Diabetes Overview

Hypertension, hyperlipidemia, and type 2 diabetes (T2D) are becoming more prevalent in younger age groups; in some instances parents may find themselves outliving their children who succumb to these diseases.2

In 2000, one of the most insightful reports surfaced in the form of a directive by the nation’s Surgeon General urging action by the dental community to promote access to care for all Americans. The Surgeon General’s intention was to educate, motivate, and mobilize the public to tackle a variety of access issues head on. In addition to the oral health initiatives, the U.S. government realizes the medical cost drain on the national resources and that the greatest resource is the health of its people. In remarks made at the time of the report’s release, the Surgeon General stated:

“In the past half-century, we have come to recognize that the mouth is a mirror of the body, it is a sentinel of disease, and it is critical to overall health and well-being. The challenge facing us today – to help all Americans achieve oral health – demands the best efforts of public and private agencies as well as individuals.”3

Dentistry plays a major role in reaching these goals by accepting our responsibility in helping individuals reach their full health potential, which includes an active role in recognizing diabetes and overall care. Improved outcomes in the health of the patient with diabetes are accomplished through the collaboration of all members of the healthcare team along with an education component from each discipline on management and self-care. In July 2018, the US Department of Health and Human Services announced that the Surgeon General’s Report on oral health will be updated and will include the effects of poor oral health on physical and economic well-being.

Referring to diabetes mellitus as a disease would be inaccurate since diabetes is considered to be a group of metabolic diseases which are more precisely described as a constellation of metabolic abnormalities or a multifaceted syndrome. Frequently, patients will reveal that they have a “touch of sugar,” yet “sugar” is only one component of diabetes. Diabetes is a systemic condition distinguished by abnormalities in the metabolism of carbohydrates, proteins, fats, and insulin. Patients may even share that they have “borderline” diabetes and feel they just need to watch their dietary intake of “sugar,” yet even a diagnosis of pre-diabetes can lead to the long-term complications associated with diabetes. Another common myth is that the patient’s diabetes went away. The patient had been diagnosed with diabetes but they are no longer on insulin or an antidiabetic medication and, therefore, no longer have diabetes. Unfortunately, diabetes is a chronic condition.

The Centers for Disease Control and Prevention (2017) has indicated that 9% of the U.S. population (23 million) have diabetes that has been diagnosed, with an estimated 24% (7 million) who are undiagnosed. An additional 34% (84 million) of American adults ages 18 and over are estimated to have pre-diabetes. T2D accounts for approximately 95% of individuals with diabetes over the age of 30, with an alarming increase in obese children and adolescents (Figure 1). An estimated 193,000 children age 10 years and younger have T2D.4

Figure 1.
Source: CDC. Diabetes.

Research supporting the association between diabetes and oral health is not new. Documents of the impact of systemic disease on oral health and the impact of poor oral health on progression of a systemic disease date back to the times of Hippocrates.5 Yet, much is still to be learned and shared regarding the effect of diabetes on oral health and how these oral issues impact diabetes. Diabetes education is complex, requiring the expertise of a variety of healthcare professionals, including dental professionals. All healthcare professionals are responsible for understanding, promoting, and incorporating health measures for their patients with diabetes within their discipline.

A patient with uncontrolled diabetes in a dental environment presents many medical and dental concerns. The dental professional needs to assess these patients prior to any invasive treatment. An individual with high blood glucose levels is at an increased risk of periodontitis and other dental problems. There is a clear relationship between degree of hyperglycaemia and severity of periodontitis. Researchers are also investigating a bidirectional relationship between diabetes and periodontal health.