How are periodontitis and diabetes related?

Posted: May 22, 2024
At a glance
Periodontitis and diabetes drive each other. People with diabetes are three times more likely to develop periodontitis, and the inflammation in the gums weakens the effect of insulin, so blood sugar rises and becomes harder to control. The link can be used in the other direction as well: in a Cochrane review of 35 randomised trials, treating periodontitis lowered the long-term blood sugar value HbA1c by 0.43% after three to four months (Simpson et al., 2022). Thorough oral hygiene, regular visits to the dentist and targeted action against inflammation protect the gums and the blood sugar at the same time.

Updated on: October 2, 2026

⏱ 9 min read

New research findings show that periodontitis and diabetes are mutually reinforcing! To answer the question of how these two widespread diseases are linked, it must first be clarified how periodontitis occurs.

How does periodontitis develop?

Every time you eat, small pieces of food stick to your teeth. If these are not removed thoroughly and regularly, plaque builds up. It is precisely this plaque that encourages bacteria to colonize and multiply in our mouth. This throws our entire oral flora out of balance.  

In order to get rid of the bacteria, our body fights them mercilessly with the help of the immune system. This leads to inflammatory reactions in the gums and jawbones. Both recede over time and expose the tooth necks. Gum pockets develop in which the bacteria feel right at home.

If the inflammation continues, it leads to a gum infection - periodontitis. This is a disease of the entire periodontium. Periodontitis causes the gums to detach from the teeth, damaging the gums, bone and teeth. As the disease progresses, it leads to tooth loss and other serious problems.

 

➤ Every 2nd German now suffers from periodontitis!

Periodontitis promotes diabetes

Scientists assume that periodontitis is not only responsible for tooth loss, but also for type 2 diabetes or a heart attack.

  1. Bacteria lead to severe inflammation in the mouth
  2. Reduced effect of insulin due to inflammatory molecules
  3. Blood sugar remains in the blood and blood sugar increases as a result
  4. Increased insulin production and cell exhaustion
  5. Increased risk of insulin resistance and diabetes

Advanced periodontitis leads to severe inflammation in the entire oral cavity. Inflammatory molecules lead to a reduced effect of insulin. The blood sugar is less able to reach its destination - the body cells. Instead, the sugar remains in the blood and blood sugar levels rise. The body tries to compensate for this by increasing insulin production. However, this can lead to the insulin-producing cells in the pancreas becoming exhausted. As a consequence, the risk of insulin resistance and therefore diabetes increases enormously.

This is how non-diabetics develop into pre-diabetics, pre-diabetics into diabetics and well-controlled diabetics into diabetics with poor blood sugar control.

➤ People with periodontitis have twice the risk of developing diabetes!

The inflammatory molecules that weaken insulin can be influenced through nutrients as well. In a meta-analysis of 41 randomised clinical trials, alpha lipoic acid lowered the inflammation markers TNF-α, interleukin-6 and CRP as well as fasting blood sugar and the long-term blood sugar value HbA1c (Rahimlou et al., 2019). The Herbano Diabetic Carefree Package combines R-alpha lipoic acid with the amino acid L-arginine.

Herbano Diabetic Carefree Package with R-alpha lipoic acid capsules and L-arginine capsulesView the Diabetic Carefree Package  ➜
✓ R-alpha lipoic acid + L-arginine

Current study situation

Studies confirm these statements. A Finnish study from 2018 found that the risk of diabetes was up to 50% higher in subjects suffering from severe periodontitis than in healthy subjects.

Furthermore, scientists assume that periodontitis and diabetes reinforce each other, as diabetes is associated with wound healing disorders.

Research results confirm this. Diabetics are said to be three times more likely to develop periodontitis than healthy people. Periodontitis increases insulin resistance, making it more difficult to control blood sugar levels. In addition, diabetics with periodontitis suffer more frequently from diabetes complications.

 

➤ Diabetics, in turn, have a threefold increased risk of developing periodontitis!

