Prevent diabetes problems

Keep your mouth healthy

Number

7

in a

Series 

of 7

National Diabetes Information 

Clearinghouse

Prevent diabetes problems:

Keep your mouth healthy
Contents

How can diabetes affect my mouth? ...................... 1

What happens if I have plaque? ............................. 3

What are the most common mouth 

problems from diabetes? ......................................... 4

How will I know if I have mouth 

problems from diabetes? ......................................... 7

How can I prepare for a visit to 

my dentist?................................................................ 8

What if my mouth is sore after 

my dental work? ..................................................... 10

How does smoking affect my mouth? .................. 11

How can I keep my mouth healthy?..................... 12

Pronunciation Guide.............................................. 16

For More Information ........................................... 17

More in the Series.................................................. 19

Acknowledgments.................................................. 21
 1

How can diabetes affect my mouth?

Too much glucose,* also called sugar, in your blood 

from diabetes can cause pain, infection, and other 

problems in your mouth. Your mouth includes

*See the Pronunciation Guide for tips on how to

say the words in bold type.

● your teeth

● your gums

● your jaw

● tissues such as your tongue, the roof and bottom 

of your mouth, and the inside of your cheeks

Teeth

Gums

Roof of 

the mouth

Bottom of 

the mouth

Jaw

Tongue

Inside 

of cheek
2 

Glucose is present in your saliva—the fluid in your 

mouth that makes it wet. When diabetes is not 

controlled, high glucose levels in your saliva help 

harmful bacteria grow. These bacteria combine 

with food to form a soft, sticky film called plaque. 

Plaque also comes from eating foods that contain 

sugars or starches. Some types of plaque cause 

tooth decay or cavities. Other types of plaque 

cause gum disease and bad breath.

high glucose levels = plaque

Gum disease can be more severe and take longer 

to heal if you have diabetes. In turn, having gum 

disease can make your blood glucose hard to 

control. 
 3

What happens if I have plaque?

Plaque that is not removed hardens over time into 

tartar and collects above your gum line. Tartar 

makes it more difficult to brush and clean between 

your teeth. Your gums become red and swollen, and 

bleed easily—signs of unhealthy or inflamed gums, 

called gingivitis.

When gingivitis is not treated, it can advance to 

gum disease called periodontitis. In periodontitis, 

the gums pull away from the teeth and form spaces, 

called pockets, which slowly become infected. This 

infection can last a long time. Your body fights the 

bacteria as the plaque spreads and grows below the 

gum line. Both the bacteria and your body’s response 

to this infection start to break down the bone and the 

tissue that hold the teeth in place. If periodontitis is 

not treated, the gums, bones, and tissue that support 

the teeth are destroyed. Teeth may become loose and 

might need to be removed. If you have periodontitis, 

your dentist may send you to a periodontist, an expert 

in treating gum disease.

Healthy gums Periodontitis
4 5

What are the most common mouth 

problems from diabetes?

The following chart shows the most common 

mouth problems from diabetes.

