Gingivitis is a very common condition¹. The NHS reports that approximately half of adults in the UK have gingivitis or a more serious form of gum disease¹. One contributory factor is that carbohydrates are broken down by saliva into glucose and acids in the mouth. Additionally, if blood sugar is high, saliva will have higher levels of glucose encouraging bacteria to grow and increase the risk of gum damage¹. If not treated early, gingivitis may develop into more serious forms of gum disease such as periodontitis¹.

Clinical research has consistently confirmed that periodontal treatment leads to improvements in glycaemic control2. In a review published in 2013, Professor P Preshaw concluded²:

“There is no doubt that diabetes (particularly if glycaemic control is poor) increases the risk of periodontitis. Furthermore, periodontitis appears to have a negative effect on diabetes, and treatment of periodontitis has been consistently shown in meta-analysis to result in reductions of HbA1c of around 0.4%.”

What should a community pharmacy do?

1. Identify patients with diabetes who come into the Pharmacy with a prescription for diabetes related medicines
2. Ask whether the person with diabetes has sore gums or spits traces of blood after brushing their teeth.
3. State that it is very important to look after your mouth and brushing and flossing regularly is important. Refer to http://www.bdasmile.org/adults/adults.cfm?contentid=1116&contentparentid=1036
4. Ask about smoking. Smoking makes gum disease worse so consider stopping³
5. Reinforce the need to visit the dentist and hygienist on a regular basis

Offer the following advice:

Use a soft to medium small head tooth brush and replace every three months⁴
Brush at least twice daily using a pea sized blob of fluoride toothpaste4 (at least 1,350ppm)
Brush with a circular motion (not up and down) and make sure you reach the difficult to reach parts, like behind the teeth⁴
Use floss regularly⁴
Consider using chlorhexidine based mouthwash if gums bleed
See your dentist on a regular basis and visit your hygienist