Did you know? People with diabetes are 2 to 3 times more likely to develop periodontitis (severe gum disease).

Diabetes complications involving the eyes, heart, kidneys, nerves and feet are more widely known, however, few are aware of the correlation between diabetes and oral health.

Proper gum care is an important part of diabetes management as studies have shown that those with diabetes are at higher risk of both gingivitis (early-stage or initial gum disease) and periodontitis (advanced or severe gum disease). 

How common is gum disease in people with diabetes?

Globally, a 2003 study published in the Singapore Dental Journal found that 40% of adult diabetes patients had moderately advanced periodontitis. 

In diabetes patients with poor glucose control, the risk is even greater as they may experience an inflammatory response that could result in the loss of supporting gums and bone of your teeth. Eventually, the tooth could become so loose it has to be removed.

In this ‘Ask the Specialist’ Q&A forum, if you have diabetes or are caring for a loved one with the condition, don't miss the chance to find out more about gum care for diabetes by asking questions such as:

• What is the link between diabetes and gum disease?

• Why is it important for people with diabetes to have good oral health? 

• What are ways to prevent gum infection?

• How do I know if I have gum problems?

• When should I see a doctor for gum disease?
  

• What treatment is there for gum disease?

• Anything else related to gum health
  

About periodontal disease in Singapore

Periodontal disease is generally common in Singapore. In 2019, the Singapore national adult oral health survey reported that 15.7% and 41.2% of those interviewed had moderate and severe periodontitis, respectively.

Related articles:

Tips to Prevent Gum Disease in People with Diabetes

Diabetes Oral Health Complications: How To Prevent

About Dr Chee Hoe Kit

Dr Chee Hoe Kit is an experienced periodontist who is passionate about your gums. He is a Senior Consultant with the Department of Restorative Dentistry, Periodontics, at National Dental Centre Singapore (NDCS). 

Dr Chee leads the Perio Clinic at the Diabetes & Metabolism Centre in the Singapore General Hospital (SGH), a clinical service that provides periodontal screening and treatment in patients with diabetes. 

Apart from all things pertaining to the gums, Dr Chee also treats patients with dental implants and its related surgical therapies. 

Dr Chee is also an educator with SingHealth Duke-NUS, teaching postgraduate students in periodontology. He also takes on the role of a clinician-scientist, undertaking research on periodontal health and its impact on diabetes mellitus.

Questions and answers on gum disease

1. Question by Ivy

Hi Doctor,

I am diabetic and also on blood thinner for ischaemic heart condition. Is it advisable for me to go for deep cleansing? Thanks.

Answer by Dr Chee Hoe Kit

Hi Ivy, 

Although you have diabetes and are on antiplatelet or anticoagulant medication (blood thinners), you can still go for deep cleaning of your teeth and gums known as periodontal treatment. 

Even though gum treatment is likely to cause bleeding of the gums, the risk of post-operative complications (eg. prolonged gum bleeding) is generally low. You should inform your dentist or oral health therapist (OHT) the type of blood thinners that you are taking to minimise excessive bleeding during the gum treatment. 

Your physician/cardiologist may be given a memo by the dentist/OHT for their advice on whether your blood thinner should be stopped a few days before any dental procedure that will cause gum bleeding. 

If you are on warfarin, you may be advised to go for a blood test just before your periodontal appointment to ascertain if the INR (international normalised ratio) is within the therapeutic range for dental procedures which may cause gum bleeding to be carried out safely.

2. Question by Binwee

Dear doctor,

I am taking medicine for my bone density and was informed by my dentist that extraction could cause the blood not to clot. What is your advice? Thank you.

Answer by Dr Chee Hoe Kit

Dear Binwee, 

If you are taking medicine known as oral bisphosphonates for osteoporosis, you ought to inform your dentist the type of bisphosphonates and the duration you have been taking it. Bisphosphonates are not known to prevent blood clotting after extractions.

3. Question by Jan

Hi Dr Chee,

What treatments are available for receding gums, leading to sensitive teeth due to exposed roots? Is there any way to re-grow gums? Thank you for your advice.

Answer by Dr Chee Hoe Kit

Hi Jan, 

Receding gums that result in teeth sensitivity due to the exposed roots can be treated either non-surgically or surgically. 

Non-surgical methods are such as placing a tooth-coloured restoration onto the exposed roots if there is a cavitation on the root surface. Alternatively, a desensitising agent (fluoride varnish, dentine bonding agents) can be applied onto the sensitive teeth areas by the dentist.

On the other hand, surgical treatment of the receded gumline is via gum grafting procedures where the gum graft is obtained from the palate and sutured onto the receding gum areas for regeneration of the gumline to as close as the original gum level. 

However not every type of gum recession can be treated surgically and you should consult with a periodontist (gum specialist) who will be the right specialty in performing such gum grafting procedures.

4. Question by Eileen

Hi Dr,

Will flossing with vigorous force damage the gums? Is it advisable to floss immediately after eating?

Answer by Dr Chee Hoe Kit

Hi Eileen, 

Vigorous flossing may cause the gums to bleed and get lacerated which over time can result in gum recession or soft tissue damage. 

Flossing too aggressively via the wrong technique over time may also wear away the teeth enamel interdentally. 

It is good to floss soon after meals because this will prevent food trap in between teeth for too long a duration that will encourage caries initiation or gum irritation.

5. Question by Lai Yoke

Dear Dr,

Is LANAP (Laser-Assisted New Attachment Procedure) dental treatment offered to treat gum disease in NDCS? 

I heard this treatment is effective and minimally invasive. It may even help with bone regeneration. 

Our rapidly ageing population will lead to a potential increase in the number and severity of gum disease cases. Perhaps NDCS can consider making LANAP treatment available if it is not being offered. The impending patient load will justify its ROI (return on investment)!

Thank you.

Answer by Dr Chee Hoe Kit

Dear Lai Yoke, 

Although LANAP (Laser-Assisted New Attachment Procedure) is currently not available in NDCS for treatment of gum disease, the non-surgical and surgical methods (non-laser) of gum treatment have shown to produce equally effective results as demonstrated also in evidence-based studies. 

Thank you for your suggestion for NDCS to offer LANAP in its services and this will be directed to the Periodontics Unit for its consideration in the future.

Ref: H24