Key points in brief
- Gum disease can be treated when you have diabetes, and treatment follows the same stages as without diabetes: hygiene, cleaning of the pockets below the gum, checking the result, usually after about 3 months, and maintenance visits.
- When planning treatment and assessing the result, the dentist takes into account how well your diabetes is controlled, how you look after your teeth and whether you smoke. The pockets are usually cleaned without waiting for your blood sugar results to improve.
- Before the first visit, prepare your latest HbA1c result (your average blood sugar over the last 3 months) with its date, and a list of your medicines. Tell the doctor who treats your diabetes that you are starting gum treatment.
- On the day of the procedure, eat a normal meal and take your medicines as usual, unless the doctor who treats your diabetes has advised otherwise. If you notice shaking, sweating, a pounding heart or sudden hunger during the procedure, tell the dentist straight away.
- Gum treatment may slightly improve the HbA1c result in type 2 diabetes, but it does not replace diabetes treatment and is not a reason to change your medicines on your own.
Consult your case with an expert and get your treatment plan
How diabetes affects gum disease
Diabetes, especially when it is poorly controlled, raises the risk of gum disease and of a more severe course. So treating gum disease when you have diabetes starts with the question of how well your blood sugar is controlled.
Gum disease, or periodontitis, is a chronic inflammation of the periodontium, that is, the gums and the bone that hold the teeth in place. It starts with bacteria building up along the edge of the gum. Over time, pockets form between the tooth and the gum, and the inflammation gradually destroys the bone around the root. The disease does not hurt for a long time - the first sign can be bleeding gums when brushing, and later receding gums and loose teeth.
When blood sugar stays high for a long time, proteins in the gums become permanently bound to glucose. The body then reacts to bacteria with stronger inflammation, and the bone around the tooth repairs itself less well. The less well controlled the diabetes, the greater this effect usually is. This applies to both types of diabetes, although most is known about type 2.
The link also works the other way: periodontitis is associated with poorer blood sugar control and with complications of diabetes. Gum treatment may slightly improve the HbA1c result in type 2 diabetes, but it does not replace diabetes treatment. That is why European specialists in gum disease and family doctors recommend that the dentist and the family doctor work together.
If you have diabetes and are planning an implant, read the article on when a dental implant is possible with diabetes. In that case the gums are treated first, and further criteria decide about the implant itself.
What to tell your dentist and the doctor who treats your diabetes
Tell your dentist:
- which type of diabetes you have and since when;
- your latest HbA1c result and the date of the test;
- the full list of your medicines - especially insulin and any tablets after which your blood sugar sometimes drops too low;
- whether you have episodes of low blood sugar and how you recognise them, and, if you wear a glucose sensor, what your readings have looked like over the last few days;
- whether diabetes has already caused complications, for example in the kidneys or the eyes, and whether you smoke.
Ask your dentist how many visits to expect, when the result will be checked and what you can do yourself between visits. Tell the doctor who treats your diabetes that you are starting gum treatment, how many visits the dentist is planning and when the procedures with a local anaesthetic will take place. It is this doctor who decides whether anything should change in your diabetes medicines. Do not stop or change any medicine on your own before a dental visit.
On the day of the procedure:
- eat a normal meal and take your medicines as usual, unless the doctor who treats your diabetes has advised otherwise;
- bring your blood glucose meter or glucose sensor reader, and something sweet;
- if you notice shaking, sweating, a pounding heart or sudden hunger during the procedure, tell the dentist straight away. The dentist then stops the procedure and checks your blood sugar first.
