Prevent diabetes problems

Keep your mouth healthy 

Number 

7

in a 

Series 

of 7 

U.S. Department 

of Health and 

Human Services 

NATIONAL INSTITUTES OF HEALTH National Diabetes Information Clearinghouse

 

Prevent diabetes problems: 

Keep your mouth healthy 

U.S. Department 

of Health and 

Human Services 

NATIONAL INSTITUTES OF HEALTH National Diabetes Information Clearinghouse

 

 

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? .......................................................... 6

How can I prepare for a visit to 

my dentist? ................................................................... 7

What if my mouth is sore after my 

dental work? ............................................................. 9

How does smoking affect my mouth? .................... 9

How can I keep my mouth healthy?..................... 10

Pronunciation Guide ............................................. 14

For More Information ......................................... 15

More in the Series ................................................. 18

Acknowledgments .............................................. 19

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 

●	 your teeth 

● your gums 

●	 your jaw 

●	 tissues such as your tongue, the roof and bottom 

of your mouth, and the inside of your cheeks 

Inside of 

cheek 

Jaw Tongue 

Gum 

Teeth 

Gum 

Roof of 

the mouth 

Bottom of 

the mouth 

Tooth 

*See page 14 for tips on how to say the words in 

bold type. 

1 
Glucose is present in your saliva—the liquid in 

your mouth that makes it wet. When diabetes is 

not controlled, high glucose levels in your saliva 

help harmful germs, called plaque, grow. 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. 

high glucose levels = plaque 

Gum disease can happen more often, 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. Some studies 

show that treating your gum disease makes it easier 

to control your blood glucose. 

2 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

What happens if I have plaque? 

Plaque that is not removed hardens over time and 

collects above your gum line. Hardened plaque 

makes it more difficult to brush and clean between 

your teeth. Your gums become red, swollen, 

and bleed easily—signs of the first stage of gum 

disease, called gingivitis. 

When gingivitis is not treated, it can advance to 

periodontitis. In periodontitis, the gums pull away 

from the teeth and form spaces, called pockets, 

which become infected. Your body fights the germs 

as the plaque spreads and grows below the gum 

line. But the germs 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 

3 
What are the most common mouth 

problems from diabetes? 

This chart shows the most common mouth problems 

from diabetes. 

Problem What it is Symptoms Treatment 

Gingivitis • the first stage of gum 

disease 

• red, swollen, and bleeding gums • daily brushing and flossing 

• regular cleanings at the dentist 

Periodontitis • a more severe form of 

gum disease 

• red, swollen, and bleeding gums 

• gums that have pulled away from 

the teeth 

• pus between the teeth and gums 

• bad breath that won’t go away 

• permanent teeth that are loose or 

moving away from each other 

• changes in the way your teeth fit 

together when you bite 

• changes in the fit of dentures, which are teeth you can remove 

• deep cleaning at your dentist 

• medicine prescribed by your dentist 

• gum surgery 

Thrush • 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 

• taking medicine prescribed by your doctor or dentist to kill 

the fungus 

• fixing dentures that do not fit well 

• removing dentures for part of the day or night, and keeping 

them clean 

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 prescribed by your doctor or dentist to keep 

your mouth wet 

• rinsing with a fluoride mouthrinse 

• using sugarless gum or mints to increase saliva flow 

• taking frequent sips of water 

• avoiding tobacco, caffeine, and alcohol 

• 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 

Burning 

mouth 

syndrome 

• a painful, complex mouth 

problem 

• cause unknown but linked to nerve damage, painful 

dentures, changes in 

hormones, dry mouth, 

and poor diet 

• burning feeling in the mouth 

• dry mouth 

• bitter taste 

• symptoms may worsen throughout 

the day 

• depends on your needs and the cause 

4 5
More signs of a problem in your mouth are 

●	 pain in the mouth, face, or jaw that 

doesn’t go away 

●	 loose teeth 

●	 pain when chewing 

●	 a changed sense of taste 

●	 dark spots or holes in your teeth 

●	 a sore, or ulcer, that does not heal 

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 there are no 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. 

6 
 

Check your mouth for signs of problems 

from diabetes. 

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 food with you to the dentist’s office. 

7 
You may need to postpone any non-emergency 

dental work if your blood glucose is not under 

control. 

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. 

Tell your dentist and the staff about 

your feelings. 

8 
 

What if my mouth is sore after my 

dental work?

If your mouth is sore after your dental work, you 

might not be able to eat or chew 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 

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. 

9 
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, ask your doctor to help you quit or 

call 1–800–QUITNOW (1−800−784−8669). 

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. 

10
 

●	 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 

snack. 

• Use a soft toothbrush. 

• Gently brush the gum line. 

• Use small, circular motions. 

• 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 mouthrinse to 

prevent tooth decay. 

●	 Ask your dentist about using an anti-plaque or 

anti-gingivitis mouthrinse to control plaque or 

prevent gum disease. 

11 
 

 

 

●	 Use dental floss to clean in 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 

• use clean sections of floss as you move from 

tooth to tooth 

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. Have 

them adjusted if they become loose or 

uncomfortable. 

●	 Call your dentist right away if you have any signs 

of mouth problems. 

●	 See your dentist twice a year for a cleaning and 

checkup. Your dentist may suggest more visits if 

you need them. 

12 
 

 

 

 

 

See your dentist twice a 

year for a cleaning and 

checkup. 

● 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, get help to quit. 

13 
Pronunciation Guide 

amputation (AM-pyoo-TAY-shuhn)

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)

14
For More Information 

To find diabetes teachers (nurses, dietitians, 

pharmacists, and other health care providers), 

contact

American Association of Diabetes Educators 

Phone: 1–800–TEAMUP4 (1–800–832–6874) or 

1–800–338–3633

Email: aade@aadenet.org

Internet: www.diabeteseducator.org 

Under “About Diabetes Education,” click on 

“Find a Diabetes Educator.”

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 

15 
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 

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 

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 

16 
Juvenile Diabetes Research Foundation 

International 

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 

17 
More in the Series 

The Prevent Diabetes Problems Series includes 

seven booklets that can help you learn more about 

how to prevent diabetes problems. 

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. 

18
19

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 Donald J. DeNucci, 

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

the updated version of this publication.
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. 

20
 

 

 

 

 

 

 

 

 

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 booklet 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. 

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 (1–800–463–6332) or visit 

www.fda.gov. Consult your health care provider for more 

information. 
 

U.S. DEPARTmENT OF HEALTH 

AND HUmAN SERvICES 

National Institutes of Health 

NIH Publication No. 12–4280 

February 2012 

The NIDDK prints on recycled paper with bio based ink.