Diabetes and gum disease travel a two-way street. Develop one condition and you raise your risk of developing the other. As one 2014 paper put it,

Diabetes increases the risk for periodontitis (particularly if poorly controlled) and evidence suggests that advanced periodontitis also compromises glycaemic control. Periodontal treatment has been associated with improvements in glycaemic control (with HbA1c reductions of approximately 0.4% reported in systematic reviews and meta-analyses), though more research is required to investigate this further.

To put that in more everyday language, if you’ve got poorly-controlled diabetes, you’re more likely to develop severe gum disease. At the same time, severe gum disease makes it harder to control your blood sugar.

The glimmer of good news is that treating the gum disease may improve diabetic symptoms.

And that’s important, because periodontitis is the destructive form of gum disease. It’s not just your gum tissue at risk but the alveolar bone that supports your teeth. As bone is lost, your teeth begin to loosen in their sockets. With less and less to support them, they’ll eventually fall out – if your dentist doesn’t recommend them for extraction before things get to that point.

That raises an interesting question: Just how much of a difference does glycemic control make when it comes to tooth loss? That’s the focus of a study published this past summer in Diabetology International.

Its authors culled and analyzed data from over a quarter million Japanese individuals in a database of employment-based health insurance claims and medical checkup data. Participants were grouped according to both HbA1c and fasting blood glucose levels. The researchers then compared participant’s glycemic status with the number of natural teeth they had.

testing blood glucose What they found was a continuous relationship between glycemic control and tooth loss in adults over the age of 30. The higher their glucose levels, the fewer natural teeth they had compared to their peers with better glycemic control.

Unsurprisingly, smokers who struggled to control their blood sugar showed even greater tooth loss. After all, smoking or other tobacco use is the number one risk factor for developing periodontitis. (What might surprise you is the number two factor, according to some research: sleep debt.)

Of course, a poor diet – made up largely of ultra-processed foods, including lots of added sugars and refined carbs – plays a big role in gum disease, as well, and not just by helping control blood sugar. It also helps you maintain a healthy gut (yes, gut health and gum disease are linked, too!) and more alkaline conditions in the mouth.

Ultimately, it’s a two-pronged strategy of regular periodontal treatment and better glycemic control that gives you the best odds of keeping all of your natural teeth for a lifetime.