Diabetes and Dental Health: Gums, Dental Treatment and Implants

How diabetes and gum disease are linked

Gum disease starts with plaque, the soft film of bacteria on the teeth. Gingivitis is inflammation of the gums alone. Periodontitis goes further and damages the bone that holds the teeth. Gingivitis can be reversed with better daily cleaning⁴; the damage from periodontitis cannot be fully reversed, but the disease can be stabilised.

UK guidance for dentists advises assuming an increased risk of gum disease⁵ for anyone who has diabetes. The same guidance says that well-controlled diabetes is not a risk factor. Control is not fixed, though; it changes over time, so the risk does too.

Treating gum disease may also help blood sugar a little. A Cochrane review pooled 30 trials with 2,443 people who had periodontitis and diabetes, mostly type 2. Gum treatment lowered HbA1c, the long-term blood-sugar measure, by about 0.43 percentage points after three to four months⁶ compared with no treatment or usual care. The certainty of this evidence was rated moderate. After six months the reduction was about 0.30 points, from fewer studies. Gum treatment is an addition to diabetes care, not a replacement for it.

Signs of gum disease to watch for

• Gums that bleed when you brush or eat hard food⁷
• Red, swollen or sore gums
• Bad breath that does not go away
• Gums that recede, or teeth that look longer
• Teeth that feel loose or have moved

Gum disease is often painless in its early stages, so it can be missed without regular check-ups.

Dental treatment when you have diabetes

Having diabetes does not rule out dental treatment. What changes is what your dental team needs to know and how closely your gums are monitored.

• Tell the team about your diabetes. Say which type you have, how it is treated and which medicines you take. If you know your latest HbA1c result, bring it. For surgery such as an extraction or an implant, your dentist may ask how well your diabetes has been controlled recently.
• Gum treatment. The European guideline on periodontitis describes treatment in steps⁸: better daily cleaning and help with risk factors such as smoking and diabetes, deep cleaning below the gum, further treatment such as surgery where deep pockets remain, then supportive care for life at intervals of 3 to 12 months set by your risk.
• Healing after surgery. Ask your dentist and your doctor how your diabetes may affect healing after surgery; the sources we reviewed for this article do not cover healing after extractions in diabetes. We do not give a blood-sugar cut-off for treatment; that is a decision for your dentist and your doctor together.
• Dry mouth. Tell your dentist if your mouth often feels dry. Our sources for this article do not cover dry mouth in diabetes.

The gum diseases page explains gum treatment in more detail.

Dental implants and diabetes

Diabetes does not rule out implants, but the findings are mixed and worth knowing.

• Implant loss. Two of three reviews found no significant difference between people with and without diabetes (2021 review¹; 2016 review²). The third, pooling 89 publications, reported an odds ratio of about 1.8 per implant³ for implant loss in people with diabetes. An odds ratio is not the same as a risk that is 1.8 times higher. A finding of no significant difference does not show that the risk is the same.
• Bone and gum around the implant. All three reviews found more bone loss around implants in people with diabetes. The 2021 review, which covered type 2 diabetes, also found more bleeding of the gum around implants. Within the type 2 group, higher blood sugar was not linked with worse gum and bone measurements around implants, provided oral hygiene was strictly maintained.

These are averages from observational studies, not your personal risk. In practice this means blood-sugar control, daily cleaning and regular reviews matter more, not less, once you have implants. The 2017 consensus report recommends a baseline X-ray and gum measurements⁹ when the crown or bridge on the implant is completed. The dental implants page explains the treatment stage by stage.

Looking after your mouth with diabetes

• Clean every day. Brush twice a day with fluoride toothpaste and spit it out¹⁰; do not rinse afterwards⁷. Clean between your teeth every day. Tartar cannot be brushed away; it needs professional cleaning.
• Do not smoke. Smoking is a separate risk factor: in long-term studies, smokers had about 85 per cent higher risk of periodontitis starting or getting worse¹¹ than non-smokers.
• Regular check-ups. The interval between check-ups is set for each patient¹² by their risk; tell your dentist about your diabetes so it can be taken into account. With implants, a structured supportive care programme¹³ is recommended.
• Keep your doctor and dentist informed. Tell your dentist when your diabetes treatment changes, and your doctor if you are having gum treatment or surgery.

When to see a dentist

See a dentist if your gums bleed, are swollen or sore, or if you have bad breath that does not go away. Ask for an urgent appointment if your gums are very sore and swollen, if teeth feel loose, or if you notice an ulcer, a red patch or a lump in your mouth. If you have implants, bleeding, pus or receding gum around an implant are also reasons to be seen.

Emergencies. Difficulty breathing or swallowing, rapidly spreading swelling of the face or neck, high fever or swelling around the eye are serious signs. Go to the nearest emergency department or call 112. With diabetes, also follow the advice your doctor has given you for illness and fever.

Frequently asked questions