When we think of diabetes, we usually focus on blood sugar levels, insulin and diet. What many patients – and unfortunately even some general practitioners – are still unaware of is that for people with diabetes, looking into the mouth is just as important as checking blood glucose levels.
Today, the scientific evidence is clear: diabetes mellitus and periodontitis (chronic inflammation of the supporting structures of the teeth) are closely linked. They form a kind of toxic relationship: ignoring one often leads to losing control over the other.
The Underestimated Risk: A Two-Way Street
For a long time, diabetes was thought to simply worsen oral health. We now know that the relationship is bidirectional – a two-way street with consequences in both directions.
- From diabetes to the teeth: People with diabetes have up to a threefold increased risk of developing periodontitis. Persistently elevated blood sugar levels damage the fine blood vessels in the gums, while the immune system is weakened and less able to fight oral bacteria.
- From the teeth to diabetes: This aspect is often overlooked. Untreated periodontitis is essentially an open wound in the mouth. If the inflamed surface of all periodontal pockets were added together, it would roughly equal the size of the palm of a hand. Through this area, inflammatory mediators continuously enter the bloodstream. These substances interfere with insulin receptors, reducing insulin effectiveness and making blood sugar levels difficult to control.
A brief explanation: What happens in Periodontitis?
To understand the risk, we need to correct a common misconception: a tooth is not fused to bone. It is suspended in a complex supporting system known as the periodontium.
- The beginning: Bacteria form a biofilm along the gum margin. If it is not removed, the body responds with inflammation (gingivitis). The gums begin to bleed.
- Progression: Without treatment, bacteria migrate deeper, forming pockets between tooth and gum. In this low-oxygen environment, bacteria become more aggressive.
- The consequence: To protect itself, the body retreats – breaking down the jawbone. The tooth loses its foundation, becomes loose and may eventually be lost.
Warning Signs: When should you pay attention?
Periodontitis is particularly insidious because – like early-stage diabetes – it often progresses without pain. Watch for the following warning signs:
- Bleeding gums when brushing or eating (e.g. biting into an apple)
- Persistent bad breath despite good oral hygiene
- Teeth appearing longer due to receding gums
- An unstable HbA1c level that does not improve despite good diet and medication
The Good News: Treatment works – twice
This vicious cycle can be broken. Studies clearly show that consistent periodontal treatment—through systematic cleaning of gum pockets and reduction of the bacterial biofilm—can also improve diabetes control. HbA1c levels often decrease significantly, which in turn lowers the risk of other diabetes-related complications affecting the eyes, kidneys or feet.
Your action plan as a person with Diabetes
If you have diabetes, your dentist should be a fixed part of your healthcare team.
- Transparency: Inform us about your condition and your current HbA1c value.
- Frequency: Attend dental check-ups and professional cleanings more frequently—ideally two to four times per year, depending on your risk profile.
- Daily care: Use interdental brushes every day. The spaces between teeth are prime habitats for bacteria that negatively affect blood sugar control.
A healthy mouth supports stable blood sugar. Do not view your teeth in isolation—see them as an essential component of your overall diabetes management.