Large-print version 

in a 

Series 

of 7 

Number 

7

Prevent diabetes problems: 

Keep your mouth healthy

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 are the most common mouth problems

How will I know if I have mouth problems 

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

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

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

How can I prepare for a visit to my dentist?.......................... 8

What if my mouth is sore after my dental work? .................. 9

How does smoking affect my mouth? ................................ 10

How can I keep my mouth healthy? ................................... 11

Pronunciation Guide .......................................................... 15

For More Information .......................................................16

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

Acknowledgments ........................................................ 20
 

 

 

 

 

 

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 

Teeth 

Gum 

Roof of 

the mouth 

Bottom of 

the mouth 

Jaw 

Tongue 

Inside of 

cheek 

Tooth 

Gum 

*See page 15 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, • a lack of saliva in your • dry feeling in your mouth, often or all of • taking medicine prescribed by your doctor or dentist to keep your mouth wet 

called mouth, which raises your the time • rinsing with a fluoride mouthrinse 

xerostomia risk for tooth decay and 

gum disease 

• dry, rough tongue 

• pain in the mouth 

• cracked lips 

• mouth sores or infection 

• problems chewing, eating, swallowing, 

or talking 

• 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 • a painful, complex mouth • burning feeling in the mouth • depends on your needs and the cause 

mouth problem • dry mouth 

syndrome • cause unknown but linked 

to nerve damage, painful 

dentures, changes in 

hormones, dry mouth, 

and poor diet 

• bitter taste 

• symptoms may worsen throughout 

the day 

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 

6 
 

 

 

 

 

 

 

 

 

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. 

Check your mouth for signs of problems 

from diabetes. 

7 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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. 

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 

9 
 

 

 

 

 

 

 

 

 

 

 

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, ask your doctor to help you quit or call 1–800– 

QUITNOW (1−800−784−8669). 

10 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 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. 

11 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

• 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 antigingivitis mouthrinse to control plaque or prevent gum 

disease. 

●	 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 

12 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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. 

●	 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. 

13 
 

 

 

 

 

 

 

 

 

 

See your dentist twice a year 

for a cleaning and checkup. 

● 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. 

14 
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)

15 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 

16 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 

17 
 

 

 

 

 

 

 

 

 

 

 

 

 

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 

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 

18 
 

 

 

 

 

 

 

 

 

 

 

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. 

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., F.A.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. 

20 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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. 

21 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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. 12–4280L 

February 2012 

The NIDDK prints on recycled paper with bio based ink.