A bidirectional relationship between diabetes and oral health is widely recognised.[i] There have never been more diabetic people than today; an estimated 6 million people are affected in the UK, with more than 4.7 million having a diagnosis and another 1.3 million estimated to have type 2 diabetes but are yet to be diagnosed.[ii]
Dental professionals are in turn expecting to treat more diabetic patients, as well as people who are pre-diabetic. This requires up-to-date knowledge of how diabetes interacts with oral healthcare, what patients need to consider in their routines, and what dental practices should be aware of in order to fully support patients.
Managing diabetes
Patients with poorly controlled diabetes are predisposed to a greater risk of developing periodontal disease. Increased inflammation is heavily linked with both type 1 and type 2 diabetes, with a heightened inflammatory cytokine expression observed in periodontal tissues.[iii] This response can be incredibly damaging, and patients should be warned of such a connection; if they already have poor oral hygiene routines, the chances of destructive periodontitis will no doubt be of concern.
Hyperglycaemia, where blood sugar levels are too high, mostly affects diabetic patients.[iv] The condition can result in increased oxidative stress in the periodontium, elevating inflammatory mediators which in turn cause periodontitis.[v] The potential evidence of an association between the oral health condition and hyperglycaemia has been explored in the literature, with a noted awareness of an increase in plasma glucose exacerbating inflammation and causing the destruction of the crestal alveolar bone.
Patients with diabetes will likely be aware of the need to take considerable care with their diets in order to optimise their wellbeing. Whilst large changes are not necessarily needed in each case, a balanced diet will be imperative to managing blood sugar levels.[vi] Carbohydrate intakes may need to be adjusted in accordance with insulin dosage in order to avoid hypoglycaemia.vi Those that are able to maintain a healthy, balanced diet will be part of the way towards reducing their periodontal disease risk; patients that are struggling to manage their diabetes and their diet, however, are predisposed to greater risks of periodontal disease alongside systemic problems. Clinicians can therefore act as a source of support by reinforcing dietary advice where appropriate in everyday appointments.
Support in the practice
Aiding diabetic patients in the dental practice takes many forms. In person, clinicians will be expected to provide a thorough oral health needs assessment, including screeding for periodontitis. Treatment, if needed, will then be tailored to the individual’s needs.[vii]
The NHS notes that integrated healthcare support would see patients with diabetes being signposted to see a general dental practitioner for a periodontal screening, and to repeat this visit with regularity. Whilst patients are not routinely screened for type 2 diabetes, conversations around its link with periodontitis may heighten awareness and support the patient base of undiagnosed individuals too.vii
Not only does an integrated workflow ensure patients receive timely treatment, with more effective outcomes the sooner that periodontitis is intercepted, but an economic analysis shows that periodontal treatment is cost effective for those with type 2 diabetes, assuming improvements in blood glucose levels are well maintained.[viii]
Support will also need to be in place for patients that encounter diabetes-related difficulties on practice premises. Hypoglycaemia, sometimes referred to as ‘a hypo’, is where blood sugar is low and requires fast treatment. Usually, this can be managed by the individual. Affected patients may feel dizzy, anxious, tired or weak, and experience shaking, tingling lips and confusion.[ix] They may have food or drink on hand to raise their blood sugar quickly, but it may be worth keeping glucose tablets or drinks on hand for unexpected emergencies. This can then be followed by a slow-release carbohydrate, such as biscuits or bread. In more extreme situations, contact the emergency services immediately.
Management at home
Support for patients does not end in the dental practice. Effective oral hygiene advice for diabetic patients will include the recommendation of regular toothbrushing and interdental cleaning with reliable solutions. Where the management of the periodontal tissue can aid diabetes control, trusted adjuncts are imperative.
The Cordless Pulse water flosser from Waterpik™ is a key addition that clinicians can recommend with confidence, as more than 80+ clinical research studies back its effectiveness. The rechargeable unit features two pressure settings for ultimate comfort, whilst removing up to 99.9% of plaque bacteria from treated areas,[x] and being twice as effective as string floss for improving gum health.[xi]
Diabetic patients need to pay close attention to their oral health to maximise their wellbeing. A clinical understanding of the relationship between diabetes and periodontal disease, other problems that may arise, and the steps that can be taken to maximise patient health is vital for every oral healthcare professional.
For more information on Waterpik™ water flosser products visit www.waterpik.co.uk. Waterpik™ products are available from Amazon, Costco UK, Argos, Boots and Tesco online and in stores across the UK and Ireland.
[i] Natarajan, P., Madanian, S., & Marshall, S. (2025). Investigating the link between oral health conditions and systemic diseases: A cross-sectional analysis. Scientific reports, 15(1), 10476.
[ii] Diabetes UK, (N.D.) How many people in the UK have diabetes? (Online) Available at: https://www.diabetes.org.uk/about-us/about-the-charity/our-strategy/statistics [Accessed June 2026]
[iii] Graves, D. T., Ding, Z., & Yang, Y. (2020). The impact of diabetes on periodontal diseases. Periodontology 2000, 82(1), 214-224.
[iv] NHS, (2026). High blood sugar (hyperglycaemia). (Online) Available at: http://www.nhs.uk/conditions/high-blood-sugar-hyperglycaemia/ [Accessed June 2026]
[v] Mirzaei, A., Shahrestanaki, E., Daneshzad, E., Heshmati, J., Djalalinia, S., Asayesh, H., … & Qorbani, M. (2021). Association of hyperglycaemia and periodontitis: an updated systematic review and meta-analysis. Journal of Diabetes & Metabolic Disorders, 20(2), 1327-1336.
[vi] British Heart Foundation, (2026). Diet and diabetes: how can I eat healthily? (Online) Available at: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/nutrition/diet-and-diabetes [Accessed June 2026]
[vii] NHS England, (2024). Commissioning standard: dental care for people with diabetes. (Online) Available at: https://www.england.nhs.uk/long-read/commissioning-standard-dental-care-for-people-with-diabetes/ [Accessed June 2026]
[viii] National Institute for Health and Care Excellence, (2022). Periodontal treatment to improve diabetic control in adults with type 1 or type 2 diabetes. (Online) Available at: https://www.nice.org.uk/guidance/ng17/evidence/d-periodontal-treatment-to-improve-diabetic-control-in-adults-with-type-1-or-type-2-diabetes-pdf-11129467357 [Accessed June 2026]
[ix] NHS, (2023). Low blood sugar (hypoglycaemia). (Online) Available at: https://www.nhs.uk/conditions/low-blood-sugar-hypoglycaemia/ [Accessed June 2026]
[x] Gorur, A., Lyle, D. M., Schaudinn, C., & Costerton, J. W. (2009). Biofilm removal with a dental water jet. Compendium of continuing education in dentistry (Jamesburg, NJ: 1995), 30, 1-6.
[xi] Mancinelli‐Lyle, D., Qaqish, J. G., Goyal, C. R., & Schuller, R. (2023). Efficacy of water flossing on clinical parameters of inflammation and plaque: a 4‐week randomized controlled trial. International Journal of Dental Hygiene, 21(4), 659-668.
