Because diabetes reduces the body’s resistance to infection, the gums are among the tissues likely to be affected. Periodontal diseases are infections of the gum and bone that hold your teeth in place.

Periodontal disease is often linked to the control of diabetes. For example, patients with inadequate blood sugar control appear to develop periodontal disease more often and more severely, and they lose more teeth than persons who have good control of their diabetes. It is possible to have periodontal disease and not have all of the warning signs. If you notice any of the warning signs of gum disease, see your dentist immediately.

Because of lowered resistance and a longer healing process, periodontal diseases often appear to be more frequent and more severe among persons with diabetes. That’s why good maintenance of blood sugar levels, a well-balanced diet that meets your needs, good oral care at home, regular dental checkups and periodontal examinations are important.

When Joanne Maglares, now 50, visited her dentist for a broken tooth from chewing on ice, she had no inkling that her overall health was in jeopardy. A scholarship coordinator at a New York City high school and mother of four, she was so consumed with work and family that she often ignored her own well-being.

But her dentist took one look at her mouth, noticed multiple tooth fractures and rapidly advancing gum (periodontal) disease, and surmised that she had an underlying health problem.”Those were red flags that something was not right,” says her dentist, Maria Emanuel Ryan, DDS, PhD, professor of oral biology and pathology at Stony Brook University School of Dental Medicine.

Ryan urged Maglares to see her primary care doctor to get to the root of the problem. She was diagnosed and treated for high blood pressure and anemia. Five months later, she suffered a massive heart attack.

Oral Health, Overall Health

Researchers know there’s a synergic relationship between oral health and overall wellness. Gum disease is linked to a host of illnesses including heart disease, diabetes, respiratory disease, osteoporosis, and rheumatoid arthritis. By combing through 1,000-plus medical histories, researchers at the University of North Carolina School of Dentistry found that people with gum disease were twice as likely as others to die from a heart attack and three times as likely to have a stroke.

Gum disease is the most common chronic inflammatory condition in the world, yet it’s often a silent disease, Ryan says. Why? The mouth can act as a portal of entry for an infection, says Salomon Amar, DMD, PhD, professor and director at the Center for Anti-inflammatory Therapeutics at Boston University School of Dental Medicine. Ongoing inflammation in your mouth can allow bacteria to enter the bloodstream, which may lead to more inflammation in other parts of your body, such as the heart.

Some studies point to a reciprocal relationship between gum disease and diabetes.”When you treat and control diabetes, immediately the condition in the mouth improves. And when you treat periodontal disease, the need for insulin is reduced,” Amar says.

Maglares is on the road to recovery and indebted to her dentist. “If I hadn’t gone to the dentist, I don’t know if I’d be alive today. I pay a lot more attention to my teeth and gums. I believe it’s all connected.”

Teeth are tough — their enamel is the hardest part of the body — but they’re no match for neglect, misuse, or abuse. Here are some surefire ways to find out how vulnerable your teeth are — trust us, you don’t want to do this:

1. Don’t Brush After Every Meal.

The ideal is to brush your teeth three times a day: after breakfast, lunch, and dinner. But if you do it too soon, you can scrub away tooth enamel that becomes softer in the acidic environment created in your mouth when you eat.

“Make sure you wait 30 to 60 minutes after each meal, which gives the acidity time to neutralize and the teeth time to remineralize,” says Debra Gray King, DDS, FAACD, of the Atlanta Center for Cosmetic Dentistry.

Brushing too much, too hard, or with a hard-bristle brush can also erode your enamel. Brush gently, using circular strokes and a soft brush.

2. Forget About Flossing.

Flossing stimulates gum health by cleaning between the teeth and under the gum line. Gums bleed when you brush vigorously? That’s a sign of mild gingivitis, or inflammation of the gums, which can lead to tooth loss.

“You need to brush and floss your teeth every time you eat,” says Jeffrey Gross DDS, FAGD, a Cleveland dentist. “The longer food stays in contact with the teeth and the gums, the easier it is to create problems.”

3. Skip checkups.

Dentists recommend every six months, but most patients fail to comply. This allows plaque to form tartar, which attracts more plaque on its surface, carrying the plaque deeper within the gums. This can weaken supporting structures, such as bone.

“The sooner you find issues, the easier and a lot less expensive they will be to address,” King says.

4. Use Your Teeth as Tools.

Chomping ice and hard candy, not to mention popping off bottle caps and ripping open potato chip bags, can crack or break your teeth.

“People tend to do some wild things with their teeth,” King says. She recalls a patient in her 50s who habitually gripped the ropes of her sailboat’s mast between her teeth.

Over time, the woman’s natural teeth had worn to the point she needed porcelain veneers. Find a bottle opener or pair of scissors. And if you’re sailing, use your hands.

5. Ditch the Mouthguard.

The Academy of General Dentistry (AGD) recommends mouthguards for many athletes.

“Anytime there is a strong chance for contact with other participants or hard surfaces, it is advisable to wear a mouthguard. Players who participate in basketball, softball, football, wrestling, soccer, lacrosse, rugby, in-line skating, and martial arts, as well as recreational sports such as skateboarding and bicycling, should wear mouthguards while competing,” the AGD’s web site states.

The most common oral health problems associated with diabetes are:

• tooth decay;
• periodontal (gum) disease;
• salivary gland dysfunction;
• fungal infections;
• lichen planus and lichenoid reactions (inflammatory skin disease);
• infection and delayed healing;
• taste impairment.