Stages of gum disease treatment with diabetes and how the result is checked
Gum disease treatment in people with diabetes follows the same order as in people without diabetes. Diabetes control is part of it from the first stage: the dentist asks about your results and talks to you about blood sugar and diet.
| Stage | What research and guidelines say | What the dentist checks at the practice |
|---|---|---|
| Hygiene at home and diabetes control | diabetes control is part of gum treatment from start to finish | how much plaque is left after brushing, which areas bleed, the latest HbA1c result |
| Thorough cleaning of the pockets below the gum | in people with diabetes, the pockets become shallower and the gums bleed less often; the effect may be similar to that in people without diabetes | whether all the pockets have been cleaned and how the gums heal over the following weeks |
| Checking the result | the result is assessed only once the gums have healed | measuring the pockets again: which have become shallower and stopped bleeding, and which are still deep |
| Further treatment of deep pockets | the guidelines provide for repeated cleaning or a procedure on the gum | whether diabetes is well controlled before a surgical procedure is planned |
| Maintenance visits | an interval of 3 to 12 months, matched to the risk and the condition of the gums | pocket depth, bleeding, hygiene and the current HbA1c result |
In the first stage, tartar and deposits are removed from the teeth above the gum, and you learn to clean between your teeth, most often with interdental brushes. The aim of the whole treatment is a state in which no deep pockets remain and the slightly deeper ones do not bleed when measured. The dentist carries out the pocket cleaning and any further treatment, but the result also depends on how your gums heal between visits, and that is something you can influence.
What the first examination and the treatment plan look like
Before the first stage begins, the dentist talks to you about your diabetes and examines your gums. The dentist measures the pockets with a thin probe, gently slid between the tooth and the gum, and records which areas bleed. When the gums are inflamed, the measurement can be unpleasant, but it usually does not need an anaesthetic. The dentist also checks whether any teeth are loose, and uses X-rays to assess how much bone has been lost.
On this basis, the dentist establishes how advanced the disease is and how fast it is progressing. In your records, this is noted as a stage and a grade: the stage describes how much tissue has already been lost, and the grade describes how fast the disease is moving. When assessing the grade, the dentist takes diabetes into account, because it can speed up the progression of the disease.
The plan usually involves several visits. The pockets are usually cleaned under local anaesthetic. The cleaning can be spread over several shorter visits or done in one or two longer ones. In people with type 2 diabetes, neither approach has been shown to work better for the gums. So the choice depends on how widespread the disease is, your general health and how well you cope with longer procedures. Before the procedure, the dentist may ask you to check your blood sugar with a glucose meter - especially if you are treated with insulin.
At the practice, you will hear the terms closed and open curettage. Closed curettage is cleaning of the pockets under local anaesthetic. Open curettage is a surgical procedure for pockets that are still deep after cleaning: the dentist folds back the gum.
Diabetes on its own is usually not a reason to add antibiotic tablets to the cleaning. The European guidelines do not recommend them routinely. In studies, people with diabetes reported side effects, such as diarrhoea, more often than other patients after a combination of two antibiotics often used in gum treatment. If the pockets do not respond to treatment, or the dentist is considering an antibiotic, the dentist may suggest a periodontal pocket bacteriological test, which shows which bacteria live in the pocket.
What diabetes control changes in healing
With poorly controlled diabetes, wounds heal more slowly. Even so, pocket cleaning usually does not wait: the dentist cleans the pockets, and at the same time the doctor who treats your diabetes helps to stabilise your blood sugar. Surgical procedures on the gum, such as open curettage, are usually put off until blood sugar is better controlled.
If your HbA1c result is high or your blood sugar swings a lot, the dentist refers you to the doctor who treats your diabetes to improve its control. It is not yet known whether poorly controlled diabetes weakens the effect of pocket cleaning. The dentist will assess the effect in your case once your gums have healed.
You have a real influence on how your gums heal. Clean your teeth thoroughly, including the spaces between them, and keep to regular meals and blood sugar checks. Alongside diabetes, smoking is one of the two main risk factors for gum disease, and it can worsen the result of treatment. The guidelines therefore recommend help with stopping smoking. If increasing swelling, pus or a fever appears after the procedure, call the practice the same day.
Maintenance visits and working with your doctor
Maintenance visits begin once treatment of the pockets is finished, and they continue for years. With diabetes, the interval between them can be shorter than in people without other long-term conditions, because diabetes is one of the main risk factors for gum disease. When your blood sugar and gums are stable, the dentist may lengthen the interval over time. When diabetes control gets worse or the gums start bleeding again, the dentist shortens it.
