Diabetes mellitus and oral health

The first section on medical considerations reviews the definition of diabetes and discusses underlying pathologic mechanisms, classification, diagnosis, and medical complications of the disease It also promotes the comprehensive management of patients with diabetes in the dental office, with a thorough discussion of lifestyle changes and medications used to treat diabetes The second section on dental considerations provides guidance on how treat patients with diabetes Oral complications are covered in detail, with a focus on management and treatment strategies that can be used in the dental office The third section includes multiple case studies illustrating common complications and how-to instruction on appropriate patient management Ideal for all members of the dental team, Diabetes Mellitus and Oral Health is an essential tool for providing optimal clinical care to patients with diabetes About the Author Ira Lamster, D.D.S., M.M.Sc is Professor of Health Policy & Management at the Columbia University Mailman School of Public Health, and Dean Emeritus of the Columbia University College of Dental Medicine Prior to becoming Dean, he served as director of the Division of Periodontics at Columbia Dr Lamster has extensive experience in oral health research, particularly in the area of oral health and systemic disease He has served on the editorial boards of the Journal of Periodontology and Journal of Clinical Periodontology and is a Diplomate of both the American Board of Periodontology and the American Board of Oral Medicine Dr Lamster has published numerous peerreviewed articles and the book Improving Oral Health for the Elderly ISBN 978-1-118-37780-2 An Interprofessional Approach Edited by Ira B Lamster Lamster Other Titles of Interest Dentist’s Guide to Medical Conditions, Medications & Complications, Second Edition By Kanchan Ganda ISBN: 9781118313893 Risk Assessment & Oral Diagnostics in Clinical Dentistry By Dena Fischer, Nathaniel S Treister, and Andres Pinto ISBN: 9780813821184 Diabetes Mellitus and Oral Health An Interprofessional Approach Key Features • Provides a succinct, clinical guide to dental treatment and management of the diabetic patient • Presents information in an easily accessible format, ideal for clinical practice • Includes multiple case scenarios with a discussion of appropriate patient management Diabetes Mellitus and Oral Health Diabetes Mellitus and Oral Health: An Interprofessional Approach is a practical tool for dentists and dental hygienists providing oral health care to patients with diabetes mellitus Firmly grounded in the latest evidence, the book addresses medical considerations, dental considerations, and case scenarios from clinical practice in three easily accessible sections 781118 377802 Lamster_Diabetes_9781118377802_pb.indd 10/03/2014 14:45 www.pdflobby.com Diabetes Mellitus and Oral Health www.pdflobby.com www.pdflobby.com Diabetes Mellitus and Oral Health An Interprofessional Approach Edited by Ira B Lamster www.pdflobby.com This edition first published 2014 © 2014 by John Wiley & Sons, Inc Editorial Offices 1606 Golden Aspen Drive, Suites 103 and 104, Ames, Iowa 50010, USA The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 For those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged The fee codes for users of the Transactional Reporting Service are ISBN-13: 978-1-1183-7780-2/2014 Designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions Readers should consult with a specialist where appropriate The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read No warranty may be created or extended by any promotional statements for this work Neither the publisher nor the author shall be liable for any damages arising herefrom Library of Congress Cataloging-in-Publication Data Diabetes mellitus and oral health: an interprofessional approach / edited by Ira B Lamster    p ; cm   Includes bibliographical references and index   ISBN 978-1-118-37780-2 (pbk.)   