Diabetes and periodontal diseases:
Because of blood vessel changes that occur with diabetes, the thickened blood vessels can impair the efficiency of the flow of nutrients and removal of wastes from body tissues. This impaired blood flow can weaken the gums and bone, making them more susceptible to infection.

In addition, if diabetes is poorly controlled, higher glucose levels in the mouth fluids will encourage the growth of bacteria that can cause gum disease.

A third factor, smoking, is harmful to oral health even for people without diabetes. However, a person with diabetes who smokes is at a much greater risk for gum disease than a person who does not have diabetes. (Smokers with diabetes over age 45 are 20 times as likely to develop severe gum disease than a person without those risk factors.)

Paired with poor oral hygiene, diabetes can lead to gingivitis, the first stage of periodontal disease, or to periodontitis, severe gum disease.

What are the symptoms of periodontal disease?
The following are the most common symptoms of gum disease. However, each individual may experience symptoms differently. Symptoms may include:

• red, swollen, tender gums
• bleeding while brushing and/or flossing
• receding gums
• loose or separating teeth
• persistent odorous breath
• dentures no longer fit
• puss between the teeth and gums
• a change in bite and jaw alignment

The symptoms of gum disease may resemble other conditions or medical problems. Consult a dentist or other oral health specialist for a diagnosis.

What are the different types of periodontal disease?
The different types of periodontal disease are often classified by the stage the disease has advanced to at the time of evaluation, including:

• gingivitis
  With gingivitis, the mildest form of periodontal disease, the gums are likely to become red, swollen, and tender, causing them to bleed easily during daily cleanings and flossing. Treatment by a dentist and proper, consistent care at home help to resolve the problems associated with gingivitis.

• mild periodontitis
  Untreated gingivitis leads to mild periodontitis. This stage of gum disease shows evidence of the bone around the tooth starting to erode. Prompt medical attention is necessary to prevent further erosion and damage.

• moderate to advanced periodontitis
  This most advance stage of gum disease shows significant bone and tissue loss surrounding the teeth.

Treatment for periodontal disease:
Specific treatment for periodontal disease will be determined by your dentist based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include any, or a combination of, the following:

• plaque removal
  Deep cleaning can help remove the plaque and infected tissue in the early stages of the disease, while smoothing the damaged root surfaces of the teeth. The gums can then be reattached to the teeth.

• medication

• surgery
  When the disease is advanced, the infected areas under the gums will be cleaned, and the tissues will then be reshaped or replaced. Types of surgeries include:

• pocket reduction
• a regeneration procedure
• a soft tissue graft
• crown lengthening

• dental implants

Diabetes and other oral problems:
Diabetes can also cause other oral problems, including:

• thrush
  Thrush, a fungal infection of the mouth, occurs more often in persons with diabetes because of high sugar levels in the saliva (fungus thrives on glucose).

• dry mouth
  Often a symptom of undetected diabetes, dry mouth means the mouth does not have enough saliva to keep itself wet. Saliva is necessary to help digest food, and prevent infection and tooth decay by controlling bacteria and fungi. Dry mouth can make tasting, chewing, and swallowing food difficult, and can impede speech. In addition, dry mouth can cause mouth infections and tooth decay.

Although each individual may experience symptoms differently, symptoms of dry mouth may include:

• sticky, dry mouth
• dry lips
• sense of burning in the mouth
• tough tongue
• mouth sores or infection

Always consult your physician for a diagnosis.

Treatment for dry mouth depends on the cause of the condition. Dry mouth can be caused by medication, disease, cancer treatment, and nerve damage. Some tips to prevent dry mouth symptoms include:

• Take frequent sips of water or sugarless fluids.
• Avoid caffeine.
• Drink fluids during meals.
• Avoid spicy or salty foods.
• Avoid tobacco and alcohol.
• Use a humidifier at night.
• Chew sugarless gum or sugarless candy.

Preventing periodontal disease and other oral problems:
Proper care of your teeth and gums can go a long way in preventing the onset of oral problems associated with diabetes. The following toothbrushing and flossing tips are recommended by the National Institute of Dental and Craniofacial Research: