Good oral health care can lead to better management of diabetes

Jeanne Eder Rhodes didn’t realize how the simple acts of regularly brushing and flossing her teeth could lead to better health for diabetics. Rhodes, 66, who recently retired as head of the University of Alaska’s history department, was diagnosed with type 2 diabetes in 1998.

“I didn’t learn about the importance of oral care until 2004,” says Rhodes, a Dakota Sioux from the Fort Peck Reservation in Montana. “My dentist said that he could tell how my diabetes was doing just by examining my teeth. That’s when I started paying attention to my gums and teeth.”

Oral health and diabetes experts alike universally agree that proper oral care is an essential tool in managing diabetes. The American Diabetes Association reports in its online journal that “periodontal treatment leads to an improvement of glycemic [blood sugar] control in type 2 diabetic patients for at least three months.”

In a population where some one-third of all Native diabetics and 25 percent of all American Indians and Alaska Natives age 65 and over have lost all their teeth, maintaining good oral health is vital to the health of all Native people. 

However, too many Natives are not seeing a dentist regularly.  “Just as you have to get an annual physical examination, you also need to get a dental examination,” says Dr. Anh Thu Becker, a dentist at Native Health, a Phoenix community health facility that serves many Phoenix-area Native people. “Most people think ‘if it doesn’t hurt, I don’t have a problem.’”

Healthy teeth = healthier body

Dr. Alex Cota, a dentist with Sun Life Family Health Centers in Sun City, Arizona, says that he can tell a new patient has diabetes with just a simple diagnostic instrument—his nose. “A basic sign of diabetes is breath that smells like a rotten apple,” Cota says.

Reduced resources in communities served primarily by Indian Health Service facilities may also contribute to less oral care. IHS is aware of the connection, though, and it offers information for both patients and providers on including oral care education and evaluation in diabetes management programs.

However, “By the time people have symptoms [like inflamed and bleeding gums],” Becker says, “it’s too late to prevent periodontal disease” and the possibility of bone and tooth loss that can result from delaying treatment.

Cota adds that bone loss is especially worrisome for diabetics, as dentures are harder to fit. Also, he warns diabetic patients that gum care is still a priority even after losing healthy teeth to periodontal disease, as a fungal infection known as candidosis can occur. 

Failing to maintain good oral health has other pitfalls for diabetics. “Because diabetes lowers a patient’s resistance to infection, periodontal disease is harder to treat in diabetics,” Becker says. “Uncontrolled blood glucose is very worrisome.”

Cota says that chronic inflammation, such as uncontrolled gum diseases coupled with diabetes, also contributes to a host of other diseases linked to diabetes such as:

  • Thrush
  • Canker sores
  • Life-threatening conditions like coronary heart disease and kidney disease


Becker notes that periodontal disease, which starts as gingivitis or inflamed, bleeding gums, is caused by bacterial growth in the mouth. “We all have these bacteria in our mouth,” she says. “Controlling the bacteria levels in your mouth will control gum disease. There is a balance between healthy teeth and a healthy body.”

Home care is the basis of good oral care for all. Becker says, “Patients have to be the ones to care for their teeth.”

She recommends that people brush their teeth at least twice a day and floss daily, and visit a dentist for twice-yearly cleanings and exams.

Cota adds, “Simple treatments like cleanings don’t cost nearly as much as treating advanced oral diseases. It’s like paying $100 for a filling or $1,000 for a root canal from not getting the filling.”

People with periodontal disease, which like diabetes is a chronic, incurable condition, will need to have deeper cleanings three to four times a year. Antibiotics can also be prescribed in some cases, Becker says.

Also, Becker stresses, “Don’t smoke – smoking causing basal constriction of blood vessels, and smokers are 20 times more prone to get periodontal disease.”

Just as diabetics are urged to keep their blood sugar under control, Becker says that keeping oral bacteria in check prevents a host of health threats. “It’s all about control,” she says.

Indeed, maintaining good oral health contributes to good overall health; the ADA notes that a 1 percent change in A1C levels contributes to an average 35mg/dl drop in blood glucose. 

Dentists now routinely take medical histories of new and regular patients, and regularly check for signs that may indicate undiagnosed diabetes or other diseases.

When dentists & physicians collaborate – you benefit

A 2014 American Dental Association study encouraged dentists and other medical providers to collaborate as part of a chronic care model. A collaborative model might include dental office screenings for diabetes and pre-diabetes, which in the study were found to provide important health benefits.

When Cota sees signs of diabetes, he refers his patients to a Sun Health Center physician; Becker refers to a Native Health provider. They will also refer a patient with other warning signs such as changes in the tongue to a physician for evaluation.

However, patients should also notify their dentists of any health concerns, says Cota. “Even if diabetes is in a patient’s medical records, they should still tell their dentist before having work done,” he says. “We can be ready to properly treat our diabetic patients if we know.”

Rhodes, who has private insurance but was treated at an innovative diabetic management program for Native people while in Alaska, says that after her dentist educated her about how maintaining her dental health enhances her diabetic management, she “got on the program.”

She purchased an electronic vibrating toothbrush and WaterPik water flosser, and added oral care to her health regimen, which includes diet, exercise and checking her blood sugar four times a day.

She sees her dentist regularly for exams and cleanings, and while living in Alaska, her A1C level, which provides a person’s average level of blood glucose, dropped from 10 percent to 7 percent.

“I could actually feel the difference” that proper dental care makes in general health, says Rhodes, who is also exploring pre-contact dental care means like willow toothpicks and sage teas.