There are more bacteria in your mouth right now than there are people on Earth. If those germs settle into your gums, you’ve got gum disease. “Not me?” you say. Here are the facts.

• More than half of all adults have at least the early stages of gum disease.
• About 90% of adults have gum disease during their lives.
• If you have diabetes, you are at higher risk for gum problems. Poor blood glucose control makes gum problems more likely.
• Gum disease can start at any age. Children and teenagers who have diabetes are at greater risk than those who don’t have diabetes.

Just when you thought the news was all bad, remember that there is a lot you can do to fight gum disease.

• Learn how gum problems start.
• Brush your teeth twice a day.
• Floss your teeth every day.
• Look for early signs of gum disease.
• Visit your dentist at least twice a year.

A big plaque attack

When you have gum disease, germs work to destroy your gums (gingiva) and the bone around your teeth. It starts with plaque. Plaque is a sticky film of food, saliva, and germs. Plaque loves to settle at the gum line. There, germs get busy making your gums red, tender, and likely to bleed.

The goal of your daily tooth brushing and flossing is to clean away plaque. When plaque stays put, it hardens into tartar. Tartar builds up under the gum line. More plaque forms over the tartar. Only your dentist or dental hygienist can get tartar off your teeth.

If plaque and tartar are not cleaned away, even gentle brushing can cause your gums to bleed. This is called gingivitis. It is the first stage of gum disease. You can fight gingivitis with:

• daily good brushing and flossing habits, and
• getting your teeth cleaned at least twice a year at your dentist’s office.

If you ignore gingivitis, the gum disease gets worse.

The more severe form of gum disease is called periodontitis. When you reach this stage, your gums begin to pull away from your teeth. Pockets form between your teeth and gums. These fill with germs and pus, and deepen. When this happens, you may need gum surgery to save your teeth. If nothing is done, the infection goes on to destroy the bone around your teeth. The teeth may start to move or get loose. Your teeth may fall out or need to be pulled.

Warning Signs

As if this is not enough, diabetes can make things worse. Plaque is the main bad guy of gum disease. But diabetes can also be a culprit. Diabetes may weaken your mouth’s germ-fighting powers. High blood sugar levels can help the gum disease get worse. At the same time, gum disease can make diabetes harder to control.

Often gum disease is painless. You may not even know you have it until you have some serious damage. Regular dentist visits are your best weapon. While gum disease may not hurt, there are warning signs to watch for.

• Bleeding gums when you brush or floss. This bleeding is not normal. Even if your gums don’t hurt, get them checked.
• Red, swollen, or tender gums.
• Gums that have pulled away from teeth. Part of the tooth’s root may show, or your teeth may look longer.
• Pus between the teeth and gums (when you press on the gums).
• Bad breath.
• Permanent 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.

If you have any of the above, see your dentist.

Brush and Floss

The three main steps in fighting gum disease are brushing, flossing, and seeing your dentist regularly. Brush at least twice a day and floss at least once a day. Ask your dentist or hygienist to show you the correct way to brush and floss. Here are some tips.

Brushing. A toothbrush can only clean one or two teeth at a time. Allow about 3 minutes of brushing to clean all your teeth well.

• Use a brush with soft bristles and rounded ends. Soft bristles are less likely to hurt your gums.
• Angle the brush against the gum line, where teeth and gums meet.
• Move the brush back and forth with short strokes. Use a gentle, scrubbing motion.
• Brush the outside surfaces of the teeth. Do the same for the backs of the teeth and chewing surfaces.
• Brush the rough surface of your tongue to remove germs and freshen your breath.
• Remember to brush your gums too.
• Get a new toothbrush when the bristles are worn or bent, about every 3-4 months.

Flossing. Few people really enjoy flossing. But if you don’t floss, you’re only doing half the job of cleaning your teeth and gums. Flossing cleans away plaque and bits of food from between your teeth and below the gum line. It gets places your brush can’t reach. Floss once a day.

1. Break off 18 inches of floss and wind most of it around one of your middle fingers. Wind the rest around the same finger of the other hand.
2. Hold the floss tightly between your thumbs and index fingers. Leave about an inch between them.
3. Use a gentle sawing motion to get the floss between your teeth. Never snap the floss into the gums.
4. When you get the floss to the gum line, curve it into a C-shape against one tooth. Scrape up and down on the sides of each tooth to remove plaque.
5. As floss gets worn and dirty, move to a clean section and continue. Don’t forget the backsides of your rear teeth.
6. When you’re done brushing and flossing, rinse your mouth with water.

If you have arthritis in your hands, trouble moving your fingers, or if you have bridgework in your mouth, a floss holder might help. Ask your dentist about tools to make flossing easier for you.

When you schedule your visit to the dentist, plan to:

• Tell your dentist you have diabetes. Also, share any problems with infections or trouble keeping your blood sugar levels under control.
• Eat before you go to see your dentist. The best time for dental work is when your blood sugar level is in a normal range and your diabetes medication action is low. If you take insulin, a morning visit after a normal breakfast is best.
• Take your usual medicines before your dentist visit, unless your dentist or doctor tells you to change your dose for dental surgery. Your dentist should consult with your doctor to decide about adjustments in your diabetes medicines, or to decide if an antibiotic is needed before surgery to prevent infection.
• Stick to your normal meal plan after dental work. If you can’t chew well, plan how to get the calories you need. You may need to use your sick-day meal plan that uses more soft or liquid foods.
• Wait to have dental surgery until your blood sugar is in better shape, if your diabetes is in poor control. If your dental needs are urgent, (pain or swelling), talk to your dentist and doctor about having dental treatment in a hospital or special setting where you can be checked on during and after surgery.

More on the Mouth

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 one 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 in your teeth.

Infections can make your blood sugar hard to control. By planning ahead and discussing a plan of action with your dentist and doctor, you will be prepared to handle needed adjustments.

Fungal infections. Having diabetes means you are more prone to fungal infections such as thrush. If you tend to have high blood sugar levels or 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. Smoking and wearing dentures all day and night can increase the risk of thrush. Quitting smoking and limiting the time dentures are worn can reduce the risk of getting thrush. If you think you have a fungal infection, talk to your dentist or doctor.

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

Dry mouth. Some people with diabetes complain of dry mouth. This may be caused by medicines you take. You may notice a dry mouth if your blood sugar levels are high. 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 dry mouth, try drinking more fluids. You can also try chewing sugar-free gum or sugar-free candy to help keep the saliva flowing. Some people use saliva substitutes, available at drug stores.

Keeping your teeth and mouth healthy requires a team effort. You’re the most important person on this team to do the day-to-day mouth care. If you have questions or concerns, talk to a team member. Remember, good dental health can create a healthy mouth and a smile that will last a lifetime.