I Lamster, Ira B., editor of compilation [DNLM: 1.  Diabetes Complications–Case Reports.  2.  Periodontal Diseases–etiology–Case Reports.  3.  Diabetes Mellitus–Case Reports.  4.  Periodontal Diseases–prevention & control–Case Reports WU 240]  RK450.P4  617.6′32–dc23 2013050122 A catalogue record for this book is available from the British Library Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books Cover images: Background image: © Pattie Calfy, cstar55; iStock # 2252593; Left image: © ozgurdonmaz; iStock #16906572; Middle image: © pkruger; iStock #1685161; Right image: © evgenyb; iStock #5499109 Cover design by Meaden Creative Set in 10/12.5pt Times by SPi Publisher Services, Pondicherry, India 1 2014 www.pdflobby.com To my wife Gail, and our children and grandchildren, for the love and balance they provide www.pdflobby.com www.pdflobby.com Contents Contributorsix Acknowledgmentsxi Introductionxiii Section 1  Medical considerations 1 Etiology of diabetes mellitus Ravichandran Ramasamy and Ann Marie Schmidt Classification, epidemiology, diagnosis, and risk factors of diabetes Jeffrey M Curtis and William C Knowler 27 Medical complications of diabetes mellitus Lewis W Johnson and Ruth S Weinstock 45 Glycemic treatment of diabetes mellitus Harpreet Kaur and Ruth S Weinstock 69 Section 2  Dental considerations 97 Management of the patient with diabetes mellitus in the dental office Brian L Mealey 99 Periodontal disease as a complication of diabetes mellitus George W Taylor, Dana T Graves, and Ira B Lamster 121 The influence of periodontal disease on glycemic control in diabetes Dana Wolf and Evanthia Lalla 143 Non-periodontal oral complications of diabetes mellitus Ira B Lamster 157 Identification of dental patients with undiagnosed diabetes Evanthia Lalla, Dana Wolf, and Ira B Lamster 191 www.pdflobby.com viii Contents Section 3  Case reports 203 Case 1  A patient with type diabetes mellitus is seen for dental care Ira B Lamster, Nurit Bittner, and Daniel Lorber 205 Case 2  A patient with type diabetes mellitus requires oral surgery Ira B Lamster, Nurit Bittner, and Daniel Lorber 209 Case 3 A patient with diabetes mellitus has a hypoglycemic episode in the dental office Ira B Lamster, Nurit Bittner, and Daniel Lorber Case 4  The patient with diabetes mellitus and xerostomia Ira B Lamster, Nurit Bittner, and Daniel Lorber 215 221 Case 5 A patient diagnosed with diabetes mellitus after comprehensive prosthodontic rehabilitation Ira B Lamster, Nurit Bittner, and Daniel Lorber 229 Case 6 Prosthodontic treatment for the newly diagnosed patient with type diabetes mellitus Ira B Lamster, Nurit Bittner, and Daniel Lorber 237 Index247 www.pdflobby.com 244  Case reports Figure 8  Immediately after removal of the maxillary incisors Figure 9  Maximum intercuspation, intraoral view, after healing of maxillary anterior extractions After communication with the physician and because the patient’s HbA1c was 6.8% the previous three months, the physician and dentist agreed that the implant surgery could proceed Implants were placed in the #2, 7, 10, 23, and 26 locations After a four-month healing period, the implants were loaded with provisional screw-retained restorations to confirm osseointegration and implant stability as well to contour the soft tissues Six months after implant placement the implants were restored with porcelain fused to metal fixed partial dentures A maxillary night guard was provided to the patient to protect the implant restorations against porcelain fracture The patient was placed in a three-month periodontal recall program, which included full periodontal evaluation and scaling Even though the patient was not felt to be at high risk for