Oral health related to diabetes

Oral hygienist, Sarie Liebenberg, educates us on oral health related to diabetes and whether you should go to a dentist during COVID-19.

There is a direct link between oral health and systemic conditions, like diabetes, respiratory disease and cardiovascular disease. Therefore, it’s of utmost importance to exercise good oral health in the presence of one or more of these underlying systemic diseases.

Should I go to the dentist during COVID-19?

Currently, with the COVID-19 pandemic, you might wonder if it’s important and necessary to go to the dentist/hygienist. The answer is a definite ‘yes’.

HIV-AIDS, tuberculosis and hepatitis, to only mention a few, have been around for a very long time. COVID-19 is just another addition to the list.

Dental professionals are trained to prevent the transfer of bacteria and viruses. Not only does the dental professional have adequate protective measures to prevent the transfer of bacteria and/or viruses from one person to another, but also have the knowledge and understanding not to cross contaminate their working environment. Ultimately, the environment that you will be treated in. With relation to contracting the COVID-19 virus, it’s probably safer to go to the dentist than to the supermarket.


Epidemiological data unequivocally confirms diabetes as a major risk factor for periodontitis. (This is also true for children and young adults). Uncontrolled diabetes being an even higher risk factor for periodontitis.

Periodontitis is a chronic inflammatory disease of the gums (gingiva), characterised by the destruction of the supporting bone structure around the teeth (periodontium). In most cases, periodontitis starts off as a mild, inflammatory disease, called gingivitis.

Gingivitis is characterised by the gums presenting signs of redness (erythema), swelling (oedema) and bleeding (haemorrhage), especially with brushing or flossing.

At this stage of the disease, the inflammation is limited to the gums and probably asymptomatic, or only with slight discomfort and possibility of bad breath (halitosis).

If treated, the gums can heal with no permanent damage to the bone structure around the teeth. With a good daily oral hygiene routine and regular visits to your dentist/hygienist, the gums can heal and you can prevent the reoccurrence of gingivitis.

If left untreated, gingivitis might develop into a more advanced gum disease, called periodontitis.


Periodontitis is one of the leading causes of bad breath and is responsible for tooth mobility, with the ultimate result of tooth loss.

Unfortunately, lots of patients do not seek treatment while their gum disease is still in the early stages (gingivitis). By the time gingivitis has developed into periodontitis, it’s not possible to reverse the damage of the supporting bone structure around the teeth.

If you manage to get periodontal treatment in time, and if you are lucky enough to save some of your teeth, it will take great effort, discomfort and financial strain, to slow down periodontal disease.

In rare cases, you can arrest periodontal disease permanently. But even after periodontal disease is arrested, the damage to the supporting bone structure around the teeth is irreversible and will always be compromised.

Patients who had periodontal disease will always have a propensity to relapse. Reduced blood supply to the gums in a person living with diabetes, will always compromise present and future healing.

Link between hyperglycaemia and periodontal disease

There is a clear relationship between the degree of hyperglycaemia (high levels of glucose in the blood) and the severity of periodontal disease and even dental decay.

The mechanism that underpins the link between these two conditions are not completely understood. But, involve aspects of immune functioning, neutrophil activity (white blood cells responsible for healing damaged tissue and resolve infection) and cytokine biology (messaging network that regulates the immune system).

There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontal disease. With diabetes increasing the risk of periodontal disease and periodontal disease negatively affecting glycaemic control.

Compared to diabetic individuals without severe periodontal disease, incidences of macroalbuminuria (protein albumin in urine – a risk factor for kidney and cardiovascular disease in diabetic individuals) increases two-fold in diabetic individuals with severe periodontal disease. End-stage renal disease increases three-fold in diabetic individuals with severe periodontal disease.

Furthermore, risk of cardio-renal mortality (ischaemic heart disease and diabetic nephropathy combined) is three times higher in diabetic individuals with severe periodontal disease than in diabetic individuals without severe periodontal disease.