Problem What It Is Symptoms Treatment

gingivitis ● unhealthy or

inflamed gums

● red, swollen, and bleeding gums ●

●

daily brushing and flossing

regular cleanings at the dentist

periodontitis ● gum disease, which

can change from

mild to severe

●

●

●

●

●

●

●

●

red, swollen, and bleeding gums

gums that have pulled away from the 

teeth

long-lasting infection between the 

teeth and gums

bad breath that won’t go away

permanent teeth that are loose or 

moving away from one another

changes in the way your teeth fit 

together when you bite

sometimes pus between the teeth 

and gums

changes in the fit of dentures, 

which are teeth you can remove

●

●

●

deep cleaning at your dentist

medicine that your dentist prescribes

gum surgery in severe cases

thrush, 

called 

candidiasis

● the growth of a

naturally occurring

fungus that the

body is unable to

control

●

●

sore, white—or sometimes red—

patches on your gums, tongue, 

cheeks, or the roof of your mouth

patches that have turned into 

open sores

●

●

●

medicine that your doctor or dentist prescribes to kill the fungus

cleaning dentures

removing dentures for part of the day or night, and soaking them in medicine 

that your doctor or dentist prescribes

dry mouth, 

called 

xerostomia

● a lack of saliva in

your mouth, which

raises your risk for

tooth decay and

gum disease

●

●

●

●

●

●

dry feeling in your mouth, often 

or all of the time

dry, rough tongue

pain in the mouth

cracked lips

mouth sores or infection

problems chewing, eating, 

swallowing, or talking

●

●

●

●

●

●

●

taking medicine to keep your mouth wet that your doctor or dentist prescribes

rinsing with a fluoride mouth rinse to prevent cavities

using sugarless gum or mints to increase saliva flow

taking frequent sips of water

avoiding tobacco, caffeine, and alcoholic beverages

using a humidifier, a device that raises the level of moisture in your home, 

at night

avoiding spicy or salty foods that may cause pain in a dry mouth

oral burning ● a burning sensation

inside the mouth

caused by

uncontrolled blood

glucose levels

●

●

●

●

burning feeling in the mouth

dry mouth

bitter taste

symptoms may worsen throughout 

the day

●

●

seeing your doctor, who may change your diabetes medicine 

once your blood glucose is under control, the oral burning will go away
6 

More symptoms of a problem in your 

mouth are

● a sore, or an ulcer, that does not heal

● dark spots or holes in your teeth

● pain in your mouth, face, or jaw that doesn’t 

go away

● loose teeth

● pain when chewing

● a changed sense of taste or a bad taste in 

your mouth

● bad breath that doesn’t go away when you 

brush your teeth
 7

How will I know if I have mouth 

problems from diabetes?

Check your mouth for signs of problems from 

diabetes. If you notice any problems, see your 

dentist right away. Some of the first signs of 

gum disease are swollen, tender, or bleeding 

gums. Sometimes you won’t have any signs of 

gum disease. You may not know you have it until 

you have serious damage. Your best defense is 

to see your dentist twice a year for a cleaning and 

checkup.

Check your mouth for signs of problems 

from diabetes.
8 

How can I prepare for a visit to 

my dentist?

Plan ahead. Talk with your doctor and dentist 

before the visit about the best way to take care of 

your blood glucose during dental work.

You may be taking a diabetes medicine that can 

cause low blood glucose, also called hypoglycemia. 

If you take insulin or other diabetes medicines, 

take them and eat as usual before visiting the 

dentist. You may need to bring your diabetes 

medicines and your snacks or meal with you to the 

dentist’s office.

You may need to postpone any nonemergency 

dental work if your blood glucose is not under 

control. 
 9

If you feel nervous about visiting the dentist, tell 

your dentist and the staff about your feelings. 

Your dentist can adapt the treatment to your 

needs. Don’t let your nerves stop you from having 

regular checkups. Waiting too long to take care of 

your mouth may make things worse.

If you feel nervous about visiting the 

dentist, tell your dentist and the staff 

about your feelings. 
10 

What if my mouth is sore after my 

dental work?

A sore mouth is common after dental work. If this 

happens, you might not be able to eat or chew the 

foods you normally eat for several hours or days. 

For guidance on how to adjust your usual routine 

while your mouth is healing, ask your doctor

● what foods and drinks you should have

● if you should change the time when you take 

your diabetes medicines

● if you should change the dose of your diabetes 

medicines

● how often you should check your blood glucose
 11

How does smoking affect my mouth?

Smoking makes problems with your mouth worse. 

Smoking raises your chances of getting gum 

disease, oral and throat cancers, and oral fungal 

infections. Smoking also discolors your teeth and 

makes your breath smell bad.

Smoking and diabetes are a dangerous mix. 

Smoking raises your risk for many diabetes 

problems. If you quit smoking,

● you will lower your risk for heart attack, stroke, 

nerve disease, kidney disease, and amputation

● your cholesterol and blood pressure levels might 

improve

● your blood circulation will improve

If you smoke, stop smoking. Ask for help so that 

you don’t have to do it alone. You can start by 

calling 1–800–QUITNOW or 1–800–784–8669.
12 

How can I keep my mouth healthy?

You can keep your mouth healthy by taking 

these steps:

● Keep your blood glucose numbers as close to 

your target as possible. Your doctor will help 

you set your target blood glucose numbers and 

teach you what to do if your numbers are too 

high or too low.

● Eat healthy meals and follow the meal plan that 

you and your doctor or dietitian have worked out.

● Brush your teeth at least twice a day with 

fluoride toothpaste. Fluoride protects against 

tooth decay. 

• Aim for brushing first thing in the morning,

before going to bed, and after each meal and

sugary or starchy snack.

• Use a soft toothbrush.

• Gently brush your teeth with the toothbrush

angled towards the gum line.

• Use small, circular motions.
 13

• Brush the front, back, and top of each tooth.

Brush your tongue, too.

• Change your toothbrush every 3 months

or sooner if the toothbrush looks worn or

the bristles spread out. A new toothbrush

removes more plaque.

● Drink water that contains added fluoride or ask 

your dentist about using a fluoride mouth rinse 

to prevent tooth decay.

● Ask your dentist about using an anti-plaque or 

anti-gingivitis mouth rinse to control plaque or 

prevent gum disease.

● Use dental floss to clean between your teeth at 

least once a day. Flossing helps prevent plaque 

from building up on your teeth. When flossing, 

• slide the floss up and down and then curve it

around the base of each tooth under the gums

• use clean sections of floss as you move from

tooth to tooth
14 

● Another way of removing plaque between teeth 

is to use a dental pick or brush—thin tools 

designed to clean between the teeth. You can 

buy these picks at drug stores or grocery stores.