Periodontitis - also a danger to the heart?

Germs in the mouth not only lead to periodontitis, they threaten the entire body, including our heart! If they enter the bloodstream, they can trigger inflammation.

For example, a Korean study showed that people with periodontitis have a 15% higher risk of heart attack, stroke and cardiac death. In comparison, regular tooth brushing reduced the risk of heart attack by 9 %.

Reduce your risk of diabetes and heart attack today

  • Good oral hygiene: It is best to take preventative measures and get rid of plaque at an early stage by brushing your teeth regularly and having them professionally cleaned.
  • Regular check-ups: In addition to thorough oral hygiene, the German Diabetes Society recommends regular visits to the dentist to reduce the risk.
  • Combat inflammation in a targeted manner: Reduce inflammation in your body in a targeted manner, for example with nutritional supplements.
  • Periodontitis therapy: Some scientific studies have shown that effective periodontal treatment can reduce blood sugar levels and alleviate symptoms. Such non-surgical periodontitis therapy therefore has a positive effect on people with type 2 diabetes.

Experts also suggest that diabetes tests should be carried out specifically in dental practices, as around 2 million people in Germany alone are unaware that they have diabetes.

Which nutrients are studied for gums and blood sugar?

Combating inflammation in a targeted manner works with nutrients that have been tested in clinical trials:

  • Omega-3 fatty acids for the gums: A meta-analysis of 10 randomised trials looked at people with periodontitis who took omega-3 fatty acids alongside professional deep cleaning. Their gum pockets shrank by 0.39 mm more and the gums regained 0.41 mm more attachment to the teeth than with deep cleaning alone (Van Ravensteijn et al., 2022).
  • Alpha lipoic acid for blood sugar: In a meta-analysis of 24 randomised controlled trials in people with metabolic diseases, alpha lipoic acid lowered fasting glucose, insulin, insulin resistance (HOMA-IR) and HbA1c (Akbari et al., 2018).
  • L-arginine for blood sugar and insulin: In a meta-analysis of 10 randomised controlled trials, L-arginine lowered fasting blood sugar and the insulin level in the blood (Yousefi Rad et al., 2020).

High-dose omega-3 capsules are available on their own. R-alpha lipoic acid and L-arginine come together in the Herbano Diabetic Carefree Package.

Herbano Diabetic Carefree Package with R-alpha lipoic acid capsules and L-arginine capsulesView the Diabetic Carefree Package  ➜
✓ R-alpha lipoic acid + L-arginine

How much does periodontitis treatment lower blood sugar?

Periodontitis treatment at the dentist means that plaque and tartar are removed from below the gumline with hand or ultrasonic instruments. A Cochrane review pooled 35 randomised trials with 3,249 participants who had both diabetes and periodontitis and compared this treatment with no treatment or usual care (Simpson et al., 2022). The long-term blood sugar value HbA1c fell as follows:

Time after treatmentHbA1c reduction in %HbA1c reduction in mmol/mol
3 to 4 months0.434.7
6 months0.303.3
12 months0.505.4

The authors of the review rate this improvement in blood sugar control as clinically significant. The treatment also calms inflammation in the whole body: in an analysis of nine randomised trials in people with type 2 diabetes, it lowered the inflammation marker CRP together with HbA1c (Baeza et al., 2020). The joint guidelines of the European Federation of Periodontology and the International Diabetes Federation describe periodontal therapy as safe and effective in people with diabetes (Sanz et al., 2018).

Why does diabetes make periodontitis more likely?

Blood sugar is the decisive factor: there is a clear relationship between the degree of high blood sugar and the severity of periodontitis (Preshaw et al., 2012). The link runs through the immune system. It involves the way the immune defence works, the activity of the neutrophils, which are the white blood cells that attack bacteria first, and the inflammatory messengers. The same messengers turn up on both sides of the link: interleukin-1β, interleukin-6 and TNF-α are elevated, and oxidative stress increases (Sanz et al., 2018).

