Can diabetes cause bad breath?

Diabetes affects the mouth in several connected ways, according to NIDDK and NIDCR:

• Gum disease. High blood glucose raises the chance that gum disease will progress from mild to severe. NIDCR notes periodontal disease can cause persistent bad breath, and MouthHealthy calls it the most common dental concern for people living with diabetes.
• Dry mouth. NIDDK describes dry mouth as an important sign of diabetes. Less saliva means bacteria build up on the tongue and teeth.
• More glucose in saliva. NIDCR explains that diabetes can raise the sugar level in saliva, which, together with dry mouth, can lead to thrush, a fungal infection.
• Slower healing and a higher risk of infection after dental work.

The relationship runs both ways: MouthHealthy notes that serious gum disease can make blood sugar harder to control, and research suggests treating gum disease may help blood sugar control.

The NHS advises calling emergency services or going to the emergency department if you have a high ketone level or symptoms of DKA such as fruity-smelling breath with thirst, frequent urination, sleepiness or confusion. MedlinePlus describes DKA as a medical emergency.

NIDDK suggests checking your mouth regularly for:

• Gums that are red, swollen or bleeding
• Gums pulling away from your teeth
• Loose teeth or growing spaces between teeth
• Dry mouth
• Bad breath that does not go away when you brush your teeth

NIDCR adds dryness, soreness, white patches or a bad taste. Painful white patches can be thrush, a fungal infection that NIDDK says is more likely with diabetes; a dentist or doctor can treat it.

1. Keep your blood glucose in your target range. NIDCR says people with poor glucose control get gum disease more often and more severely.
2. Brush twice a day and clean between your teeth daily to control the plaque that drives gum disease.
3. Clean your tongue as part of your routine; it is the main home of odor bacteria in most mouths.
4. Ease dry mouth with water through the day and sugar-free gum, and ask your dentist about saliva substitutes if needed.
5. Tell your dentist you have diabetes and about any changes in your glucose levels or medicines, as NIDDK advises.
6. Do not smoke. NIDCR notes smoking makes gum disease worse.
7. If you wear dentures, clean them daily and take them out at night; tell your dentist if they do not fit well or your gums are sore.

For gum disease, a dentist may do a deep cleaning below the gumline or refer you to a periodontist, a gum specialist. Thrush is treated with antifungal medicine from a dentist or doctor. For dry mouth, a dentist or doctor may suggest products or prescribe medicine to keep the mouth moist. If you need extensive dental work, NIDDK suggests asking your doctor how to manage your glucose and medicines around the procedure, since high glucose raises the risk of infection and slows healing.

See a dentist if you have bleeding gums, loose teeth, persistent dry mouth or bad breath that brushing does not fix. See your doctor if you have dry mouth with thirst, frequent urination or unexplained weight loss and have not been diagnosed with diabetes, since these can be early signs. Get emergency care for fruity breath with the DKA symptoms above.