Diabetes Mellitus and Oral Health

- Brian L. Mealey, DDS, MS

Introduction

Diabetes mellitus is a metabolic disease characterized by dysregulation of carbohydrate, protein, and lipid metabolism. The primary feature of this disorder is elevation in blood glucose levels (hyperglycemia), resulting from either a defect in insulin secretion from the pancreas, a change in insulin action, or both. Sustained hyperglycemia has been shown to affect almost all tissues in the body and is associated with significant complications of multiple organ systems, including the eyes, nerves, kidneys, and blood vessels.

These complications are responsible for the high degree of morbidity and mortality seen in the diabetic population.

Epidemiology and classification

About 16 million Americans have diabetes (between 6 and 7% of the total US population). Around the world, the prevalence of diabetes is expected to double between 1994 and 2010, at which time about 240 million people will have the disease. In the United States, the incidence of diabetes rises as the population ages and as the prevalence of obesity increases.

Unfortunately, about half of those Americans with diabetes are presently unaware that they have the disease. Most dental practices have a significant number of diabetic patients in their population. Based on US prevalence data, an "average" practice would have between 60 and 70 diabetic individuals for every 1,000 patients, and 30 to 35 of these patients would be undiagnosed.

The American Diabetes Association provided the most recent classification of diabetes mellitus, in 1997. The most common forms of diabetes are termed type 1 and type 2. Type 1 diabetes was previously called insulin-dependent diabetes or juvenile diabetes while type 2 diabetes was formerly known as non-insulin-dependent diabetes or adult-onset diabetes.

The older terminology was often confusing since both insulin-dependent and non-insulin-dependent diabetic individuals may take insulin as part of their management regimen. The difference is that type 1 patients are truly dependent on insulin therapy whereas type 2 patients may benefit from insulin therapy but are not dependent on it for survival. The new classification system minimizes this confusion because it is based on the pathophysiology of the different disease types, rather than on the treatment methodology used.

Gestational diabetes occurs during pregnancy and usually resolves after delivery. Other types of diabetes may occur in individuals with certain genetic disorders, pancreatic diseases, infections, injuries to the pancreas, and endocrine diseases. Drug therapy with certain agents may also induce a diabetic state.

Conclusion

Diabetes mellitus is a metabolic condition affecting multiple organ systems. The oral cavity frequently undergoes changes that are related to the diabetic condition, and oral infections may adversely affect metabolic control of the diabetic state. The mechanisms underlie the oral effects of diabetes share many similarities with the mechanisms that are responsible for the classic diabetic complications. The intimate relationship between oral health and systemic health in individuals with diabetes suggests a need for increased interaction between the dental and medical professionals who are charged with the management of these patients. Oral health assessment and treatment should become as common as the eye, foot, and kidney evaluations that are routinely performed as part of preventive medical therapies. Dental professionals with a thorough understanding of current medical treatment regimens and the implications of diabetes on dental care are able to help their diabetic patients achieve and maintain the best possible oral health.