Regular visits matter a great deal for whether the result lasts. They are part of periodontal treatment, that is, treatment of gum disease, just like pocket cleaning. At each of them, your teeth are professionally cleaned.
Everyone involved in this care has their own role:
| Who | What they keep an eye on |
|---|---|
| Dentist | pockets, bleeding and hygiene at every maintenance visit |
| The doctor who treats your diabetes | HbA1c result, medicines and complications |
| You | daily cleaning of your teeth and the spaces between them, blood sugar checks, visits to both doctors |
Bring your current HbA1c result to every dental visit and mention any changes in your medicines. Pass on to the doctor who treats your diabetes what the dentist says about your gums. If your gums start bleeding again when you brush between visits, do not wait for the scheduled appointment - it is a sign that the inflammation may be coming back.
How to start treating gum disease when you have diabetes
Do not put off gum treatment until your blood sugar is perfect, because pocket cleaning and diabetes control are usually carried out at the same time. Bring your latest HbA1c result and a list of your medicines to the first visit. Once treatment of the pockets is finished, come to the scheduled maintenance visits, because whether the result lasts depends to a large extent on them.
Frequently asked questions
Does gum disease raise HbA1c?
Gum disease can make blood sugar harder to control. Long-term inflammation is also associated with complications of diabetes. Among people with type 2 diabetes, those with periodontitis usually have a higher HbA1c result than those with healthy gums. However, it is not possible to predict by how much gum disease raises the result in a particular person. So gum treatment complements diabetes treatment, but does not replace it.
Does periodontal treatment lower HbA1c in people with diabetes?
In type 2 diabetes, the HbA1c result may improve slightly after gum treatment, on average by a few tenths of a percentage point within 3–6 months. This is an average across many people: in your case, the fall may be larger, smaller or none at all. It is not known exactly how long this improvement lasts. Do not change your medicines because of it.
Is gum treatment different with type 1 diabetes?
No, the principles are the same: hygiene, cleaning of the pockets, checking the result and maintenance visits. Type 1 diabetes also makes periodontitis more likely. However, it is not known whether gum treatment improves the HbA1c result in type 1, because most studies concern type 2. With insulin treatment, low blood sugar is more likely, so a meal before the visit and a glucose meter to hand are particularly important.
When does the dentist check whether gum treatment has worked?
The result of gum treatment is usually assessed about 3 months after the pockets are cleaned, once the gums have healed. The dentist then measures the pockets again and checks which have stopped bleeding and which need further treatment: repeated cleaning or a procedure on the gum. With poorly controlled diabetes, the gums may heal more slowly, so the dentist sets the date after looking at them.
How do the gums heal in the first two weeks when blood sugar is high?
With poorly controlled diabetes, wounds heal more slowly, although it is not known exactly by how much. In people without diabetes, the thin layer of tissue that attaches to the tooth rebuilds within about 2 weeks of cleaning. During this time, clean your teeth gently but thoroughly, do not smoke and keep an eye on your blood sugar. Report increasing swelling, pus or a fever the same day.
Read more:
- Periodontist in Warsaw Wola
- Periodontitis: Symptoms, causes and modern treatment methods. How to treat periodontal disease
- Closed vs open curettage — a comparison of methods for treating advanced periodontitis
- Periodontal pocket bacteriological test – is it worth it and when does it make sense
- Bleeding gums when brushing — when is it normal and when is it a sign of disease?
Content and liability disclaimer
This article is informational and educational in nature and does not constitute medical advice, a diagnosis or a therapeutic recommendation — it does not replace a consultation with a specialist. If you are experiencing symptoms, have doubts or are facing a decision about treatment, consult a dentist. The methods described and the data cited are general in nature. The results of scientific studies relate to populations, not to an individual patient. The course and outcome of therapy depend on the individual clinical situation and may vary between patients. No information contained in this article constitutes a guarantee of result. The content has been prepared with due care, based on publicly available medical knowledge and the scientific publications indicated in the Sources section. We do not advise taking or refraining from any health-related action solely on the basis of the content of this article, without prior consultation with a doctor.
