Braces and Diabetes UK — What You Need to Know

How diabetes affects oral and gum health

Diabetes is a significant risk factor for periodontal (gum) disease. Elevated blood glucose levels impair immune function and reduce the body's ability to fight bacterial infection in the gum tissue. People with poorly controlled diabetes are two to three times more likely to develop periodontitis than non-diabetic individuals. Periodontitis involves loss of the bone and ligament that support the teeth — the same structures that orthodontic treatment relies on to move teeth safely. Additionally, diabetes slows wound healing and reduces saliva flow, which can increase the risk of soft tissue irritation and oral infections during brace treatment. The relationship is bidirectional: active gum disease also makes blood glucose harder to control.

What orthodontists need to know before starting treatment

Before beginning orthodontic treatment, your orthodontist should be informed of your diabetes diagnosis, whether it is Type 1 or Type 2, your current HbA1c (the three-month average blood glucose measure), and whether your diabetes is well controlled or fluctuating. If your HbA1c is above 58 mmol/mol (7.5%), many orthodontists will recommend stabilising blood glucose control before starting treatment. A periodontal assessment by your dentist or a periodontist is advisable before fixed braces are fitted — active gum disease should be treated and resolved before orthodontic forces are applied. Some orthodontists will request a letter from your GP or diabetologist confirming that treatment is appropriate at this time.

Blood glucose control during treatment

Maintaining good blood glucose control throughout orthodontic treatment is essential. High glucose levels impair healing after each adjustment appointment, increase susceptibility to gum inflammation around brackets and wires, and can slow the rate of bone remodelling that enables tooth movement. Patients should attend their regular diabetic reviews throughout treatment and inform their orthodontist of any significant changes in glucose control. If you experience a period of poor glucose control — for example, due to illness, medication changes, or lifestyle factors — it is worth informing your orthodontist, who may adjust the treatment schedule or apply lighter forces during that period.

Increased hygiene requirements for diabetic patients with braces

Fixed braces create additional plaque retention sites and make thorough cleaning more challenging. For diabetic patients, whose gum tissue is already more vulnerable to bacterial infection, oral hygiene must be meticulous. Your orthodontist or dental hygienist will advise on the right combination of tools: an electric toothbrush, interdental brushes for cleaning around brackets and under wires, and fluoride mouthwash. Diabetic patients are strongly recommended to see a dental hygienist regularly throughout treatment — every three to four months — rather than the standard six-monthly interval. Monitoring gum health at each orthodontic adjustment appointment is also important.

Healing and adjustment appointment considerations

After each adjustment appointment, the periodontal ligament undergoes controlled remodelling as teeth are moved. In diabetic patients, this healing process may be slower due to impaired immune function and reduced tissue vascularity. This can mean that tooth movement progresses more slowly, and that adjustment intervals may need to be extended. Soreness and soft tissue irritation may also last longer after adjustments. Patients should not hesitate to contact their orthodontic practice if they notice persistent gum bleeding, swelling around brackets, or signs of ulceration that are not resolving.

Clear aligners vs fixed braces for diabetics

Clear aligners offer several practical advantages for diabetic patients. They are fully removable, making oral hygiene significantly easier — there are no brackets or wires to clean around. Aligners are removed for eating and drinking, which means dietary choices are not restricted and blood glucose management is unaffected by food-related brace limitations. The smooth aligner surface is also less likely to irritate gum tissue than metal brackets. For patients with well-controlled diabetes and mild to moderate tooth misalignment, clear aligners are often the preferred option. However, for complex cases requiring precise biomechanical control, fixed braces may still be clinically indicated. Discuss the options with your orthodontist in the context of your specific case and medical history.

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This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.