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Periodontal diseases are infections that affect the soft gum tissues of the mouth and the bones that support and anchor the teeth in place. People with diabetes are more susceptible to these oral disorders if they have poorly controlled blood glucose (blood sugar).

In healthy teeth, gum tissue (gingiva) surrounds the neck of the teeth and leaves a shallow crevice. It is normal for bacteria from food particles, tissues and saliva to get into gingival crevices. When cleaning does not remove these substances, they form plaque, the main cause of periodontal disease.

Diabetes can promote periodontal diseases in several ways:

• Excess glucose in bodily fluids such as saliva provides a breeding ground for bacteria and increase buildup of plaque.
  
  
• Thickening of blood vessel walls is a common effect of diabetes. This can hinder blood from bringing oxygen and nutrients to body tissues and removing waste products created by the cells.
  
  
• High blood glucose (hyperglycemia) makes patients more susceptible to infections. Poor blood supply, another common diabetic complication, can leave the periodontal tissues too weak to fight infections. In addition, hyperglycemia can hinder the body’s ability to heal infections. Infections that are untreated or that linger can cause damage that becomes progressively worse. Pain, bleeding, difficulty chewing and tooth loss are some of the symptoms that can develop.
  
  
• The gum tissues may lose collagen. Collagen is a protein that supports the gums, skin, tendons, cartilage and bone. People with diabetes often lose collagen in the gum tissue, which hastens periodontal destruction.

Almost one-third of people with diabetes have severe periodontal diseases, according to the American Diabetes Association (ADA). This is defined as loss of attachment of the gums to the teeth that measures at least 5 millimeters. Even gestational diabetes, a temporary condition that can affect any woman during pregnancy, dramatically increases the risk of periodontal disease, and periodontal disease can aggravate prediabetes, according to recent research.

Periodontal disease begins with gingivitis, an infection of the gums. This occurs when plaque (a combination of bacteria, food and saliva, not to be confused with vascular plaque of atherosclerosis) settles at the gum line, builds up and begins to attack the tissues. The gums become swollen and may bleed when the patient brushes or flosses. Regular brushing, flossing and dental cleanings can clear away plaque and help reverse gingivitis.

Left untreated, gingivitis can lead to another gum disease called periodontitis. This is a more serious infection of the soft tissues and bone that anchor the teeth in place. Plaque builds and hardens and sinks under the gums, which pull away from the teeth and open pockets of infection. Germs and pus fill these pockets, which then deepen. As the gum tissues recede, teeth loosen. Surgery is often necessary at this point to save the teeth.

Without treatment, periodontitis will progress and eventually cause a loss of the bone that holds the tooth in its socket. The tooth may become loose and start to move before falling out. However, treatment of periodontal disease may help control diabetes by decreasing oxidative stress (increasing levels of antioxidants), according to recent research.

Other dental conditions associated with diabetes include:

• Oral thrush (oropharyngeal candidiasis).  An infection caused by a fungus that grows in the mouth and that feeds on high levels of glucose in saliva. Thrush creates white (or sometimes red) patches in the mouth that become sore and can turn into ulcers. It occurs in moist spots that are chafed or sore, such as under dentures that do not fit well. Smoking can trigger this fungal infection, which can be treated with medication.
  
  
• Dry mouth (xerostomia). Frequently a symptom of undetected diabetes that results from poor control of glucose.  Saliva helps curb the growth of germs, washes away sticky foods that form plaque and strengthens teeth with minerals. Dry mouth can cause soreness, ulcers, infections and tooth decay.

While diabetes raises the risk of periodontal disease, dental infections can in turn complicate management of diabetes. Periodontal disease can affect diabetes by:

• Triggering several conditions that hinder a patient’s ability to control blood glucose. These include hyperglycemia, mobilization of fatty acids and acidosis (abnormal increase in acidity in body fluids).
  
  
• Preventing proper nutrition when sore gums or loose teeth make chewing difficult. As a result, these patients may choose softer foods that may also be dietetically inappropriate.

Numerous research studies have linked dental health to cardiovascular health and periodontal disease to disorders of the heart and blood vessels. These findings are especially significant for diabetic individuals because cardiovascular conditions, such as heart attack and stroke, are the leading cause of death for people with diabetes. Scientists from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) have also found diabetic periodontal disease to be a strong predictor of fatal kidney disease as well as fatal heart disease. Other research has linked periodontal disease to complications including increased risk of rheumatoid arthritis and premature labor.