cal community to develop and implement these types of referred to a physician for diabetes testing.
interventions that begin prevention of chronic diseases
early in life. Yet, unless healthcare providers believe that Several interventions targeting risk reduction should be
certain dietary practices are harmful and start to under- noted. Moderate weight loss improves glycemic control,
stand that inaction may endanger their patients, motiva- reduces CVD risk, and may prevent the development
tion to change will be very limited. of type 2 diabetes in pre-diabetic individuals. ² There is
a significant body of evidence that suggests that being

Primordial prevention of periodontal disease includes overweight in childhood and adolescence is associated targeting women of child-bearing years to ensure peri- with insulin resistance, dyslipidemia, and elevated blood odontal wellness before pregnancy, and education of chil- pressure in young adulthood. ³⁸ It is also known that dren and adults regarding the importance of oral health weight loss in obese children and adolescents improves in ensuring systemic health. insulin sensitivity. The components of the insulin-resis-tance syndrome (obesity, hypertension, dyslipidemia, and

Primary Prevention hyperinsulinemia) track from childhood to adulthood,
Primary prevention of diabetes includes aggressive supporting the conclusion that the precursors of CVD are
screening and risk-reduction strategies targeting pa- present early in life. Lifestyle modification and weight
tients with risk factors for diabetes and patients with control in overweight children and adolescents reduce
undetected diabetes. Approximately one-third of all dia- the risk of developing insulin resistance, type 2 diabetes,
betics may be undiagnosed, ² and dental providers are and CVD. ³⁸ According to the AHA, once a child or adoles-
uniquely positioned to identify these undetected cases. cent is identified as obese, vigorous clinical efforts should
Insurance utilization patterns indicate that individu- be directed at treatment. ³⁸ Currently, these interventions
als tend to seek routine and preventive oral healthcare target behavior modification; however, pharmacological
on a more frequent and regular basis than routine and approaches are being considered for the future. ³⁸ Clini-
preventive medical care, ³⁵ placing dentists and dental cians are cautioned to look for subtle signs indicating that
hygienists at the front line of screening interventions. children oradolescentsaredevelopinginsulin resistance.
In the 2006 Standards of Medical Care in Diabetes, the According to the AHA, “The best approach to prevention
ADA has established criteria for screening for diabetes of future cardiovascular disease in these young patients
in asymptomatic adults and children. ² ADA Criteria for is early recognition and aggressive therapy.” ³⁸ Without
testing for diabetes in asymptomatic adults and ADA this, it is likely that this patient population is destined to
criteria for testing for type 2 diabetes in children may be develop cardiovascular complications and require sub-
accessed in the Clinical Decision-Making Tools section at stantial resources for future management. ³⁸
www.thesystemiclink.com. These screening criteria can
be easily incorporated into new patient as well as peri- The distribution of fat tissue is an independent predic-
odic dental examinations. tor of diabetes. Abdominal obesity, defined as waist cir-
cumference of > 40 inches in men and > 35 inches in

Besides screening for diabetes utilizing the criteria rec- women, increases the risk of developing diabetes by 3. 5 ommended by the ADA guidelines, astute clinicians also fold after adjusting for BMI. ³⁹ Identifying individuals at will be aware of any oral conditions that may be a mani- risk for MSyn and modifying their risk factors may pre-festation of diabetes. Some of these include xerostomia, vent the progression to MSyn. (Criteria used to establish which may be related to thirst (a symptom of diabetes), the presence of the Metabolic Syndrome may be accessed oral mucosal diseases such as lichen planus, recurrent and downloaded from the Clinical Decision-Making Tools aphthous stomatitis and oral fungal infections, the pres- section at www.thesystemiclink.com.) For individuals ence of opportunistic infections like candidiasis, distur- diagnosed with MSyn, modifications of diet, exercise, bances in taste, and neurosensory disorders such as burn- and other lifestyle factors may help reduce detrimental ing mouth syndrome. ³⁶ Gingivitis is almost twice as preva- health consequences. ¹⁰ lent in populations of diabetic children and adolescents as it is in age-matched cohort groups without diabetes. ³⁷ On the dental side, obesity is a significant predictor of For those children who present with gingivitis, looking for periodontal disease independent of age, gender, race and less obvious signs of diabetes or unattended risk factors ethnicity, and smoking. ³ Evidence suggests that insulin may help identify undetected cases, which can then be resistance mediates the relationship between obesity