Diabetes and Periodontal Disease: The Link Between Blood Sugar and Gum Health
How diabetes and gum disease affect each other — and how periodontal treatment can help
Key Takeaways
- Diabetes can increase the risk and severity of periodontal disease, particularly when blood glucose is not well controlled1.
- Periodontitis is a chronic form of gum disease that damages the gums, connective tissues and bone supporting the teeth2.
- The relationship appears to work in both directions: diabetes can make periodontal disease more difficult to control, while periodontal inflammation may make blood glucose management more difficult1,3.
- Treating periodontitis improves gum health and may also produce a modest improvement in glycaemic control in people who have diabetes and periodontitis4.
- Regular dental examinations, good daily oral hygiene and appropriate management of diabetes are important parts of reducing risk1,3.
What Is the Connection Between Diabetes and Periodontal Disease?
Diabetes and periodontal disease have a well-established association. People with diabetes are more likely to develop periodontal disease, and the condition can be more severe when blood glucose levels are poorly controlled1.
Periodontal disease affects the tissues that surround and support the teeth. Its early stage, gingivitis, causes inflammation of the gums. If disease progresses to periodontitis, inflammation and infection can damage the connective tissue and bone holding the teeth in place2.
Diabetes can affect the body's inflammatory response, immune function and healing. These changes can make infections and inflammation in the mouth more difficult to control3.
At the same time, periodontal disease creates an ongoing inflammatory burden. Research suggests this may negatively affect glycaemic control, which is why diabetes and periodontitis are often described as having a two-way or bidirectional relationship1,3.
How Does Diabetes Affect Your Gums?
When blood glucose remains high, several changes can make periodontal problems more likely or more difficult to manage. People with diabetes may experience:
- • Increased gum inflammation1,3
- • A greater risk of periodontal infection1,3
- • Slower healing1,3
- • Dry mouth1,3
- • Changes in saliva1,3
- • Increased susceptibility to oral infections1,3
- • More severe periodontal disease when diabetes is poorly controlled1,3
Poor blood glucose control is particularly important. The Australian Dental Association advises that oral complications associated with diabetes can become more severe when blood glucose is not adequately managed1.
This does not mean everyone with diabetes will develop periodontitis. Diabetes is one of several risk factors, alongside dental plaque, smoking, genetics and other health and lifestyle factors2.
Can Gum Disease Affect Diabetes?
Evidence suggests the relationship between diabetes and periodontal disease can work in both directions.
Periodontitis causes persistent inflammation in the tissues surrounding the teeth. In people with diabetes, this additional inflammatory burden may make blood glucose levels more difficult to manage1,3.
Research has also found that people with periodontitis can have poorer glycaemic status than people without periodontal disease1.
However, it is important not to interpret this association as meaning that gum disease alone causes diabetes. Periodontitis and diabetes are complex conditions influenced by multiple biological, behavioural and environmental factors.
Can Treating Periodontal Disease Improve Blood Sugar Levels?
Possibly. Periodontal treatment can modestly improve glycaemic control in people who have both diabetes and periodontitis.
A Cochrane systematic review found moderate-certainty evidence that treating periodontitis using professional subgingival periodontal treatment improved glycaemic control in people with diabetes, with benefits observed during follow-up periods of up to 12 months4.
This does not mean periodontal therapy should be considered a replacement for diabetes medication, diet, physical activity or medical management. Instead, periodontal treatment should be considered part of managing the health of a person who has both conditions.
Your dentist or periodontist should manage the periodontal disease, while your GP, endocrinologist or diabetes care team continues to manage your diabetes.
What Are the Signs of Periodontal Disease in People With Diabetes?
Periodontal disease can progress without significant pain, so symptoms should not be ignored. Signs can include:
The Australian Dental Association notes that untreated severe periodontitis can eventually cause teeth to loosen and may lead to tooth loss1. If you have diabetes, do not wait until gum disease becomes painful before arranging a dental examination.
Who Is Most at Risk?
A person with diabetes may have a greater risk of periodontal problems when other risk factors are also present. These can include:
- • Poorly controlled blood glucose2
- • Smoking2
- • Inadequate plaque control2
- • An existing history of periodontal disease2
- • Irregular dental care2
- • Genetic susceptibility2
- • Certain medications or other health conditions2
Smoking is particularly important because it is independently associated with periodontal disease and can also make treatment less successful2.
How Is Periodontal Disease Diagnosed?
A dentist or periodontist can assess your periodontal health as part of a comprehensive dental examination. Assessment may include:
- Reviewing your dental and medical history
- Asking about your diabetes and current management
- Examining the gums for inflammation or bleeding
- Measuring the spaces between the gums and teeth, known as periodontal pockets
- Checking for gum recession and tooth mobility
- Taking dental X-rays when appropriate to assess the bone supporting the teeth
If you have diabetes, tell your dentist about your condition and any medications you take. It can also be useful for your dentist to understand how your diabetes is currently being managed1,3.
How Is Periodontal Disease Treated If You Have Diabetes?
Treatment depends on the severity and extent of the periodontal disease. Australian periodontal treatment guidance follows a stepwise approach5.
1. Improve Daily Plaque Control
The first step is usually improving oral hygiene at home. This may include:
- • Brushing thoroughly twice a day
- • Cleaning between the teeth every day
- • Using appropriate interdental brushes or floss
- • Following personalised instructions provided by your dental practitioner
Managing risk factors such as smoking and diabetes is also an important part of treatment5.
2. Professional Periodontal Cleaning
For periodontitis, professional treatment usually involves thoroughly removing plaque and calculus from above and below the gumline. This may be described as:
- • Periodontal debridement
- • Deep cleaning
- • Subgingival instrumentation
- • Scaling and root surface treatment
Treatment may take place over several appointments and local anaesthetic may be used5.
