Control Diabetes and Say Cheese!

Dr Natalie Strand discusses diabetes and your mouth

/ Author:  / Reviewed by: Joseph V. Madia, MD

Diabetes can lead to other health problems throughout your body. Some of these problems, such as gum disease, are less well known than others. So we thought we'd give you a little overview on the relationship between diabetes and gum disease. 

In people with diabetes, poorly controlled blood sugar levels can increase the risk of oral health problems. Such problems include dry mouth, gum inflammation, poor healing of tissues in the mouth and burning mouth.

A survey supported by Colgate Total showed that many diabetes patients are not aware of the link between diabetes and oral health. Even though the majority of patients in the survey had symptoms of gum disease, an even greater number said they did not talk to their doctors about oral health.

These findings suggest that there is a need to continue educating patients about diabetes and gum disease and to give them the tools to manage diabetes and its complications.

Recently, dailyRx had the privilege of speaking with Natalie H. Strand, MD, assistant professor of clinical anesthesiology and practicing physician of interventional pain management at the University of Southern California's Keck School of Medicine.

In recent months, Dr. Strand has worked with Colgate Total and the American Diabetes Association to boost awareness of oral care for those living with diabetes.

Dr. Strand has her own experience with diabetes.

"As a person with diabetes myself, I know first-hand how challenging it can be to manage this disease," she said.

In addition, Dr. Strand won season 17 of the CBS series The Amazing Race, which required traveling 32,000 miles across four continents in 3 weeks - all while managing her diabetes!

Ask an Expert

dailyRx spoke to Dr. Strand about diabetes and oral health.

dailyRx: What is your experience with diabetes and gum disease?

Dr. Strand: Though I have not personally dealt with oral health issues, research shows that people with diabetes are at a greater risk for gum disease because they are more susceptible to bacterial infection, so I know I need to take extra care of my oral health.

It is important for people with diabetes to work with both their doctor and their dentist to understand the connection and take charge of their diabetes not only with medical care but also with proper oral care.

dailyRx: What is the relationship between diabetes and oral health?

Dr. Strand: People with diabetes are at an increased risk for serious gum disease because they are more susceptible to bacterial infection and have a decreased ability to fight bacteria that can invade the gums.

Research also suggests that the relationship between serious gum disease and diabetes can go two ways. If blood glucose levels are poorly controlled, a person with diabetes is more likely to develop serious gum disease and lose more teeth than non-diabetics. Like all infections, serious gum disease can be a factor in causing blood sugar to rise and may make diabetes harder to control.

dailyRx: What are the symptoms of diabetes-related gum disease?

Dr. Strand: Gum disease can often be painless so a person may not even know he or she has it until there is serious damage. The best way to watch for symptoms is with regular dentist visits every six months.

A person with diabetes should also watch for early warning signs of gum disease that can include bleeding gums when brushing or flossing, or gums that have pulled away from the teeth and bad breath.

If a person with diabetes has any of these symptoms, he or she should speak with his or her healthcare provider.

dailyRx: What are the risks and complications of developing gum disease?

Dr. Strand: The more severe form of gum disease, periodontitis, occurs when a person's gums begin to pull away from his or her teeth. Pockets form between the teeth and gums, fill with germs and pus, and deepen. This can lead to destruction of the bone around the teeth and require surgery to save the teeth. This can, however, be prevented and managed by taking some simple daily steps to maintain healthy glucose levels and healthy gums.

dailyRx: How can patients prevent diabetes-related gum disease?

Dr. Strand: Taking steps recommended by a doctor to control diabetes can decrease the likelihood of developing gum disease.

First and foremost, people with diabetes need to take charge of their diabetes with small steps like walking one extra block before returning home each day, eating smaller portions of favorite foods and brushing their teeth after every meal. This isn’t easy to do alone so people taking steps towards improving their diabetes should keep their doctor and family informed every step of the way.

It's also important to help maintain gum health by brushing for 2 minutes twice a day with a toothpaste specially formulated for gum health and floss at least once a day.

dailyRx: How can patients treat diabetes-related gum disease?

Dr. Strand: A person with diabetes-related gum disease should work with his or her dentist to create a personalized treatment plan, but again, brushing with antibacterial toothpaste can help manage the infection.

Controlling glucose levels can significantly decrease the risk of gum disease and manage its progress if detected in the early stages.

dailyRx: Is there a lack of awareness about the relationship between diabetes and oral health?

Dr. Strand: Yes, there is absolutely a lack of awareness. A recent survey conducted by Harris Interactive on behalf of Colgate Total found that more than one-third of people with diabetes aren't aware of its link to oral health.

While more than half (54 percent) report symptoms of gum disease, another 67 percent do not discuss their oral health with their doctor.

dailyRx: What advice do you give to diabetes patients regarding their oral health?

Dr. Strand: As I said earlier, first and foremost, I tell patients to control their glucose levels.

I also encourage them to brush their teeth for 2 minutes twice a day with a toothpaste specially formulated for gum health and to floss at least once a day.

Along with at-home care, I advise them to see the dentist every 6 months, as their dentists are the best tool they have to manage their oral health.

Patients with diabetes can also visit for more information about how to take charge of their diabetes and oral health.

We would like to thank Dr. Natalie Strand for taking the time to share her knowledge and experience with diabetes with us.

The study cited at the opening of the article was sponsored by Colgate Total, a brand of toothpaste that claims to be the only FDA-approved and American Dental Association-accepted product to prevent gingivitis - the most common form of gum disease.

Colgate Total contains triclosan - an ingredient used to reduce or prevent bacterial contamination.

According to the FDA, triclosan is not known to be harmful to humans. However, some studies on animals have suggested that triclosan may cause hormonal changes and make bacteria resistant to antibiotic drugs.

In light of these potential risks, the FDA is working on a scientific and regulatory review of the ingredient.

Review Date: 
January 4, 2013