warning signs

Gum disease is one of the lesser-known complications that can affect patients with diabetes.

It is estimated that 1 in 3 diabetics suffer from periodontitis at some stage of their disease.

Key points

  • People with diabetes are prone to get problems affecting their gums, teeth and mouth.

  • Gum disease is the most common mouth problem for people with diabetes.

  • Gum disease can start at any age.

  • There’s a lot you can do to fight gum disease (such as brushing your teeth twice daily, flossing once every day, looking for early signs of gum disease, and visiting your dentist at least twice a year).

Abscess Overview

gingival abscess

An abscess is a tender mass generally surrounded by a colored area from pink to deep red. Abscesses are often easy to feel by touching. The middle of an abscess is full of pus and debris.

Abscess Causes

Abscesses are caused by obstruction of oil (sebaceous) glands or sweat glands, inflammation of hair follicles, or minor breaks and punctures of the skin. Germs get under the skin or into these glands, which causes an inflammatory response as your body’s defenses try to kill these germs.

The middle of the abscess liquefies and contains dead cells, bacteria, and other debris. This area begins to grow, creating tension under the skin and further inflammation of the surrounding tissues. Pressure and inflammation cause the pain.

People with weakened immune systems get certain abscesses more often. Those with any of the following are all at risk for having more severe abscesses. This is because the body has a decreased ability to ward off infections.

What causes a dental abscess?

A dental abscess is caused by bacteria. The bacteria usually enter the tooth when the enamel (outer part of the tooth) is damaged by tooth decay. Bacteria may also enter after an injury to the tooth, such as when a tooth is broken or chipped. Procedures on the tooth or gums may also cause a dental abscess. Food particles that are stuck between the teeth for a long time may also lead to an abscess.

How is a dental abscess diagnosed?

Your caregiver will examine your teeth and gums. He will check for pus, redness, swelling, or a mass. You may also have any of the following:

  • X-rays: X-rays of your mouth will show broken teeth or fluid buildup.

  • Needle aspiration: A needle will be used to take the fluid out of the abscess. The fluid is sent to a lab for tests. These tests may show what is causing your abscess.

What are the risks of a dental abscess?

swelling and infection inside tooth.

Pus may need to be drained more than once. You may become dehydrated if you cannot drink due to pain or swelling. The abscess may burst and the infection may spread to the rest of your body. Even with successful treatment, the infection may come back. Your airway may become blocked and cause breathing problems. Depending on its location, the abscess may spread to the throat, cheek, or face. The infection can also spread to the blood. These problems can be life-threatening.


How can diabetes affect  mouth?

Too much glucose also called sugar, in your blood from diabetes can cause pain, infection, and other problems in your mouth. Your mouth includes

  • your teeth

  • your gums

  • your jaw

  • tissues such as your tongue, the roof and bottom of your mouth, and the inside of your cheeks

Glucose is present in your salivathe fluid in your mouth that makes it wet. When diabetes is not controlled, high glucose levels in your saliva help harmful bacteria grow. These bacteria combine with food to form a soft, sticky film called  plaque. Plaque also comes from eating foods that contain sugars or starches. Some types of plaque cause tooth decay or cavities. Other types of plaque cause gum disease and bad breath.

Gum disease can be more severe and take longer to heal if you have diabetes. In turn, having gum disease can make your blood glucose hard to control.

Within the diabetic population, there is a serious risk of dental complications. It has long been known that having diabetes increases the risk of severe periodontal disease. Poorly controlled type 2 diabetics are more likely to develop periodontal disease than are well-controlled diabetics. Why?

Studies conclude that poorly-controlled diabetics respond differently to bacterial plaque at the gum line than do well-controlled diabetics and non-diabetics. Having poorly-controlled diabetes correlates with having more harmful proteins (cytokines) in their gingival tissue — and that can cause destructive inflammation of the gums. In turn, beneficial proteins (growth factors) are reduced, which interferes with the healing response to infection.

Diabetics tend to lose collagen, a protein that supports gums, skin, tendon cartilage, and bone, in their gum tissue, thus increasing periodontal destruction. Diabetic vascular disorders, such as reduced circulation in tiny blood vessels in the gums, interfere with nutrition and healing in the gum tissues. Young people with type 1 diabetes, especially those with poor control, are very vulnerable to early-onset periodontal disease as they reach puberty.

Diabetes causes its own problems

Plaque is the “bad guy” of gum disease. But things are not helped by your diabetes. This is because:

  • Diabetes can weaken your mouth’s germ fighting powers.

  • High blood glucose levels can make gum disease worse.

  • Diabetes may cause damage to the blood vessels supplying your gums.

If you have an infection from gum disease this can make your diabetes harder to control (usually causing your blood glucose levels to go up).

Warning signs of gum disease

healthy tooth and periodeontal disease

Because gum disease is often painless, you may not know you have a problem until you have some serious damage. Regular check-ups at your dentist are your best weapon, but you can also help prevent it from happening by looking out for the early warning signs of gum disease. These are:

  • Bleeding gums when you brush or floss. Bleeding from your gums is not normal. Even if your gums don’t hurt, get them checked

  • Red, swollen, or tender gums

  • Gums that have pulled away from your teeth. Part of the tooth’s root may show, or your teeth may look longer

  • Pus between your teeth and gums (when you press on the gums)

  • Bad breath

  • Adult teeth that are loose or moving away from each other

  • Changes in the way your teeth fit when you bite

  • Changes in the fit of partial dentures or bridges

  • The symptoms of gum disease as a result of diabetes may manifest themselves individually or in groups.

    To obtain an accurate diagnosis, it is necessary to consult a dental health expert.

    The symptoms may include the following:

    • Bleeding in mouth stimulated by brushing and/or flossing

    • Swollen, red or tender gums

    • Gums in recession

    • Loose teeth

    • Presence of pus between teeth/gums

    • Changed bit or jaw alignment

    • Persistent bad breath

If you have any of the above, visit your dentist as soon as possible.

Risk factors for gum disease

The following factors raise the risk of developing gum disease:

  • Regularly high blood glucose levels

  • Insufficient oral hygiene

  • Smoking

  • Viral infections

  • Certain medications – including some blood pressure medications may also increase risk

  • Having any condition that affects immunity – such as Addison’s disease or HIV

What are the most common mouth problems from diabetes?


What It Is




  • unhealthy or inflamed gums

  • red, swollen, and bleeding gums

  • daily brushing and flossing

  • regular cleanings at the dentist


  • gum disease, which can change from mild to severe

  • red, swollen, and bleeding gums

  • gums that have pulled away from the teeth

  • long-lasting infection between the teeth and gums

  • bad breath that won’t go away

  • permanent teeth that are loose or moving away from one another

  • changes in the way your teeth fit together when you bite

  • sometimes pus between the teeth and gums

  • changes in the fit of dentures, which are teeth you can remove

  • deep cleaning at your dentist

  • medicine that your dentist prescribes

  • gum surgery in severe cases

thrush, called candidiasis

  • the growth of a naturally occurring fungus that the body is unable to control

  • sore, white—or sometimes red—patches on your gums, tongue, cheeks, or the roof of your mouth

  • patches that have turned into open sores

  • medicine that your doctor or dentist prescribes to kill the fungus

  • cleaning dentures

  • removing dentures for part of the day or night, and soaking them in medicine that your doctor or dentist prescribes

dry mouth, called xerostomia

  • a lack of saliva in your mouth, which raises your risk for tooth decay and gum disease

  • dry feeling in your mouth, often or all of the time

  • dry, rough tongue

  • pain in the mouth

  • cracked lips

  • mouth sores or infection

  • problems chewing, eating, swallowing, or talking

  • taking medicine to keep your mouth wet that your doctor or dentist prescribes

  • rinsing with a fluoride mouth rinse to prevent cavities

  • using sugarless gum or mints to increase saliva flow

  • taking frequent sips of water

  • avoiding tobacco, caffeine, and alcoholic beverages

  • using a humidifier, a device that raises the level of moisture in your home, at night

  • avoiding spicy or salty foods that may cause pain in a dry mouth

oral burning

  • a burning sensation inside the mouth caused by uncontrolled blood glucose levels

  • burning feeling in the mouth

  • dry mouth

  • bitter taste

  • symptoms may worsen throughout the day

  • seeing your doctor, who may change your diabetes medicine

  • once your blood glucose is under control, the oral burning will go away

More symptoms of a problem in your mouth are

  • a sore, or an ulcer, that does not heal
  • dark spots or holes in your teeth
  • pain in your mouth, face, or jaw that doesn’t go away
  • loose teeth
  • pain when chewing
  • a changed sense of taste or a bad taste in your mouth
  • bad breath that doesn’t go away when you brush your teeth

The prospects for fighting periodontal disease are excellent, as there are many things that someone with diabetes can do to stop the process or correct the disease, once it starts. The first goal is easy.

1. Good blood glucose control

The degree to which a person exercises good diabetes control appears to have a direct relationship to the severity of periodontal disease. This is clearly a very good thing to know, especially on those mornings when you think you are running too late to brush and floss. Among poorly-controlled diabetics, bone loss from periodontal disease is particularly severe.

2. Oral hygiene

Make sure you schedule regular dental check-ups. For a diabetic this may mean every six months, or, if you have periodontal disease, more often, until you get it under control. According to many periodontists, revisiting a dental hygienist every three months (“periodontal recall,”) may ensure problems can be controlled with relatively minor procedures.