3. Reassessment
Your dentist or periodontist will reassess the gums after healing to determine how well the periodontal tissues have responded. If deep periodontal pockets or active disease remain, additional treatment may be required5.
4. Additional Periodontal Treatment When Necessary
Some people with more advanced disease may require further non-surgical treatment or periodontal surgery. The aim is to reduce areas where harmful plaque can accumulate and, where possible, improve the environment around affected teeth5.
5. Ongoing Periodontal Maintenance
Periodontitis is a chronic condition and requires ongoing monitoring. Once active treatment is complete, regular supportive periodontal care is important to reduce the risk of recurrence and further loss of the tissues supporting the teeth5.
How Can Someone With Diabetes Protect Their Gums?
Good oral health and good diabetes management should work together.
Brush Twice a Day
Brush your teeth twice daily using fluoride toothpaste and an appropriate toothbrush.
Clean Between Your Teeth Every Day
A toothbrush cannot effectively clean every surface between the teeth. Floss or interdental brushes may be recommended depending on the spaces between your teeth.
Keep Your Blood Glucose Well Managed
Good diabetes management can help reduce the likelihood and severity of oral complications1,3. Continue following the recommendations provided by your diabetes healthcare team rather than changing medication or glucose targets because of dental treatment. Use our directory of diabetes healthcare professionals to find support near you.
Attend Regular Dental Examinations
People with diabetes should have their gums assessed regularly. Your dentist may recommend more frequent appointments if periodontal disease or other oral complications are present1,3.
Do Not Smoke
Smoking significantly increases periodontal risk and can negatively affect treatment outcomes2.
Tell Your Dentist That You Have Diabetes
Make sure your dental team knows:
- • That you have diabetes
- • The type of diabetes you have
- • What medications you are taking
- • Whether there have been recent changes to your diabetes management
- • Whether you have experienced episodes of hypoglycaemia
This information can help the dental team plan treatment appropriately.
When Should You See a Dentist?
Arrange a dental examination if you have diabetes and notice:
You should also continue routine dental examinations even if you do not have symptoms. Periodontitis does not always cause noticeable pain in its early stages1,2.
Why Coordinated Care Matters
Diabetes management traditionally focuses on areas such as blood glucose, cardiovascular health, kidneys, eyes and feet. Oral and periodontal health should not be overlooked. Current evidence supports recognising periodontal health as part of the broader health management of people living with diabetes3,4.
For someone with both diabetes and periodontitis, the most effective approach is generally coordinated care:
- • Medical team: manages diabetes and overall metabolic health.
- • Dentist or periodontist: diagnoses, treats and monitors periodontal disease.
- • Patient: maintains daily oral hygiene, attends recommended appointments and follows their diabetes management plan.
Managing one condition does not replace treatment for the other.
Frequently Asked Questions
Does diabetes cause periodontal disease?
Diabetes does not mean you will automatically develop periodontal disease. However, diabetes is an important risk factor, and periodontal disease can be more common and more severe when blood glucose is poorly controlled.
Is periodontal disease more common in people with diabetes?
Yes. People with diabetes have a higher likelihood of developing periodontal disease compared with people without diabetes, particularly when diabetes is poorly controlled.
Can periodontal disease raise blood sugar?
Periodontal disease is associated with poorer glycaemic control, and inflammation caused by periodontitis may contribute to difficulty managing blood glucose. The relationship is complex, however, and periodontal disease should not be described as the sole cause of high blood glucose or diabetes.
Can treating gum disease lower HbA1c?
Research indicates that treating periodontitis can produce a modest improvement in glycaemic control in people who have diabetes and periodontal disease. Periodontal treatment should complement — not replace — standard diabetes management.
Can better diabetes control improve gum health?
Good blood glucose management is associated with a lower risk and severity of oral complications. People with poorly controlled diabetes are more likely to experience frequent and severe gum problems.
Should people with diabetes see a periodontist?
Not everyone with diabetes needs specialist periodontal treatment. A general dentist can assess your gums first. If moderate, severe or complex periodontitis is identified, your dentist may recommend referral to a periodontist.
How often should someone with diabetes visit the dentist?
There is no single interval that is appropriate for everyone. Your dentist should recommend a recall schedule based on your periodontal health, diabetes, oral hygiene, smoking history and other individual risk factors.
Is periodontal disease reversible?
Early gum inflammation or gingivitis can often resolve when plaque is effectively controlled. Periodontitis causes permanent loss of supporting tissues and bone, so the damage itself may not be fully reversible. Treatment aims to stop or slow further progression and maintain the teeth wherever possible.
Need Support With Your Diabetes Care?
Connect with healthcare professionals experienced in diabetes care across Australia
References
- Australian Dental Association. Diabetes. Teeth.org.au. Available from: https://www.teeth.org.au/diabetes
- National Institute of Dental and Craniofacial Research. Periodontal (Gum) Disease. Available from: https://www.nidcr.nih.gov/health-info/gum-disease
- National Institute of Dental and Craniofacial Research. Diabetes & Oral Health. Available from: https://www.nidcr.nih.gov/health-info/diabetes
- Simpson TC, Clarkson JE, Worthington HV, et al. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database of Systematic Reviews. 2022. Available from: https://doi.org/10.1002/14651858.CD004714.pub4
- Australian Dental Association / Australian & New Zealand Academy of Periodontists. Gum Disease Treatment. Teeth.org.au. Available from: https://www.teeth.org.au/gum-disease-treatment
Medical disclaimer: This information is general in nature and is not a substitute for personalised advice, diagnosis or treatment from a dentist, periodontist, GP, endocrinologist or other qualified healthcare professional.
Last reviewed: August 2026 · Next review due: August 2027
This website content is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.