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Diabetes and Oral Health Diabetes and Oral Health—Current Concepts Regarding Periodontal Disease and Dental Caries Ira B Lamster, DDS, MMSc Professor, Department of Health Policy and Management, Mailman School of Public Health, and Dean Emeritus, College of Dental Medicine, Columbia University, New York, New York, US Abstract There are a number of important oral manifestations of diabetes. Periodontal disease and dental caries are the most common oral diseases, and both are modified when diabetes is present. There is an increased prevalence of periodontal disease in patients with diabetes, and periodontal disease can adversely affect glycemic control. Root caries also is more prevalent in patients with diabetes. The sequelae of both periodontal disease and dental caries are infection, pain, tooth loss, and reduced masticatory function. Non-oral health care providers who treat patients with diabetes must be aware of the oral manifestations of the disease and inform patients that ideal oral health is part of comprehensive management of diabetes. Keywords Diabetes complications, periodontal disease, dental caries, glycemic control Disclosure: The author has no conflict of interest to declare. Acknowledgment: This work is supported in part by the Colgate-Palmolive Company, the New York State Health Foundation, the Fan Fox and Leslie Samuels Foundation, and Enhanced Education. Received: November 28, 2012 Accepted: December 4, 2012 Citation: US Endocrinology, 2012;8(2):93–7 Correspondence: Ira B Lamster, DDS, MMSc, Professor, Department of Health Policy and Management, Mailman School of Public Health, Dean Emeritus, College of Dental Medicine, Columbia University, 722 West 168th Street, Room 938, New York, NY 10032, US. E: ibl1@columbia.edu Support: The publication of this article was funded by Colgate-Palmolive Company. The views and opinions expressed are those of the author and not necessarily those of Colgate-Palmolive Company. The increased morbidity and mortality associated with diabetes are well known to health care providers. Retinopathy, nephropathy, macrovascular disease, neuropathy, and poor wound healing can have a major impact on the lives of patients with diabetes. These complications take an enormous personal and financial toll. In addition to these recognized complications, the oral cavity and contiguous structures can be dramatically affected by diabetes. These oral complications are not widely recognized by non-dental health care providers, but can have important effects on quality of life of patients with diabetes, and can also directly and indirectly effect glycemic control. There are a wide range of oral manifestations that have been reported in patients with diabetes. These include increased extent and severity of periodontal disease, changes in the prevalence of dental caries, burning mouth syndrome, Candida infection, xerostomia, altered taste sensation, altered tooth eruption, and hypertrophy of the parotid glands. Non-dental health care providers and patients need to be aware of the changes in the oral cavity associated with diabetes, emphasize the importance of an oral/dental evaluation when the diagnosis of © TOUCH MEDICAL MEDIA 2012 diabetes is first made, and make appropriate referral if the patient reports a problem. Dental professionals must be familiar with the range of oral disorders observed in patients with diabetes, and how these problems should be managed in patients with the disease. This review will focus on the two most common oral diseases (periodontal disease and caries), how these disorders are modified in patients with diabetes, and how they can affect patient management. Periodontal Disease The most common oral complication of diabetes is periodontal disease. The periodontal diseases are a group of inflammatory disorders of the supporting tissues of the teeth, which includes the gingiva (mucosal tissue about the teeth), cementum (covering the roots of the teeth), the periodontal ligament, and the alveolar bone into which the teeth are anchored. The pathology of periodontal disease is an inflammatory lesion induced by the dental plaque biofilm found at the opening of and within the gingival crevice. Beginning as an inflammation of the gingiva, the inflammatory lesion can extend to involve the alveolar bone. If the lesion continues to progress, pronounced loss of alveolar bone leads to tooth mobility and tooth drifting, abscess formation and ultimately tooth loss. 93