Brush and floss the proper way. If you are not sure, the hygienist, the person who regularly cleans your teeth at the dentist’s office, can help show you the right way. Now that you’ve read this article, you know brushing and flossing are important tools to help remove bacteria before it can cause damage. If necessary, your dentist may recommend mouthwashes that use chemicals to destroy plaque-forming bacteria and neutralize their toxins.

3. Watch for warning signs.

We’ve gone over these in the article, but, one more time let’s list them: Bleeding gums while you eat or brush and floss, abnormal changes in your mouth such as soreness, sores, bright red gums and tenderness. Also look for gums pulling away from your teeth, making your teeth look long.

How is a dental abscess treated?

Treatment is done to cure your abscess and prevent more serious problems.

  • Medicines:

    • Antibiotics: This medicine will help fight your infection. Take your antibiotics until they are gone, even if you feel better.

    • Ibuprofen or acetaminophen: These medicines decrease pain and lower a fever. They are available without a doctor’s order. Ask your caregiver which medicine is right for you. Ask how much to take and how often to take it. Follow directions. These medicines can cause stomach bleeding if not taken correctly. Ibuprofen can cause kidney damage. Do not take ibuprofen if you have kidney disease, an ulcer, or allergies to aspirin. Acetaminophen can cause liver damage. Do not drink alcohol if you take acetaminophen.

  • Incision and drainage: Your caregiver makes a cut in the abscess to allow the pus to drain. Ask your caregiver for more information.

  • Debridement: Your caregiver may cut away damaged, dead, or infected tissue to help the wounds heal.

Other mouth problems

The most common problem affecting gums and teeth for people with diabetes is gum disease. But diabetes also makes you prone to other mouth problems.

Oral infections

An oral infection is a cluster of germs causing problems in an area of your mouth. Here are some warning signs:

  • Swelling or pus around your teeth or gums or any place in your mouth. Swelling can be large, or as small as a pimple

  • Pain in the mouth or sinus area that doesn’t go away

  • White or red patches on your gums, tongue, cheeks or the roof of your mouth

  • Pain when chewing

  • Teeth that hurt when you eat something cold, hot or sweet, or when you chew

  • Dark spots or holes on your teeth

Infections can make your blood glucose hard to control. Making a plan of action with your dentist and doctor or diabetes nurse will prepare you for any adjustments you might need to make.

Fungal infections

Diabetes makes you more prone to fungal infections such as thrush. If you tend to have high blood glucose levels or if you take antibiotics often, you are even more likely to have this problem. Thrush makes white (or sometimes red) patches in areas of your mouth. These can get sore or turn into ulcers.

Thrush likes moist spots that may be chafed or sore, for example, under poorly fitting dentures (false teeth). Smoking or wearing dentures all day and night can increase the risk of thrush. Stopping smoking and limiting how long you wear dentures can reduce the risk of getting thrush. If you think you have thrush, talk to your dentist or doctor.

Poor healing

If your diabetes is poorly controlled, you heal more slowly and your chance of getting an infection after dental surgery is increased. To give yourself the best shot at healing well, keep your blood glucose under control before, during and after surgery.

Dry mouth

Some people with diabetes complain of dry mouth. High blood glucose can cause you to have a dry mouth. Some medicines can cause your mouth to be dry. Having a dry mouth can increase your risk of cavities because there’s less saliva to wash away germs and take care of the acids they create. Dry mouth can sometimes lead to other problems, such as salivary gland infections.

If you have a dry mouth, try drinking more fluids. You can also try chewing sugar-free chewing gum to help keep the saliva flowing.

How is gum disease treated?

Treating will involve maintaining strong oral hygiene and keeping your blood sugar levels well managed. Quitting smoking is also highly recommended to limit further damage.

Brushing your twice a day in the morning and evening and flossing your teeth daily can help to keep your teeth clean. Mouthwash may also be recommended by your dentist and you may need to visit a dental hygienist.

Good blood glucose control can be achieved by joining a diabetes education course and using blood glucose testing to inform meal choices.

Antibiotics or painkillers may be prescribed for treating acute necrotising ulcerative gingivitis. Surgery may be required if gum disease is severe.

Severe periodontitis may require surgery to remove or replace gum tissue.

How will my periodontal disease be treated?

Periodontal disease is treated amongst diabetics in the same way as other patients. However, the specific treatment will be assessed depending on a variety of factors.

These will include the extent of the disease, your diabetic condition, your tolerance of medications, etc.

It is important to determine which type of abscess is present so that the appropriate treatment may be rendered. In all three types of abscesses, the pus must be drained. Antibiotics may be prescribed if systemic symptoms such as fever and swelling in the lymph glands are present. (Mouth infections often affect the lymph glands in the neck region.) Deep cleaning will be undertaken for gum pocket (periodontal) abscesses.

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