making sure that you’re taking proper care of your teeth and gums will pay dividends in the future.

Dr. Raizen drives the point home by saying, “Regardless if you are T1D or T2D or have good glycemic control or poor glycemic control, you are at an increased risk for periodontal disease. Prevention is much less expensive than the costs of periodontal surgery.”

For more information on oral health and diabetes, visit these websites: