The Overlooked Link Between Diabetes and Oral Health: A Silent Public Health Crisis

When diabetes is discussed, most people immediately think of complications like heart disease, kidney failure, vision or foot problems. But there’s one critical area often left out of the conversation: oral health. These two chronic diseases are challenges with real consequences for millions of people worldwide.

Diabetes and Oral Health: A Two-Way Relationship

There is a strong, bidirectional link between diabetes and periodontal (gum) disease. People with diabetes are significantly more susceptible to oral diseases and poor oral health can, which  in turn make blood sugar control difficult.

Here’s how the connection works:

• High blood sugar weakens immune function, reducing the body’s ability to fight infections, including those in the gums.
• Dry mouth, a common side effect of diabetes, increases the risk of cavities and oral infections.
• Periodontal disease leads to chronic inflammation, which can impair the body’s ability to regulate blood glucose, forming a vicious cycle.

Periodontal disease isn’t the only oral concern for people with diabetes. A recent review by Enteghad et al. (2024) shows that diabetes is also associated with an increased risk of peri-implant diseases (Peri implantitis), an inflammatory condition affecting the tissues around dental implants. The study found that glycemic control plays a central role in determining the severity of both periodontal and peri-implant diseases. The relationship is not only bidirectional but also correlated, meaning that effectively managing either condition can potentially help prevent or mitigate the other.

Importantly, while people with diabetes can achieve dental implant success, they are more susceptible to peri-implantitis, particularly if their blood sugar is poorly controlled. This underscores the critical need for strict glycemic control and strong oral hygiene habits in diabetic patients.

The Statistics Are Striking

• People with diabetes are nearly twice as likely to suffer from periodontitis compared to those without it.
• A meta-analysis of 27 studies found that 67.8% of patients with diabetes  had periodontitis versus 35.5% of non-diabetics (Zheng et al., 2021).
• A systematic review of 13 prospective studies found diabetes increased the risk of developing or worsening gum disease by 86% (Teeuw et al., 2010).
• The Enteghad et al. (2024) review affirms that metabolic control directly affects the severity of both periodontal and peri-implant disease.
• Treating gum disease improves glycemic control. Non-surgical periodontal therapy has been shown to reduce HbA1c levels by around 0.4%, a meaningful improvement comparable to some diabetes medications, (Teeuw et al., 2010).

Like what you’re learning?  Consider enrolling in the Herman Ostrow School of Dentistry of USC’s online, competency-based certificate or master’s program in Community Oral Health.

Why This Is a Public Health Issue — Not Just a Dental One

Despite clear evidence linking diabetes and oral health, dental care remains siloed from general healthcare, especially in underserved areas. This disconnection contributes to significant and preventable public health burdens.

1. Massive Global Impact

• Over 463 million people had diabetes in 2019 (9.3% of adults), and this number is projected to reach 700 million by 2045 (Enteghad et al., 2024).
• Up to 50% of adults globally suffer from periodontal disease, with severe cases in 10–15%.

2. Health Inequities

• Low-income and rural communities often lack access to dental care.
• In the U.S., adults aged 50+ with diabetes are 46% more likely to have fewer than 20 teeth and 56% more likely to suffer severe tooth loss (CDC, 2022).

3. Cost to Health Systems

• Advanced diabetes complications and emergency dental visits are costly.
• Prevention and early care could significantly reduce healthcare spending and improve quality of life.

Integrated Care: A Critical Solution

The rising burden of both diabetes and oral diseases calls for more integrated care models, where oral and systemic health are treated as interconnected.

Solutions Include:

• Routine dental screenings for all diabetes patients.
• Coordinated care among physicians, endocrinologists, and dental professionals.
• Public health campaigns focused on oral hygiene for at-risk groups.
• Coverage expansion for dental services in diabetes management programs.

What You Can Do?

If you have diabetes or are at risk:

• Brush and floss daily using fluoride toothpaste.
• See your dentist regularly and inform them about your diabetes.
• Maintain strict glycemic control.
• Watch for signs of gum disease: bleeding, swelling, or loose teeth.

If you’re a healthcare professional or policymaker:

• Promote interdisciplinary collaboration between dental and medical teams.
• Advocate for public funding of dental care in chronic disease programs.
• Include oral health education in diabetes management strategies.

Key Findings at a Glance:

Summary and Conclusion: Bridging the Mouth-Body Gap

• Gum disease worsens blood sugar control, and poor glucose control worsens gum disease.
• Diabetes is linked not only to periodontitis but also to peri-implantitis.
• Good oral hygiene and glycemic control are essential for preventing complications.
• Treating gum disease can improve HbA1c
• Oral health should be part of every diabetes care plan

The relationship between diabetes and oral health including gum disease and peri-implant complications is clear and preventable. Yet, it’s still overlooked in public health discussions. By recognizing oral health as a critical component of chronic disease management, we can reduce complications, improve outcomes, and promote equity.

From Classroom to Community: Addressing Oral Health and Diabetes

At the Community Oral Health Master’s level program, our students explore the epidemiology and public health impacts of chronic diseases, including the important connection between diabetes and oral health.  Some of our students have chosen to focus their capstone projects on this intersection, developing educational materials to raise awareness of the bidirectional relationship between these two prevalent conditions.

By engaging with the latest research and public health strategies, our students are not only deepening their academic understanding but also contributing to real-world solutions. We are hopeful that this new generation of community oral health professionals will help bring this critical and often overlooked issue to the forefront of both public health policy and clinical care.

Earn an Online Postgraduate Degree in Community Oral Health

Do you like learning about a variety of issues while focused on the unique needs of community health dental programs? Consider enrolling in the Herman Ostrow School of Dentistry of USC’s online, competency-based certificate or master’s program in Community Oral Health.

References

1. Zheng M, Wang C, Ali A, Shih YA, Xie Q, Guo C. (2021). Prevalence of periodontitis in people clinically diagnosed with diabetes mellitus: a meta-analysis of epidemiologic studies. Acta Diabetes. 58(10):1307–1327. https://doi.org/10.1007/s00592-021-01738-2
2. Teeuw WJ, Gerdes VE, Loos BG. (2010). Effect of periodontal treatment on glycemic control of diabetic patients: a systematic review and meta-analysis. Diabetes Care. 33(2):421–427. https://doi.org/10.2337/dc09-1378
3. Enteghad S, Shirban F, Nikbakht MH, Bagherniya M, Sahebkar A. (2024). Relationship Between Diabetes Mellitus and Periodontal/Peri-Implant Disease: A Contemporaneous Review. Int Dent J. 74(3):426–445. https://doi.org/10.1016/j.identj.2024.03.010
4. Centers for Disease Control and Prevention (CDC). (2022). Diabetes and Oral Health. https://www.cdc.gov/oral-health/data-research/facts-stats/fast-facts-diabetes-and-oral-health.html
5. Singh M, et al. (2019). Prevalence of Periodontal Disease in Type 2 Diabetes Mellitus Patients: A Cross-sectional Study. Contemp Clin Dent. 10(2):349–357. https://doi.org/10.4103/ccd.ccd_652_18