caries, she will continue with a six-month recall program with the restorative dentist The dentist emphasized to the patient the importance of maintaining good metabolic control of her diabetes to ensure the best possible oral health and health outcomes www.pdflobby.com Prosthodontic treatment for the newly diagnosed patient with type diabetes mellitus  245 Discussion This case demonstrated the important role that the dentist may have in identifying undiagnosed diabetes mellitus Diabetes mellitus is associated with several intraoral conditions, including increased prevalence of periodontal disease, dental caries, reduced salivary flow, burning mouth syndrome, and Candida infection [2] As illustrated here, it is possible for patients to be seen in the dental office for a chief complaint related directly to diabetes mellitus The presence of one or more of these oral conditions may be an indication to assess the risk for diabetes mellitus In this case, a referral was given to the patient due to the severity of the periodontal disease, the deeply inflamed gingiva, and the appearance of the buccal mucosa, which was thought to be related to a Candida lesion Other identified risk factors included her BMI and family history Evidence supports the relationship between diabetes and periodontal diseases as bidirectional; that is, diabetes is associated with increased occurrence and progression of periodontitis, and periodontal infection is associated with poorer glycemic control in people with diabetes [3] The restorative treatment must also be customized to the patient’s needs Dental implants were a consideration, but a risk factor for implant complications was felt to be the presence of diabetes mellitus, and specifically the poor metabolic control at the initial assessment The literature is not clear regarding implant placement in patients with diabetes Diabetes is not a contraindication for dental implants, as long as the blood glucose level is well controlled [4] The success rate of implants in diabetic patients with better diabetes control has been reported to be as high as 94.3% [5] Based on the data, the survival rate of dental implants in controlled diabetic patients is slightly lower than that documented for the general population, but is nonetheless still impressive The increase in failure rate occurs during the first year following prosthetic loading [6] The reason for this may be altered bone metabolism [7] If the patient’s diabetes is not well controlled, an alternative restorative approach is a maxillary removable partial denture without the use of dental implants The dentist and physician must be in close communication regarding the patient’s diabetes, representing an ideal example of proper inter-professional practice The removable partial denture could be considered as an interim restoration An implant-retained restoration would be fabricated if the patient demonstrates appropriate metabolic control Moreover, because the prognosis for teeth #23, 24, and 26 is more favorable than that for the mandibular right central incisor, another plan would include extraction of the mandibular right central incisor, and a resin bonded Maryland bridge would be fabricated to replace #25 The purpose of this approach is to try to maintain the remaining dentition as long as possible Here, close post-operative monitoring is essential The re-establishment of a fully functional masticatory system and the improvement of the masticatory efficiency allow patients to maintain a more balanced diet and therefore proper nutrition This should also be considered, especially in older patients with diabetes Data suggest that patients with lower masticatory efficiency tend to be at higher risk for increased body fat, which in turn can be associated with a higher prevalence of type www.pdflobby.com 246  Case reports diabetes mellitus [8] This likely relates to the inability to chew fibrous foods and the need for a soft diet Dentists have an important role in establishing normal masticatory function for patients, and maintaining oral health in patients with diabetes mellitus In addition, they can also play an important role in identifying patients with undiagnosed or poorly managed diabetes A number of recent studies have suggested that the use of data collected at a dental examination can be used as part of an identification protocol for patients with suspected diabetes mellitus [9, 10] These studies have suggested that the dental office can be a health care location that actively participates in the management of patients with diabetes mellitus References 1.  American Diabetes Association Standards of medical care in diabetes—2013 Diab Care 2013 Jan; 36 (Suppl 1): S11–S66 2.  Lamster IBL, Lalla E, Borgnakke WS, Taylor GW The relationship between oral health and diabetes mellitus J Am Dent Assoc 2008 Oct; 139 (Suppl): S19–S24 3.  Lalla E, Papapanou PN Diabetes mellitus and periodontitis: a tale of two common interrelated diseases Nat Rev Endocrinol 2011 June 28; 7(12):738–48 4.  Oates TW, Huynh-Ba G, Vargas A, Alexander P, Feine J A critical review of diabetes, glycemic control, and dental implant therapy Clin Oral Implants Res 2013 Feb; 24(2):117–27 5.  Balshi TJ, Wolfinger GJ Dental implants in the diabetic patient: a retrospective study Implant Dent 1999; 8(4):355–9 6.  Fiorellini JP, Chen PK, Nevins M, Nevins ML A retrospective study of dental implants in ­diabetic patients Int J Periodontics Restorative Dent 2000 Aug; 20(4):366–73 7.  Retzepi M, Donos N The effect of diabetes mellitus on osseous healing Clin Oral Implants Res 2010 Jul; 21(7):673–81 8.  Sánchez-Ayala A, Campanha NH, Garcia RC Relationship between body fat and masticatory function J Prosthodont 2013 Feb; 22(2):120–5 9.  Li S, Williams PL, Douglass CW Development of a clinical guideline to predict undiagnosed diabetes in dental patients J Am Dent Assoc 2011 Jan; 142(1):28–37 10.  Lalla E, Kunzel C, Burkett S, Cheng B, Lamster IB Identification of unrecognized diabetes and pre-diabetes in a dental setting J Dent Res 2011 Jul; 90(7):855–60 www.pdflobby.com Index A1c test See Hemoglobin A1c A actinomycetemcomitans-induced periodontitis, 131–32 Acarbose, 40 side effects of, 41 ACOG See American College of Obstetricians and Gynecologists Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE), 144 Acute dental problems, managing, 106 ADA See American Diabetes Association Addison’s disease, 60 Adolescents See also Children dental caries in, 159 periodontal health and diabetes in, 126 Adult-onset diabetes See Type diabetes ADVANCE See Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation Advanced glycation end products (AGEs), 130–31 Age, 29 diabetes and, 31, 33 incidence of diabetes by, 29f type diabetes and, AGEs See Advanced glycation end products Alcoholism, chronic, 173–74 American College of Obstetricians and Gynecologists (ACOG), 35 OGTT criteria, 37 American Diabetes Association (ADA), American Indians, prediabetes prevalence in, 31 Amylin, 79 Angular cheilitis, 167–68, 170f Antibiotics, 13 Antimicrobial photodynamic therapy (aPDT), 150 Antiplatelet agents for CHD, 58 aPDT See Antimicrobial photodynamic therapy Atorvastatin, 229 Autoimmune disease associated with diabetes, 60 Autoimmune thyroid disease, 60 Autoimmunity, type diabetes and, 5–6 Autonomic neuropathy, 53 cardiac, 54 gastrointestinal, 54 genitourinary, 54 Bacteria, oral/periodontal, 152 Bacteroidetes, 6–7, 13 Bariatric surgery, 40 Basal insulin, 75 for type diabetes, 76–77 Benign parotid hypertrophy, 172–74, 173f, 174f β cell destruction, type diabetes and, 5, 28 function, in type diabetes, 10, 28 Diabetes Mellitus and Oral Health: An Interprofessional Approach, First Edition Edited by Ira