quite low. ⁹ It is unfortunate that oral health was barely graphics, and genetic predispositions. The rise in urban-
addressed in the 2006 Clinical Practice Recommendations ization and changes in lifestyle play a role as well as an
of the American Diabetes Association for the Standards increased prevalence of obesity. In the United States, obe-
of Medical Care in Diabetes. ¹⁰ Currently there is no cure sity is known to play a major role in increasing the risk for
for diabetes and periodontitis, but with the appropriate diabetes. ^{14, 15} With more than 60% of the adult population
therapy and regular follow-up care of motivated patients, now considered overweight or obese, addressing obesity
these diseases can be controlled. Successful management in our dental patients can no longer be considered an op-
of these diseases requires frequent monitoring and care- tional practice.
ful attention to therapeutic responses, both glycemic con-
trol and periodontal status. This level of diabetes care is There are a number of systemic diseases and conditions
best facilitated by a team of healthcare providers from that can increase a patient’s susceptibility to periodontitis,
both medicine and dentistry including physicians, nurses, with significant data supporting a 2 to 3 times greater risk
diabetes educators, dieticians, dentists, dental hygienists, for developing periodontal disease in diabetic patients. ¹⁶
and a number of other specialists. Poor metabolic control of diabetes may render an indi-
vidual more susceptible to developing periodontitis and,

Diabetic Patients’ Unique Dental Needs once developed, may lead to more aggressive disease. ^17-26 and Opportunities for Intervention It should be noted that well-controlled adult diabetic pa-The Center for Disease Control and Prevention (CDC) cur- tients generally do not exhibit the periodontal destruction rently estimates 20. 8 million people have diabetes, ac- commonly associated with poorly controlled diabetes. ¹⁶ counting for 7% of the United States population (2005). ¹¹

This represents an increase of 2. 6 million Americans It is also important to astutely watch for oral manifes-
from the 2004 estimates, and a dramatic jump in preva- tations of underlying disease. The presence of significant
lence in just one year. Of this large population, 14. 6 mil- periodontitis with no evident risk factors such as smok-
lion people have been diagnosed with diabetes;however, ing or poor oral hygiene may be a sign of underlying
most disturbing are the 6. 2 million individuals with dia- systemic disease such as diabetes. Dental practitioners
betes that have not been diagnosed. ¹¹ It is estimated that should be very suspicious of rapidly progressing cases of
an additional 41 million adults between the ages of 40 periodontitis with no apparent risk factors. Periodontal
and 74 are considered pre-diabetic; once pre-diabetic, risk assessment needs to be conducted on a regular basis
individuals have a significantly increased risk of develop- since a patient’s non-genetic risk may change due to en-
ing type 2 diabetes, heart disease, and stroke. Evidence vironmental and systemic factors. Accordingly, suspicious
described later in this article indicates that chronic in- cases of periodontitis should be referred to a physician
flammation may play a role in converting pre-diabetic for evaluation of underlying systemic contributions such
individuals to diabetics. Screening for both undiagnosed as those seen in diabetes.
diabetes and prediabetes among dental patients repre-
sents a valuable opportunity for dental practitioners to Diabetic patients may also experience diminished salivary
become involved in helping to identify diabetes in in- flow and increased sugar in both saliva and the gingival
dividual patients and reversing these alarming epide- crevicular fluid. These factors, in turn, may lead to in-
miologic trends. ¹¹ For guidance on referring an asymp- creased plaque and calculus formation, thereby increas-
tomatic adult or child for diabetes testing, readers may ing the risk of developing periodontal disease and dental
download the American Diabetes Association (ADA) Cri- caries. Xerostomia can contribute to the development of
teria for testing for diabetes in asymptomatic adults and candidiasis and burning mouth and tongue. Palliative in-
ADA Criteria for testing for type 2 diabetes in children, terventions for xerostomia or dry mouth include saliva
which may be accessed in the Clinical Decision-Making substitutes and stimulants. The administration of antifun-
Tools section at www.thesystemiclink.com. gal agents may be necessary for the management of can-
didiasis. The management of oral burning sensations may

From 1980-2004, the number of Americans with diabetes include the maintenance of adequate oral hydration and more than doubled. ¹² In the year 2004, about 1. 4 million restrictions on the intake of caffeine and alcohol. Because adults between 18 and 79 years of age were diagnosed diabetic individuals have a greater risk of infection and with diabetes. ¹³ Why was there such a rise? The reasons impaired wound healing, patient education and preven-include increasing awareness, longevity, change in demo- tive measures need to be incorporated into diabetic case