● If you wear dentures, keep them clean and take 

them out at night. Have them adjusted if they 

become loose or uncomfortable.

● Call your dentist right away if you have any 

symptoms of mouth problems.

● See your dentist twice a year for a cleaning and 

checkup. Your dentist may suggest more visits if 

you need them.

See your dentist twice a year 

for a cleaning and checkup.
 15

● Follow your dentist’s advice. 

• If your dentist tells you about a problem, take

care of it right away.

• Follow any steps or treatments from your

dentist to keep your mouth healthy.

● Tell your dentist that you have diabetes. 

• Tell your dentist about any changes in your

health or medicines.

• Share the results of some of your diabetes

blood tests, such as the A1C test or the fasting

blood glucose test.

• Ask if you need antibiotics before and

after dental treatment if your diabetes is

uncontrolled.

● If you smoke, stop smoking.
16 

Pronunciation Guide

amputation (AM-pyoo-TAY-shuhn)

candidiasis (can-dih-DY-uh-siss)

cholesterol (ko-LESS-tur-ol)

circulation (SUR-kyoo-LAY-shuhn)

fluoride (FLOR-eyed)

gingivitis (JIN-jih-VY-tiss)

glucose (GLOO-kohss)

humidifier (hyoo-MID-ih-FY-ur)

hypoglycemia (HY-poh-gly-SEE-mee-uh)

insulin (IN-suh-lin)

periodontist (PAIR-ee-oh-DON-tist)

periodontitis (PAIR-ee-oh-don-TY-tiss)

plaque (plak)

saliva (suh-LY-vuh)

xerostomia (ZEE-roh-STOH-mee-uh)
 17

For More Information

To find diabetes teachers (nurses, dietitians, 

pharmacists, and other health care providers), 

contact

American Association of Diabetes Educators

200 West Madison Street, Suite 800

Chicago, IL 60606

Phone: 1–800–338–3633

Internet: www.diabeteseducator.org

To find dietitians, contact

Academy of Nutrition and Dietetics

Internet: www.eatright.org

Click on “Find a Registered Dietitian.”

To learn more about mouth problems from 

diabetes, contact

National Institute of Dental 

and Craniofacial Research

National Oral Health Information 

Clearinghouse

1 NOHIC Way

Bethesda, MD 20892–3500

Phone: 1–866–232–4528

Fax: 301–480–4098

Email: nidcrinfo@mail.nih.gov

Internet: www.nidcr.nih.gov/OralHealth
18 

To get more information about taking care of 

diabetes, contact

National Diabetes Information Clearinghouse

1 Information Way

Bethesda, MD 20892–3560

Phone: 1–800–860–8747

TTY: 1–866–569–1162

Fax: 703–738–4929

Email: ndic@info.niddk.nih.gov

Internet: www.diabetes.niddk.nih.gov

American Diabetes Association

1701 North Beauregard Street

Alexandria, VA 22311

Phone: 1–800–DIABETES (1–800–342–2383)

Email: askADA@diabetes.org

Internet: www.diabetes.org

JDRF

26 Broadway, 14th Floor

New York, NY 10004

Phone: 1–800–533–CURE (1–800–533–2873)

Fax: 212–785–9595

Email: info@jdrf.org

Internet: www.jdrf.org
 19

More in the Series

The Prevent Diabetes Problems Series includes 

seven booklets that can help you learn more about 

how to prevent diabetes problems.

● Prevent diabetes problems: Keep your diabetes 

under control

● Prevent diabetes problems: Keep your eyes healthy

● Prevent diabetes problems: Keep your feet healthy

● Prevent diabetes problems: Keep your heart and 

blood vessels healthy

● Prevent diabetes problems: Keep your kidneys 

healthy 

● Prevent diabetes problems: Keep your mouth 

healthy

● Prevent diabetes problems: Keep your nervous 

system healthy 
20 

For free single copies of these booklets, write, call, 

fax, or email the

National Diabetes Information Clearinghouse

1 Information Way

Bethesda, MD 20892–3560

Phone: 1–800–860–8747

TTY: 1–866–569–1162

Fax: 703–738–4929

Email: ndic@info.niddk.nih.gov

These booklets are also available at 

www.diabetes.niddk.nih.gov.
 21

Acknowledgments

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists and 

outside experts. The National Diabetes Information 

Clearinghouse (NDIC) thanks the people who 

helped review or field-test the original version of 

this publication:

For the American 

Association of Diabetes 

Educators

Lynn Grieger, R.D., C.D.E.

Arlington, VT

Celia Levesque, R.N., C.D.E.