Sources
Source 1
Links https://doi.org/10.1111/prd.12270 │ https://pubmed.ncbi.nlm.nih.gov/32385881/
Description Genco RJ, Borgnakke WS. „Diabetes as a potential risk for periodontitis: association studies.” Periodontology 2000. 2020;83(1):40-45.
Source 2
Links https://doi.org/10.1111/prd.12318 │ https://pubmed.ncbi.nlm.nih.gov/31850631/
Description Graves DT, Ding Z, Yang Y. „The impact of diabetes on periodontal diseases.” Periodontology 2000. 2020;82(1):214-224.
Source 3
Links https://doi.org/10.1111/jcpe.13807 │ https://pubmed.ncbi.nlm.nih.gov/36935200/
Description Herrera D, Sanz M, Shapira L, Brotons C, Chapple I, Frese T, Graziani F, Hobbs FDR, Huck O, Hummers E, Jepsen S, Kravtchenko O, Madianos P, Molina A, Ungan M, Vilaseca J, Windak A, Vinker S. „Association between periodontal diseases and cardiovascular diseases, diabetes and respiratory diseases: Consensus report of the Joint Workshop by the European Federation of Periodontology (EFP) and the European arm of the World Organization of Family Doctors (WONCA Europe).” Journal of Clinical Periodontology. 2023;50(6):819-841.
Source 4
Links https://doi.org/10.1111/jcpe.13290 │ https://pubmed.ncbi.nlm.nih.gov/32383274/
Description Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Berglundh T, Sculean A, Tonetti MS; EFP Workshop Participants and Methodological Consultants. „Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline.” Journal of Clinical Periodontology. 2020;47(Suppl 22):4-60.
Source 5
Links https://doi.org/10.1007/s00784-023-05392-6 │ https://pubmed.ncbi.nlm.nih.gov/38147183/
Description Joseph P, Prabhakar P, Holtfreter B, Pink C, Suvan J, Kocher T, Pitchika V. „Systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of non-surgical periodontal treatment in patients with concurrent systemic conditions.” Clinical Oral Investigations. 2024;28(1):21.
Source 6
Links https://doi.org/10.1111/jre.13327 │ https://pubmed.ncbi.nlm.nih.gov/39343708/
Description Corbella S, Alberti A, Donos N, Morandi B, Ercal P, Francetti L, Calciolari E. „Efficacy of different protocols of non-surgical periodontal therapy in patients with type 2 diabetes: A systematic review and meta-analysis.” Journal of Periodontal Research. 2025;60(5):417-437.
Source 7
Links https://doi.org/10.1111/jcpe.13704 │ https://pubmed.ncbi.nlm.nih.gov/35851689/
Description Retamal-Valdes B, Tavares APL, Monique S, Pereira da Silva HD, Mestnik MJ, Duarte PM, Miranda TS, Borges I, Soares GMS, Faveri M, Castro Dos Santos N, Graças YTD, Souto MLS, Giudicissi M, Romito GA, Saraiva L, Pannuti CM, Figueiredo LC, Feres M. „Adverse events of metronidazole and amoxicillin: Retrospective analysis of a large data set of five randomized clinical trials.” Journal of Clinical Periodontology. 2022;49(11):1121-1132.
Source 8
Links https://doi.org/10.1111/jcpe.13830 │ https://pubmed.ncbi.nlm.nih.gov/37257917/
Description Oliveira VB, Costa FWG, Haas AN, Júnior RMM, Rêgo RO. „Effect of subgingival periodontal therapy on glycaemic control in type 2 diabetes patients: Meta-analysis and meta-regression of 6-month follow-up randomized clinical trials.” Journal of Clinical Periodontology. 2023;50(8):1123-1137.
Source 9
Links https://doi.org/10.1111/jre.70086 │ https://pubmed.ncbi.nlm.nih.gov/41664833/
Description Castelluzzo W, Rupe C, Nieri M, di Martino M, Zini M, Sartori A, Tasco A, Spoleti F, Barbato L, Cairo F. „Timing of Re-Evaluation After Periodontal Therapy: A Randomized Clinical Trial.” Journal of Periodontal Research. 2026;61(5):560-571.