B Lamster © 2014 John Wiley & Sons, Inc Published 2014 by John Wiley & Sons, Inc www.pdflobby.com 248 Index Biologic mechanisms adverse effects of diabetes on periodontal health and, 127–32 AGEs, 130–31 altered host inflammatory response, 128–30 altered subgingival microflora, 127–28 bone resorption and bone formation uncoupling, 131–32 Blood glucose, elevated, 37 Blood glucose meters, 219f Blood glucose testing, 197–98, 198f Blood pressure control CHD and, 56–57 nephropathy and, 53 BMS See Burning mouth syndrome Bolus insulin, 75 for type diabetes, 77–78 Bone disease associated with diabetes, 62–63 Bone loss, periodontal, 131, 132f Burning mouth syndrome (BMS), xiii, 168–72 Candida infection and, 170–72 chronic kidney disease and, 172 disorders associated with, 170 neuropathy and, 170–71 Calorie restriction for type diabetes, 242 Cancer, 62 pancreatic, 20 Candida albicans, 47–48 in oral cavity, 164 Candida infection BMS and, 170–72 clinical appearance of, 165–68, 166f, 167f, 168f, 169f, 170f dentures and, 164–65, 166f insulin and, 163–64 non-albicans species of, 164 Candidiasis, xiii xerostomia and, 226 Cardiomyopathy in diabetes, 59 Cardiovascular disease (CVD), 55 periodontal disease and, 144 Caries coronal, 157–58 dental, 157–60 root, 157–58, 160f Carpenter and Coustan plasma glucose criteria, 36 CD See Celiac disease CDEs See Certified diabetes educators Celiac disease (CD), 60 Cerebrovascular disease, 59 Certified diabetes educators (CDEs), 69 CGM See Continuous glucose monitoring CHD See Coronary heart disease Children dental caries in, 159 diabetes in, 33 obesity in, 29 periodontal health and diabetes in, 126 Chronic kidney disease, BMS and, 172 Classification of diabetes, 27–33 MODY, 30–31 type diabetes, 28 type diabetes, 28 Clinical Laboratory Improvement Amendments (CLIA), 116 Conditions associated with diabetes, 60t autoimmune disease, 60 bone disease, 62–63 cancer, 62 fatty liver disease, 61 hearing impairment, 63 intraoral, 245 mental illness, 62 musculoskeletal complications, 62 OSA, 61 sexual dysfunction, 61–62 skin diseases, 63, 64f Continuous glucose monitoring (CGM), 70 Continuous subcutaneous insulin infusion (CSII), 73 disadvantages of, 78–79 pump and associated equipment, 207f, 208 for type diabetes, 78–79 Coronal caries, 157–58 Coronary heart disease (CHD), 55–56 antiplatelet agents for, 58 blood pressure control and, 56–57 dyslipidemia and, 57 glycemic control and, 56 management of, 58, 58t smoking and, 57 C peptide, 30 CSII See Continuous subcutaneous insulin infusion www.pdflobby.com Index  249 CVD See Cardiovascular disease Cytokine stimulation in human islets, Dental appointments, timing of, 116–17 Dental care access to, 181–82 hypoglycemic event during, case study of, 215–20 for medically complex patients, xiv type diabetes, case study of, 205–8 Dental caries, 157–60 in children/adolescents, 159 hyperglycemia and, 158 metabolic control and, 159 type diabetes and, 159 type diabetes and, 158–59 xerostomia and, 226 Dental implants complications of, 178 diabetes mellitus and, 175–81 animal models of, 176–78 clinical studies of, 178–81 done-to-implant contact, 176–77 failure of, 101, 178–79 healing of, 176–77, 180 outcomes of, 177–78, 180 placement of, 245 success rates of, 179 therapy, 109–10 glycemic control and, 101 results of, 101 Dental office, management of diabetes mellitus in dental appointment timing and, 116–17 dental implant therapy results, 101 diabetes emergency evaluation and management in, 110–16 glycemic control and, 105–6 hypoglycemia in, 111–16 oral evaluation and, 102 pain management and, 117–18 pathways of care for diagnosis diabetes and, 104–6, 105f treatment plan and therapy, 106–18, 107f undiagnosed diabetes and, 101–4, 103f periodontal therapy results, 99–101 Dental patients diabetes identification in dental settings, 192–95, 195t diabetes testing in