Gum disease should not be seen as a problem confined to the mouth. Periodontitis creates a low-grade but persistent inflammatory burden in the body and has a two-way relationship with certain chronic diseases, diabetes in particular. In this article, we discuss in plain language the links between gum health and general health, what the scientific evidence shows, and what it does not yet show.
How can gum disease affect general health?
In periodontitis, the inner lining of the deepened gum pockets becomes thin and ulcerated in places, forming an inflamed wound surface. From this surface, bacteria and bacterial products can occasionally enter the bloodstream; substances produced during inflammation can also contribute to raised inflammatory markers throughout the body.
These mechanisms help explain why gum disease has been found to be associated with certain systemic diseases. An important distinction should be kept in mind here: showing an association does not mean that gum disease directly causes that disease. Some links are supported by strong evidence, while others are still being researched.
What is the relationship between diabetes and gum disease?
There is a two-way relationship between diabetes and periodontitis: in people with diabetes whose blood sugar is poorly controlled, periodontitis is more common and more severe, and periodontitis can in turn make blood sugar control more difficult.
This relationship is also reflected in the 2017 periodontitis classification. In people with diabetes whose HbA1c is 7.0 percent or higher, the periodontitis grade can be raised to C. For details, see our article on periodontitis stages and grades.
The effect in the opposite direction has also been studied. A Cochrane systematic review published in 2022 reported that, in people with diabetes and periodontitis, gum treatment was associated with an average reduction in HbA1c of about 0.4 percentage points after 3–4 months compared with groups that received no treatment. Although this effect may seem small, it is at a level that can contribute to diabetes management. Gum treatment does not replace diabetes treatment; it supports it.
People with diabetes may also more often experience problems such as recurrent gum abscesses, dry mouth and delayed wound healing. For the signs of a gum abscess, see our article on gum abscess symptoms.
If you have diabetes, it is recommended that you have a periodontal examination at least once a year and inform your dentist of your latest HbA1c value and the medications you take.
Is gum disease linked to cardiovascular disease?
Yes, an association has been found; however, it has not been proven to be a cause-and-effect relationship. Observational studies show that atherosclerotic cardiovascular diseases such as heart attack and stroke are more common in people with severe periodontitis. A joint consensus report published in 2020 by the EFP and the World Heart Federation also stated that there is substantial evidence supporting an association between severe periodontitis and cardiovascular disease that is independent of other risk factors.
Some studies have reported that gum treatment is associated with improvements in inflammatory markers in the body and in measures of blood vessel function. However, there is not yet sufficient evidence that gum treatment prevents heart attack or stroke. Oral health should be considered part of the general lifestyle measures aimed at protecting heart health.
It is important for people taking blood thinners to inform their dentist before dental treatment; these medications should not be stopped without consulting the prescribing physician.
Why is gum health important during pregnancy?
Because of hormonal changes during pregnancy, the gums react more strongly to plaque, so the bleeding and swelling known as pregnancy gingivitis are common. Some observational studies have reported an association between periodontitis and preterm birth and low birth weight; however, it has not been clearly shown that gum treatment during pregnancy reduces these risks.
Even so, maintaining gum health during pregnancy is important for the mother's comfort and oral health. Necessary gum treatment can often be planned for the second trimester, based on the dentist's assessment. For details, read our article on gum health in pregnancy.
What other conditions has gum disease been linked to?
Research suggests that periodontitis may also be associated with some other systemic conditions. The strength of the evidence in these areas varies, and research is ongoing on most of them:
- Chronic kidney disease: Periodontitis has been reported to be more common in people with kidney disease and may contribute to the body's inflammatory burden.
- Rheumatoid arthritis: The two diseases are thought to share common inflammatory mechanisms.
- Respiratory infections: Improving oral hygiene has been reported to possibly reduce the risk of pneumonia, particularly in older adults living in care homes or staying in the hospital.
- Cognitive decline: A possible link between periodontitis and Alzheimer's disease is a topic of current research; no clear conclusion has yet been reached.
The fact that a disease and gum disease occur together more often does not by itself show that one causes the other. Shared factors such as smoking, diet and lifestyle can affect both conditions. Still, maintaining gum health is among the measures that contribute to general health.
What information should you give your dentist?
Information about your general health is important for planning gum treatment safely and effectively. It is recommended that you share the following at your examination:
- If you have diabetes, its type and your latest HbA1c value,
- Cardiovascular conditions and any blood thinners you take,
- Pregnancy or plans for pregnancy,
- Medications used to treat osteoporosis,
- Diseases and treatments that affect the immune system,
- Use of cigarettes and other tobacco products.
This information guides the timing of treatment, the precautions to be taken and how often check-ups are needed. For example, some medications used to treat osteoporosis may require additional evaluation when planning surgical procedures.
When should you see a dentist?
If you notice bleeding gums, swelling, bad breath, gum recession or loose teeth, you should see a dentist or a periodontist. With conditions such as diabetes, cardiovascular disease or pregnancy, regular periodontal examinations are beneficial even without obvious complaints.
Periodontist Dr. Nadin Gemrekoğlu, DDS, PhD, evaluates the gums while also taking the patient's general health into account; when needed, treatment is planned in collaboration with the patient's other physicians. You can learn about treatment options on our gum disease treatment page and visit the contact page to make an appointment.