Dry mouth

Dry mouth (xerostomia) is a common side effect of some chronic medication and often associated with diabetes. There is also a significant correlation between blood glucose levels and salivary glucose levels. Together, they pose a risk for fungal infections and higher incidence of tooth decay.

Oral hygiene treatment plan

If you don’t have an existing professional dental hygiene routine with a dentist/hygienist, book an assessment to discuss a treatment plan for your individual oral health needs.

It’s recommended that everybody has a professional cleaning at least twice a year and a dental examination at least once a year. Unless, it’s recommended otherwise by your dentist/hygienist.

A patient with underlying systemic health conditions will more likely require a professional dental cleaning every three to four months and daily oral hygiene instructions will be explained and monitored.

Your typical home routine will include brushing twice a day and interdental (between the teeth) cleaning by means of flossing, use of a waterpik and/or interdental brushes at least once a day. Oral hygiene instructions will vary, depending on your existing oral health and personal dental needs.

If you have existing inflammation which is characterised by bleeding of the gums when you brush and floss, you will need to have it seen to by a professional.

Chances are good that you have calcified plaque (calculus/tartar) build-up that is responsible for the inflammation and can’t be removed with your toothbrush and needs professionally intervention.

Remember, there is hardly any point in only brushing the teeth and not the gums  and not performing interdental care of some kind.

In addition, the application of fluoride and the use of a therapeutic mouth rinse might be advised by your dentist/hygienist. This needs to happen with caution and not without consultation with your dentist/hygienist as some of these products should only be used for a recommended period of time. Long-term use of some products might have consequences.

Take care of your health

It’s always advisable to take good care of your health. Especially when an underlying systemic condition, like diabetes, is present. Right now, with a much higher risk of contracting COVID-19, keep the following in mind:

  • A healthy and nutritious diet and active lifestyle will help better manage your blood glucose levels, achieve target blood lipid levels and maintain healthy blood pressure and body weight.
  • A multivitamin supplement provides nutrients that your body needs for regular function. Vitamin D is believed to help improve the body’s sensitivity to insulin (the hormone responsible for regulating blood glucose levels). Thus reducing the risk of insulin resistance, which is often a precursor to Type 2 diabetes. Vitamin D also plays a key role in immune function.
  • Bright sunlight exposure is associated with a reduced risk of Type 2 diabetes and heart disease by lowering blood insulin and lipid levels.
  • Sleep plays an important role in healing and repair of your heart and blood vessels.
  • Drinking enough water helps maintain the balance of body fluids. The function of these bodily fluids includes digestion, absorption, circulation, creation of saliva, transportation of nutrients and maintenance of body temperature.
  • Fresh air has been shown to help digest food more effectively, improve blood pressure and heart rate, strengthen the immune system and reduce the risk of obesity.
  • Ongoing sleep deficiency is linked to an increased risk of heart-,  kidney disease, high blood pressure, diabetes and stroke.
  • Stress aggravates diabetes, raises blood glucose levels, activates fat cells, impairs glucose tolerance, increases insulin resistance and impacts blood pressure.
  • Nicotine increases cortisol levels, reducing B cell antibody formation and T cells’ response to antigens. Therefore having a harmful effect on the immune system. It also hardens and narrows the blood vessels, curbing blood flow around the body. Together, making you more susceptible to infection, damage of the lungs and puts you at higher risk for heart disease.

Stay positive and nurture the spirit

Similarly, the mind has great power to influence the body. Knowledge of how to manage your diabetes and prevent complications is an important first step. But, understanding how to stay positive and nurture the spirit can also help in a holistic approach to diabetes care.

Managing diabetes is a lifelong commitment and that includes proper dental care. Your efforts will be rewarded with a lifetime of healthy teeth and gums.


Sarie Liebenberg is an oral hygienist in private practice in Sandton, Gauteng with almost 30 years’ experience in dentistry. She is involved in various aspects of the dental industry, including lecturing, speaking and presenting on oral health. 

Header image by FreePik

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