Hypertension, hyperlipidemia, and type 2 diabetes 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 May 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:
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.
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 (2014) has indicated that 9.3% of the U.S. population (21 million) have diabetes, with an estimated 8.1 million who are undiagnosed. An additional 86 million American adults ages 20 and over are estimated to have pre-diabetes. Type 2 diabetes accounts for approximately 95% of individuals with diabetes over the age of 30, with an alarming increase in obese children and adolescents. An estimated 208,000 children and adolescents under the age of 20 years have been diagnosed with type 1 or type 2 diabetes. It is rare for a diagnosis of type 2 in those age 10 years and under.4
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 periodontal disease and other dental issues. A bidirectional connection in that infectious dental issues lead to high blood glucose values in individuals with diabetes is still being researched with inconclusive outcomes.