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Patients with diabetes can drastically reduce the risk of periodontal disease through several preventive measures. A crucial step is controlling glucose (blood sugar). Several studies have shown that diabetic patients who maintain healthy levels of glucose are at no greater risk for periodontal disease than nondiabetics.

Other tips include:

• Brushing after every meal or snack with a soft-bristle brush to prevent buildup of plaque.
  
  
• Flossing deeply and thoroughly at least once daily to prevent buildup of plaque. Many people floss and brush incorrectly. A dental hygienist or dentist can offer instruction.
  
  
• Using a tongue scraper and toothbrush to clean the tongue, which often traps germs.
  
  
• Using a fluoride toothpaste to protect teeth from decay.
  
  
• Buying red “disclosing tablets” at a pharmacy. These stain plaque and allow patients to see where plaque is building up on the teeth.
  
  
• Having a dental checkup and teeth cleaning at least twice a year, or more often as recommended by their dentist or physician.
  
  
• Informing the dentist that a patient has diabetes. Elevated glucose (hyperglycemia) can hinder healing from minor tissue injuries that may occur during dental exams and procedures. When glucose is not controlled, patients should discuss with the dentist whether dental surgery should be rescheduled, because poorly controlled glucose will slow healing. Patients may wish to ask if the surgery should be done in a hospital where the patient can be closely monitored in case of emergencies.
  
  
• Keeping false teeth clean.
  
  
• Maintaining a nutritious diet and getting regular exercise. The habits can promote oral health as well as diabetic health. For example, recent research suggests that eating high-fiber whole grains may reduce risk of gum disease in addition to stabilizing levels of glucose.
  
  
• Not smoking. Tobacco use is a risk factor for dental disease and other complications including diabetic retinopathy, diabetic neuropathy, diabetic nephropathy and cardiovascular disease.
  
  
• Avoiding alcohol-based mouthwashes. These products promote dryness of the mouth.
  
  
• Replacing the toothbrush every three months. Bacteria grow on the bristles, and a new toothbrush will remove more plaque.
  
  
• Immediately taking care of any problems noted by a dentist.
  
  
• Treating dry mouth. Drinking enough water and chewing sugarless gum can keep the mouth moist.
  
  
• Getting enough sleep. Lack of sleep may worsen progression of periodontal disease, according to recent research.

For some patients, preventive care also includes use of antibiotics before dental procedures to avert heart infections such as bacterial endocarditis. These patients include those who have received a mechanical heart valve, or who have certain congenital or valvular heart diseases or myopathies (conditions involving enlargement of the heart).

In addition, patients may be advised by their physician or dentist to suspend use of aspirin for several days before dental procedures to reduce the risk of bleeding.