The consequences reach beyond the gums:

  • Teeth: In an analysis of 10 studies, people with diabetes had a 1.63 times higher risk of losing teeth than people without diabetes. With poorly controlled diabetes, the risk rose significantly (Weijdijk et al., 2022).
  • Kidneys: People with diabetes and severe periodontitis develop protein in the urine (macroalbuminuria) twice as often and end-stage kidney disease three times as often as people with diabetes who do not have severe periodontitis.
  • Heart and kidneys: The risk of dying from ischaemic heart disease or diabetic kidney disease is three times higher in people with diabetes and severe periodontitis than in people with diabetes without it (Preshaw et al., 2012).

How do you recognise periodontitis?

Periodontitis progresses in phases, with bouts of activity followed by quiet periods (Kinane et al., 2017). These are the signs that people with periodontitis report (Nisanci Yilmaz et al., 2022):

  • Bleeding gums
  • Swollen or sore gums
  • Bad breath
  • Loose teeth
  • Teeth that drift out of position

If you have diabetes and notice one of these signs, have your gums examined by your dentist. Prevention consists of daily oral hygiene at home and the professional removal of the bacterial film every three to six months.

Frequently asked questions

Can diabetes cause periodontitis?

Yes. Diabetics are three times more likely to develop periodontitis than healthy people, and diabetes is associated with wound healing disorders. The higher the blood sugar, the more severe the periodontitis.

Does gum disease make blood sugar harder to control?

Yes. The inflammatory molecules released in periodontitis reduce the effect of insulin, so the sugar remains in the blood and blood sugar levels rise. Periodontitis increases insulin resistance, and this is how well-controlled diabetics turn into diabetics with poor blood sugar control.

Can treating periodontitis improve A1C?

Yes. In a Cochrane review of 35 randomised trials, HbA1c was 0.43% lower three to four months after periodontitis treatment and 0.30% lower after six months. The authors rate this as a clinically significant improvement in blood sugar control.

How can I improve my periodontitis?

Remove plaque thoroughly every day, have your teeth professionally cleaned and go to the dentist regularly. Existing periodontitis is treated by the dentist, who removes plaque and tartar from below the gumline. In clinical trials, omega-3 fatty acids taken alongside this treatment reduced the gum pockets by a further 0.39 mm.

What are signs of periodontitis in people with diabetes?

Bleeding, swollen or sore gums, bad breath, loose teeth and teeth that drift out of position are the signs to look out for. Receding gums and exposed tooth necks also point to periodontitis. With diabetes, it is worth having these signs examined by the dentist straight away, because periodontitis makes blood sugar harder to control.

 

Sources (in English):

Correa, F. O., Goncalves, D., Figueredo, C. M., Bastos, A. S., Gustafsson, A. & Orrico, S. R. (2010, January). Effect of periodontal treatment on metabolic control, systemic inflammation and cytokines in patients with type 2 diabetes. Journal of Clinical Periodontology, 37(1):53-8, doi: 10.1111/j.1600-051X.2009.01498.x

Navarro-Sanchez, A. B., Faria-Almeida, R. & Bascones-Martinez, A. (2007, October). Effect of non-surgical periodontal therapy on clinical and immunological response and glycaemic control in type 2 diabetic patients with moderate periodontitis. Journal of Clinical Periodontology, 34(10):835-43, doi: 10.1111/j.1600-051X.2007.01127.x

Thorstensson, H., Kuylenstierna, J. & Hugoson, A. (1996, March). Medical status and complications in relation to periodontal disease experience in insulin-dependent diabetics. Journal of Clinical Periodontology, 23(3 Pt 1):194-202, doi: 10.1111/j.1600-051x.1996.tb02076.x

Taylor, G. W., Burt, B. A., Becker, M. P., Genco, R. J., Chlossman, M., Knowler, W. C. et al. (1996, October). Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus. Journal of Periodontology, 67(10 Suppl):1085-93, doi: 10.1902/jop.1996.67.10s.1085

