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Diabetes affects millions of Americans each year and approximately 11.4 percent of African Americans 20 years of age or older. One of the lesser-known aspects of diabetes is its link to oral health. Diabetes can leave a person more vulnerable to oral infections than people without the disease. These infections can be uncomfortable and make a person’s diabetes more difficult to control.

Diabetes poses a threat to a person’s oral health by lowering a person’s resistance to infection. The mouth already harbors all kinds of infection-causing bacteria, and diabetes tends to inhibit the body’s ability to defend against periodontal diseases. Periodontal diseases are infections of the gums and the bone that hold teeth in place. Diabetes may lower the body’s resistance to infection by inhibiting the circulation of blood to the gums and other parts of the body. This makes those areas more prone to infection because the loss of blood reduces the body’s ability to fight off any infection.

Another side effect of diabetes is a decrease in saliva production. Without the presence of saliva to wash away bacteria and plaque, tooth decay and plaque buildup may occur. If plaque is not removed regularly by brushing and flossing, it can turn into hardened tartar that sits along the gum line. This can lead to constant inflammation and oral infection. A third problem associated with diabetes is high glucose levels in saliva. This too can increase the strength and number of bacteria that threaten dental health.

The need for proper dental care is especially high for people living with diabetes because oral infections have been linked to an increased risk of heart disease as well as a decrease in the control of their diabetes. Research has shown that people who have periodontal disease are almost twice as likely to suffer from coronary artery disease as those who don’t.

Experts agree that one of the most important measures people with diabetes can take to protect their health is to practice preventive oral health care. That means professional teeth cleanings, regular dental checkups every six months or according to your dentist’s recommendations, brushing twice a day with a fluoride toothpaste, and either flossing or using an interdental cleaner once a day.

If you notice any of the following signs or symptoms, contact your dentist as soon as possible:

• gums that bleed easily
• red, swollen or tender gums
• gums that have pulled away from the teeth
• pus between the teeth and gums when the gums are pressed
• persistent bad breath or bad taste in the mouth
• permanent teeth that are loose or separating
• any change in the way your teeth fit together when you bite
• any change in the fit of partial dentures.

People with diabetes should also ask their insurance provider about special benefits and coverage items for which they might be eligible. For instance, Blue Cross Blue Shield of Massachusetts Dental Blue members who have diabetes receive additional benefits such as more frequent cleanings and enhanced coverage of other periodontal services. Those members that also have medical coverage through BCBSMA are invited to enroll in the insurer’s disease management program for diabetes, which helps them coordinate their diabetes care.

According to the American Dental Association, the most common oral health problems associated with diabetes are:

• tooth decay
• periodontal (gum) disease
• salivary gland dysfunction
• fungal infections
• lichen planus and lichenoid reactions (inflammatory skin disease)
• infection and delayed healing
• taste impairment.

To learn more, visit the website of the American Dental Association at www.ada.org or the American Diabetes Association website at www.diabetes.org. Your dentist and your primary care physician are good resources for getting answers to your specific questions and concerns.