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U.S. Department of Health and Human Services

The Indian Health Service continues to work closely with our tribal partners to coordinate a comprehensive public health response to COVID-19. Read the latest info.

Division of Diabetes Treatment and Prevention (DDTP)

Diabetes Standards of Care & Clinical Practice Resources

Oral Care

People with diabetes frequently have problems with their teeth and gums, especially when they have poor glycemic control. The higher the blood glucose, the greater the risk for developing periodontal disease. American Indian and Alaska Native (AI/AN) people with diabetes have two to three times more advanced periodontal disease than people who do not have diabetes.

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Oral Care Sections

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Section 1 – Clinical Practice Recommendations: Oral Care
Section 2 – Clinician and Educator Resources: Oral Care
Section 3 – Patient Education Resources: Oral Care

Clinical Practice Recommendations

Recommendations for Oral Care

Examine the patient’s mouth as part of routine diabetes care:
- Examine teeth and gums for plaque, gingival inflammation, and caries.
- Inquire about pain and look for problems, including sores, swollen or bleeding gums, loose teeth, mouth ulcers or growths, candidiasis, or decayed teeth.
- If a patient uses oral tobacco, be sure to examine gums and oral mucosa, especially where the patient usually places the tobacco.
Refer for professional dental care:
- Annually for routine dental examination.
- More often for people with periodontal disease as determined by the dental care professional.
- As needed for evaluation of oral health problems.

More information

Periodontal disease can result in the loss of some or all teeth in people with diabetes. People without teeth can suffer emotionally and nutritionally because they may not be able to eat many important types of foods. Every attempt should be made to replace missing teeth with dental prosthetics when there is significant loss of chewing function.

Periodontitis can negatively affect diabetes control and development of diabetes complications. The infection and inflammation associated with periodontitis can aggravate blood glucose control and increase risk for many of the complications of diabetes such as cardiovascular disease and chronic kidney disease.

In addition to periodontal disease, other oral health issues observed in people with diabetes include: dental caries, burning mouth syndrome and potential difficulty in wearing dental prosthetics, salivary gland dysfunction/dry mouth, fungal infections, lichen planus and lichenoid reactions, delayed healing, and taste disorders.