dental settings and, 196–99 medical conditions screening and, 197 with undiagnosed diabetes, 191–200, 195t Dental risk factors, 102 Dental settings blood glucose testing in, 197–98, 198f diabetes identification in, 192–95, 195t, 200t diabetes testing in, 196–99 prediabetes detection in, 200t primary health care activities in, 196 screening in, 197 Dental treatment for patients with diabetes, 109–10 Dentist communication with physician, 104 diabetes management and, 203 glycemic control determination and, 107–8 questions for, 203–4 dental office screening by, 197 primary health care activities and attitudes of, 196 Dentures Candida infection and, 164–65, 166f stomatitis, 165, 165f Diabetes See also Type diabetes; Type diabetes causes of, 20, 27–28 epidemiology of, 31–33 incidence of, 27, 29f prevalence, 27 prevention of, 21 Diabetes mellitus nomenclature for, 27 periodontal health and adverse effects of, 122–27, 123t, 124t, 125t biologic mechanisms contributing to, 127–32 Diabetes Prevention Program (DPP), 39, 88–89, 234 trial, 21 Diabetic foot, 54–55 Diabetic ketoacidosis (DKA), 45–46, 46t, 110–11 www.pdflobby.com 250 Index Diagnosis of diabetes, 33t in dental office, 104–6 fasting plasma glucose and, 34 GDM, 17, 35–37, 36t glucose concentrations and, 30 HbA1c and, 33 MODY, 20 prosthodontic rehabilitation and, case study of, 229–35, 230f, 231f, 232f two-hour plasma glucose and, 34 Diagnostic criteria for diabetes mellitus, 33, 33t, 242t DIAGRAM consortium, 11 Dipeptidyl peptidase-4 (DPP-4) inhibitors, 83–84 Distal symmetric polyneuropathy (DSPN), 53–54 DKA See Diabetic ketoacidosis “Double diabetes,” DPP See Diabetes Prevention Program DPP-4 inhibitors See Dipeptidyl peptidase-4 inhibitors Dry mouth, 161 DSPN See Distal symmetric polyneuropathy Dyslipidemia, CHD and, 57 eAG See Estimated average glucose ED See Erectile dysfunction Edema, macular, 50–51 Elevated blood glucose, 37 Emergencies diabetes, dental office evaluation and management of, 110–16 hyperglycemic, 46t, 110–11 Emphysematous cholecystitis, 48 End-stage renal disease (ESRD) nephropathy and, 52 periodontitis and, 144 Environment risk factors and, 38 type diabetes and, Environmental pollution, type diabetes and, 15 Epidemiology of diabetes, 31–33 Erectile dysfunction (ED), 61 ESRD See End-stage renal disease Estimated average glucose (eAG), 108 HbA1c and, 109 Eye exams, 51 Fasting plasma glucose (FPG), diabetes diagnosis and, 34 prediabetes and, 35 Fatty liver disease, 61 Firmicutes, 13 Foot, diabetic, 54–55 FPG See Fasting plasma glucose Fractures, HbA1c and, 101 Framingham risk score, 196 “Fruity” breath odor, 111 GAD65, Gastrointestinal infections, 47–48 GCF See Gingival crevicular fluid GDM See Gestational diabetes Genetics risk factors and, 38 of type diabetes, 4–5 non-HLA loci associated with, 4–5, 5t of type diabetes, 10–11, 15–16 Genitourinary infections, 47 Genome wide association studies (GWAS) in type diabetes, 4–5 in type diabetes, 11 Gestational diabetes (GDM) definition of, 17 diagnosis of, 17, 35–37, 36t glucose concentrations and, 30 epidemiology of, 17 etiology of, 17–18 glucose regulation and, 30 hyperglycemia in, 17 inflammatory markers and, 18 insulin resistance and, 18 metabolic factors in, 17–18 obesity and, 17 OGTT for, 36 periodontal health and, 126–27 prevalence of, 33 prevention of, 40 risk factors for, 37–38 type diabetes and, 9–10 vitamin D and, 18–19 GFR See Glomerular filtration rate Gingival crevicular blood, 194–95 Gingival crevicular fluid (GCF), 162 Gingivitis, 102, 121 prevalence of, 122 Glimepiride, 215 www.pdflobby.com Index  251 Glomerular filtration rate (GFR), 52 GLP-1 See Glucagon-like peptide-1 GLP-1 receptor agonists, 233 for type diabetes, 83 Glucagon, hypoglycemia and, 86, 116 Glucagon-like peptide-1 (GLP-1), 79 Glucokinase, MODY and, 20 Glucometers, 39 in dental office, 116 glycemic control