Emrich, L. J., Schlossman, M. & Genco, R. J. (1991, February). Periodontal disease in non-insulin-dependent diabetes mellitus. Journal of Periodontology, 62(2):123-31, doi: 10.1902/jop.1991.62.2.123

Myllymäki, V., Saxlin, T., Knuuttila, M., Rajala, U., Keinänen-Kiukaanniemi, S., Anttila, S. & Ylöstalo, P. (2018, August). Association between periodontal condition and the development of type 2 diabetes mellitus-Results from a 15-year follow-up study. Journal of Clinical Periodontology, Volume 45, Issue 11, doi: 10.1111/jcpe.13005

Simpson TC, Clarkson JE, Worthington HV, MacDonald L, Weldon JC, Needleman I et al. (2022). Treatment of periodontitis for glycaemic control in people with diabetes mellitus. The Cochrane Database of Systematic Reviews, 4(4):CD004714. doi: 10.1002/14651858.CD004714.pub4

Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, Taylor R (2012). Periodontitis and diabetes: a two-way relationship. Diabetologia, 55(1):21-31. doi: 10.1007/s00125-011-2342-y

Sanz M, Ceriello A, Buysschaert M, Chapple I, Demmer RT, Graziani F et al. (2018). Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology. Journal of Clinical Periodontology, 45(2):138-149. doi: 10.1111/jcpe.12808

Baeza M, Morales A, Cisterna C, Cavalla F, Jara G, Isamitt Y, Pino P, Gamonal J (2020). Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis. Journal of Applied Oral Science, 28:e20190248. doi: 10.1590/1678-7757-2019-0248

Weijdijk LPM, Ziukaite L, Van der Weijden GAF, Bakker EWP, Slot DE (2022). The risk of tooth loss in patients with diabetes: A systematic review and meta-analysis. International Journal of Dental Hygiene, 20(1):145-166. doi: 10.1111/idh.12512

Kinane DF, Stathopoulou PG, Papapanou PN (2017). Periodontal diseases. Nature Reviews Disease Primers, 3:17038. doi: 10.1038/nrdp.2017.38

Nisanci Yilmaz MN, Bulut S, Bakirarar B (2022). Impact of stage-grade of periodontitis and self-reported symptoms on oral health-related quality of life. International Journal of Dental Hygiene, 20(2):291-300. doi: 10.1111/idh.12551

Van Ravensteijn MM, Timmerman MF, Brouwer EAG, Slot DE (2022). The effect of omega-3 fatty acids on active periodontal therapy: A systematic review and meta-analysis. Journal of Clinical Periodontology, 49(10):1024-1037. doi: 10.1111/jcpe.13680

Rahimlou M, Asadi M, Banaei Jahromi N, Mansoori A (2019). Alpha-lipoic acid (ALA) supplementation effect on glycemic and inflammatory biomarkers: A Systematic Review and meta-analysis. Clinical Nutrition ESPEN, 32:16-28. doi: 10.1016/j.clnesp.2019.03.015

Akbari M, Ostadmohammadi V, Lankarani KB, Tabrizi R, Kolahdooz F, Khatibi SR, Asemi Z (2018). The effects of alpha-lipoic acid supplementation on glucose control and lipid profiles among patients with metabolic diseases: A systematic review and meta-analysis of randomized controlled trials. Metabolism, 87:56-69. doi: 10.1016/j.metabol.2018.07.002

Yousefi Rad E, Nazarian B, Saboori S, Falahi E, Hekmatdoost A (2020). Effects of l-arginine supplementation on glycemic profile: Evidence from a systematic review and meta-analysis of clinical trials. Journal of Integrative Medicine, 18(4):284-291. doi: 10.1016/j.joim.2020.05.001

Important Notice

This guide is for informational purposes only and does not replace professional medical advice.

The content of the Herbano Health Editorial team is carefully researched and based on current scientific studies.

Content created with the support of artificial intelligence and edited by the Herbano Editorial team.