Montgomery, AL

Teresa McMahon, 

Pharm.D., C.D.E.

Seattle, WA

Barbara Schreiner, R.N., 

M.N., C.D.E.

Galveston, TX 

For the American Diabetes 

Association

Phyllis Barrier, M.S., R.D., 

C.D.E.

Alexandria, VA

Linda Haas, Ph.C., R.N., 

C.D.E.

Seattle, WA

Kathleen Mahoney, 

M.S.N., R.N., C.D.E.

Drexel Hill, PA

Randi Kington, M.S., R.N., 

C.S., C.D.E.

Hartford, CT

For the Centers for 

Medicare & Medicaid 

Services

Baltimore, MD

Jan Drass, R.N., C.D.E.

For the Diabetes Research 

and Training Centers

Albert Einstein School 

of Medicine

Norwalk Hospital

Norwalk, CT

Jill Ely, R.N., C.D.E.

Sam Engel, M.D.

Pam Howard, A.P.R.N., 

C.D.E.

Indiana University School 

of Medicine

Indianapolis, IN

Madelyn Wheeler, M.S., 

R.D., FA.D.A., C.D.E.

VA/JDF Diabetes 

Research Center

Vanderbilt School 

of Medicine

Nashville, TN

Ok Chon Allison, M.S.N., 

R.N.C.S., A.N.P., C.D.E.

Barbara Backer, B.S.

James W. Pichert, Ph.D.

Alvin Powers, M.D.

Melissa E. Schweikhart

Michael B. Smith

Kathleen Wolffe, R.N.

For the Grady Health

System Diabetes Clinic

Atlanta, GA

Ernestine Baker, R.N., 

F.N.P., C.D.E.

Kris Ernst, R.N., C.D.E.

Margaret Fowke, R.D., L.D.

Kay Mann, R.N., C.D.E.

For the Indian Health Service

Albuquerque, NM

Ruth Bear, R.D., C.D.E.

Dorinda Bradley, R.N., 

C.D.E.

Terry Fisher, R.N.

Lorraine Valdez, R.N., C.D.E.

Red Lake, MN

Charmaine Branchaud, 

B.S.N., R.N., C.D.E.

For the Medlantic 

Research Center

Washington, D.C.

Resa Levetan, M.D.

For the Texas Diabetes 

Council

Texas Department of Health

Austin, TX

Luby Garza-Abijaoude, 

M.S., R.D., L.D.

Marc Shlossman, D.D.S., M.S.

Chandler, AZ

The NDIC also thanks Timothy J. Iafolla, D.M.D., M.P.H., and Dena J. Fischer, D.D.S., 

M.S.D., M.S., National Institute of Dental and Craniofacial Research, for reviewing the 

updated version of this publication.
22 

National Diabetes Education Program

1 Diabetes Way

Bethesda, MD 20814–9692

Phone: 1–888–693–NDEP (1–888–693–6337)

TTY: 1–866–569–1162

Fax: 703–738–4929

Email: ndep@mail.nih.gov

Internet: www.ndep.nih.gov

www.yourdiabetesinfo.org 

The National Diabetes Education Program is a 

federally funded program sponsored by the U.S. 

Department of Health and Human Services’ 

National Institutes of Health and the Centers for 

Disease Control and Prevention and includes over 

200 partners at the federal, state, and local levels, 

working together to reduce the morbidity and 

mortality associated with diabetes.
National Diabetes Information 

Clearinghouse

1 Information Way

Bethesda, MD 20892–3560

Phone: 1–800–860–8747

TTY: 1–866–569–1162

Fax: 703–738–4929

Email: ndic@info.niddk.nih.gov

Internet: www.diabetes.niddk.nih.gov

The National Diabetes Information Clearinghouse (NDIC) is 

a service of the National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK). The NIDDK is part of the 

National Institutes of Health of the U.S. Department of Health 

and Human Services. Established in 1978, the Clearinghouse 

provides information about diabetes to people with diabetes and 

to their families, health care professionals, and the public. The 

NDIC answers inquiries, develops and distributes publications, 

and works closely with professional and patient organizations and 

Government agencies to coordinate resources about diabetes. 

This publication is not copyrighted. The Clearinghouse 

encourages users of this publication to duplicate and 

distribute as many copies as desired. 

This publication is available at www.diabetes.niddk.nih.gov.

This publication may contain information about medications 

and, when taken as prescribed, the conditions they treat. When 

prepared, this publication included the most current information 

available. For updates or for questions about any medications, 

contact the U.S. Food and Drug Administration toll-free at 

1–888–INFO–FDA (1–888–463–6332) or visit www.fda.gov. 

Consult your health care provider for more information.
NIH Publication No. 14–4280

July 2014

The NIDDK prints on recycled paper with bio-based ink.