How to Promote Oral Health for People With Diabetes
5 Actions for Health Care Teams
We all have a role to play to help people with diabetes live their best life!
Dentists and other oral health care providers play a key role in preventing and treating periodontal (gum) disease and other oral health problems. They can also help their patients improve their self-care behaviors, such as regular brushing and flossing of teeth.
Dentists can also use a team-based care approach to help their patients manage oral health problems more effectively. For example, if a patient needs a complicated dental procedure, the dentist can work with the patient’s primary care provider to determine the timing of the procedure and help the patient manage any needed changes in diet or medicines.
Dentists may also be able to identify people with undiagnosed diabetes by screening those at risk and referring them to their primary care provider for diagnosis.
- Encourage your patients with diabetes to get a dental exam at least once a year.
- Remind your patients that:
- Regular brushing and flossing is an important part of diabetes self-management.
- Dental problems make it hard to eat healthy foods.
- Smoking reduces the ability of the immune system to fight off or heal infections in the mouth.
- Eating foods that are high in added sugars can harm oral health.
- Share information from CDC’s Take Charge of Your Diabetes: Healthy Teeth fact sheet.
Take These 5 Actions to Help Your Patients
1. Know the risks of oral diseases for people with diabetes.
Gum disease is more common in people with diabetes, so regular dental exams are important. It can also affect insulin sensitivity and increase the risk of heart or kidney disease in people with diabetes.
In the United States:
- Gum disease is a leading health concern, affecting 46% of adults aged 45 to 64 and 59% of those 65 or older.1
- For every 1% increase in a person’s hemoglobin A1C level, their odds of having periodontitis (advanced gum disease) increases by 18%.2
- Advanced gum disease can break down the tissue that connects a person’s teeth to their gums (called clinical attachment loss). This condition is more strongly associated with diabetes that is not well-managed compared to prediabetes or well-managed diabetes.3
- People who have diabetes and periodontitis have a higher rate of death from all causes and from cardiovascular disease over 10 years compared to people with diabetes who do not have periodontitis.4
- Periodontal disease
- Xerostomia (dry mouth)
- Tooth loss, cavities, or abscesses
- Oral candidiasis (thrush)
- Oral lichen planus (inflammatory condition that causes burning and pain)
- Burning mouth syndrome (ongoing burning sensation of unknown cause)
2. Understand how diabetes can affect oral health and encourage your patients to watch for problems.
At each health care visit, tell your patients with diabetes about the signs of oral health problems. This will help them be aware of changes in their mouth, teeth, or gums when they start. Make sure your patients understand the information by asking them to repeat back what they heard.
3. Ask your patients questions about their oral health at each health care visit.
- Do you visit your dentist at least once a year for a full mouth exam?
- Do you know how diabetes can affect your teeth and gums?
- Do you know the best way to brush your teeth and clean between your teeth?
- Do you know the early signs of tooth, mouth, and gum problems?
- Do you have any problems in your mouth, such as loose teeth, red or swollen gums, pain or burning sensations, difficulty chewing, or poorly fitting dentures?
You can refer your patients to a dentist or ask them if they want more information about recommended oral health care for people with diabetes. You can base this action on how your patients answer your questions or any other concerns they share during their visit.
4. Remind your patients to keep their blood glucose, blood pressure, and blood lipids within normal levels for optimum hearing health.
Use the following discussion points to help you talk with your patients about their self-care habits and their feelings about managing diabetes:
- Promote the ABCs of diabetes (A1C, blood pressure, cholesterol, and smoking cessation) and a healthy lifestyle.
- Ensure that patients have access to health coaches, patient navigators, and community health workers when possible.
- Ask your patients what other health exams they are getting, including regular ear health checkups.
- Assess symptoms that might require referral to a specialist.
- Follow up with your patients to track how well they are managing their diabetes and connecting with their health care team.
- Assess socioeconomic factors that can affect health, such as food insecurity, housing insecurity or homelessness, financial barriers, and lack of social support. Use this information when you make treatment decisions.
- Refer patients to local community resources when available.
5. Refer your patients to diabetes self-management education and support (DSMES) services.
DSMES services help people live well with diabetes. Whether a person has just been diagnosed with diabetes or has had it for years, DSMES services will make it possible for them to:
- Work with a diabetes care and education specialist to set and track goals.
- Practice how to fit diabetes self-care behaviors, like healthy eating and problem-solving, into all parts of their life.
- Learn how to use knowledge, skills, and tools to build confidence and emotional strength to manage diabetes.
- Find ways to get support (in person or online) from family, friends, their community, and their health care team.
Learn more about DSMES and encourage your patients to find a DSMES program that is recognized by the American Diabetes Association or accredited by the Association of Diabetes Care & Education Specialists.
- Diabetes and Oral Health
- Take Charge of Your Diabetes: Healthy Teeth
- Diabetes, Gum Disease, & Other Dental Problems
- Diabetes and Oral Health (American Diabetes Association)
- Diabetes and Oral Health (Journal of the American Dental Association)
- Diabetes & Oral Health (National Institutes of Health)
- Diabetes and Your Smile
- Oral Health for People with Diabetes
- Oral Health Topics: Diabetes
- Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ. Periodontitis in US adults: National Health and Nutrition Examination Survey 2009–2014. J Am Dent Assoc. 2018;149(7):576–588.e6. doi:10.1016/j.adaj.2018.04.023
- Garcia D, Tarima S, Okunseri C. Periodontitis and glycemic control in diabetes: NHANES 2009 to 2012. J Periodontol. 2015;86(4):499–506. doi:10.1902/jop.2014.140364
- Kowall B, Holtfreter B, Völzke H, et al. Pre-diabetes and well-controlled diabetes are not associated with periodontal disease: the SHIP Trend Study. J Clin Periodontol. 2015;42(5):422–430. doi:10.1111/jcpe.12391
- Sharma P, Dietrich T, Ferro CJ, Cockwell P, Chapple IL. Association between periodontitis and mortality in stages 3-5 chronic kidney disease: NHANES III and linked mortality study. J Clin Periodontol. 2016;43(2):104–13.