Your gums and your blood sugar

Pink in the sink. It has been happening for a while now, most mornings, and you have more or less stopped registering it.

Everyone’s gums bleed a bit, is the thinking. It stops if you leave them alone for a few days.

Both halves of that are wrong, and the second half is the expensive one. Gums bleed because they are inflamed, and brushing less is what inflammation was hoping you would do.

The traffic runs both ways

Diabetes makes gum disease more likely and more severe. Higher blood sugar changes how the small blood vessels in the gum behave, how the immune system deals with the bacteria at the gumline, and how well tissue repairs itself. This is well enough established that gum health appears in Diabetes Canada’s clinical practice guidance rather than being left to dentistry alone.

The direction people are not told about is the return trip. Severe gum disease is a low-grade infection with a surface area larger than you would guess, sitting in your mouth continuously, and that kind of persistent inflammation appears to make blood sugar harder to control.

Whether treating gum disease reliably improves A1C, and by how much, is still argued about, and it would be overselling it to promise a number. What is not argued about is that the gum disease itself is worth treating, and that it is more common in people with diabetes than it should be.

What it looks like before it hurts

The reason this is missed for years is that teeth are the part that hurts, and teeth are not the part that goes first.

• Bleeding when you brush or clean between your teeth. Not normal, at any age.
• Gums that look red and puffy at the edges rather than firm and pale.
• A taste or a smell that comes back however much you brush.
• Gums receding, so teeth look longer, or gaps opening between them.
• Teeth that feel loose or have moved, or a denture or bridge that has stopped fitting the way it used to.

None of that is painful, which is exactly the problem. By the time something aches, the bone holding the tooth has usually been involved for a long time.

Teeth are the part that hurts. Teeth are not the part that goes first.

Dry mouth, and where it comes from

Saliva is not incidental. It rinses, it buffers acid, and it carries the minerals that repair the surface of a tooth all day long. A mouth that is dry is a mouth with the protection turned off, and decay in a dry mouth moves fast, often right at the gumline where the root is softer.

Two things dry it out. Blood sugar running high pulls fluid out through the kidneys, which is the thirst and the frequent trips that people recognise. And a long list of ordinary medications does it directly: diuretics such as hydrochlorothiazide, several antidepressants, bladder and overactive bladder medications, and most antihistamines.

That is a reason to mention it, not a reason to act alone. Dry mouth is a common and manageable side effect, there are often alternatives within the same class, and stopping a blood pressure medication because your mouth is dry trades a small problem for a large one. Raise it with the person who prescribed it and let them make the swap.

In the meantime: sip water rather than juice or sweetened coffee through the day, because constant sugar in a dry mouth is the worst possible combination. Sugar-free gum encourages saliva. Your dentist can suggest a high-fluoride toothpaste or a saliva substitute, and will want to see you more often if your mouth is dry.

Watch also for creamy white patches inside the cheeks or on the tongue that leave a raw, sore area when they rub off. That is oral thrush, it is more common with diabetes, dry mouth and dentures, and it is treatable once someone looks at it.

What your dentist actually needs from you

Tell them you have diabetes. Tell them your most recent A1C if you know it, and bring your medication list, including anything you buy yourself.

Then two specifics that change how the appointment should be booked:

If you take insulin or a sulfonylurea such as gliclazide, glyburide or glimepiride, a long appointment through a missed meal is a setup for a low in the chair, at the one moment you cannot easily say so. Book earlier in the day, eat normally beforehand, and bring your usual fast-acting sugar with you. Tell the front desk when you book, not when you sit down.

If you take a blood thinner, or a medication that affects healing or the jawbone, the practice needs to know before anything is extracted. Some of those need a conversation between your dentist and your prescriber first, and that takes a few days rather than a few minutes.

Healing after dental work is slower when blood sugar is running high, and infections are more likely. That is worth planning around rather than discovering.

The cost, which is the real barrier

It is worth saying plainly: dental care is not covered by provincial health insurance in Canada, and cost is the reason most people give for not going. That is a structural problem, not a personal failing.

Three things are worth checking before you decide it is out of reach. The Canadian Dental Care Plan is a federal programme for people without private dental insurance, with eligibility based on household income, and it is worth checking your eligibility on the Government of Canada website rather than assuming. Your benefits plan at work may cover more than you think, and some plans allow extra cleanings for people with diabetes specifically. And dental schools and community health centres often provide care at a substantially lower cost.

Worth a word with your care team

Call your dentist within a day or two for gums that bleed every time you brush, a tooth that has become loose, or a sore or ulcer anywhere in your mouth that has not healed within two weeks. That last one needs looking at on its own terms, whatever your blood sugar is doing.

Get seen the same day, urgently, for swelling of the face, cheek or jaw, or a tooth that is throbbing with a fever. A dental abscess is an infection that can spread.

Go to an emergency department or call 911 if that swelling is spreading toward your eye or under your jaw and into your neck, or if you have trouble swallowing, breathing, or opening your mouth. That is not a dental appointment.

Tell your care team if you are being treated for a mouth infection, because an infection anywhere tends to push blood sugar up for as long as it lasts, and your readings may not look like themselves for a week or two. That is a reason to check more often and to let your team see the numbers, not a reason to change anything yourself.

One small place to start

Tonight, clean between two teeth. Not all of them. Two, with floss or a small interdental brush, and then look at what comes away and whether it bleeds.

If it bleeds, that is information, and the answer is to keep gently cleaning that spot rather than to avoid it. Bleeding that has not settled after a week or two of cleaning it properly is a reason to book.

If you are a 360Care member, message your care team to say you are booking a dental visit and ask them what to tell the practice about your medications. They can also help you work out whether your benefits plan or the federal programme covers it.