determination with, 107 hypoglycemia and readings on, 114–15 Glucose concentrations GDM diagnosis and, 30 high-risk, 35 Glucose dysregulation, obesity and, 134 Glucose levels dental appointment timing and, 117 HbA1c values and, 108–9, 109t medications and raise in, 86–87 Glucose monitoring CGM, 70 home, 75 SMBG, 70 Glucose regulation, GDM and, 30 α-Glucosidase inhibitors for type diabetes, 84 Glyburide, 210 Glycemic control assessments of, 70–71, 71t CHD and, 56 determining dental patient’s, 106–8, 107f diabetes management in dental office and, 105–6 diabetes type and, 105–6 goals for, 70–73 setting, 71–73, 72f hypoglycemia and, 114 implant failure and, 101 level of, physician’s information about, 108 periodontal disease and longitudinal observational studies of, 143–45 treatment studies of, 145–50, 146t, 149t underlying mechanisms of, 150–52, 151f periodontal health and, 124–25 periodontal treatment and, 148, 149t poor, 107 team approach to, 69–70 Glycemic treatment, 69–89 future directions for, 89 hypoglycemia and, 85–86 sick day management and, 87 surgery, 87–88 of type diabetes home glucose monitoring and, 75 insulin therapy for, 75–79 lifestyle and, 73–74, 74f pramlintide therapy for, 79 prevention and, 88 of type diabetes lifestyle and, 79–80 pharmacological therapy for, 80–85 prevention and, 88–89 GWAS See Genome wide association studies HbA1c See Hemoglobin A1c HBV See Hepatitis B HCV See Hepatitis C Head and neck infections, 48 Hearing impairment, 63 Hemoglobin A1c (HbA1c), advantages of, 35 diagnosis of diabetes mellitus and, 33 eAG and, 109 fracture risk and, 101 gingival crevicular blood for, 194–95 glucose levels and values of, 108–9, 109t glycemic control assessment with, 70–71, 71t glycemic control determination with, 107–8 goals for, 71–73 high-risk ranges of, 35 hypoglycemia and values of, 113–14 periodontal therapy and changes in, 147, 150 retinopathy and, 34–35, 34f type diabetes and values of, 108–9 type diabetes and values of, 108–9 Hepatitis B (HBV), 48 Hepatitis C (HCV), 48 HHS See Hyperglycemic hyperosmolar state HIV See Human immunodeficiency virus HLA See Human leukocyte antigen HNF1α, MODY and, 20 Home glucose monitoring, 75 Host inflammatory response altered, 128–30 type diabetes and, 128–29 type diabetes and, 128–29 www.pdflobby.com 252 Index Human immunodeficiency virus (HIV), 49 Human leukocyte antigen (HLA), Hydrochlorothiazide, 229 Hyperglycemia, 3, 33–34 approach to management of, 72f chronic complications caused by, 50 dental caries and, 158 epigenetic changes and, 49–50 in GDM, 17 symptoms of, 218f treatment of, 220 undiagnosed, 195 Hyperglycemic crisis, 33–34 Hyperglycemic emergencies, 46t, 110–11 Hyperglycemic hyperosmolar state (HHS), 46, 46t Hyperventilation, 111 Hypoglycemia, 46, 85–86 in dental office, 111–16 glucagon for, 86, 116 glucometer readings and, 114–15 glycemic control and, 114 HbA1c values and, 113–14 insulin therapy and, 111–12, 112t neurologic impairment and, 112–13 oral diabetes medications associated with, 113, 113t oral medications associated with, 210, 211t prevention of, 114 signs of, 112t symptoms of, 86, 112t, 217f treatment of, 86, 112t, 219–20 Hypoglycemia unawareness, 114 Hypoglycemic events during dental care, case study of, 215–20 intraoperative, 115 Hypotension, 111 Hypothermia, 111 IA-2, IA-2β, IADPSG See International Association of the Diabetes and Pregnancy Study Groups IDDM See Insulin-dependent diabetes mellitus IFG See Impaired fasting glucose IGT See Impaired glucose tolerance IL2RA, Impaired fasting glucose (IFG), 35 Impaired glucose tolerance (IGT), 35 Impaired wound healing, 132–33 Incidence of diabetes, 27, 29f Infections, 46–47 Candida, 163–68 gastrointestinal, 47–48 genitourinary, 47 head and neck, 48 liver, 47–48 periodontal, 150–51 respiratory, 47 skin and soft tissue, 48–49 surgical site, 49 Infectious agents, type diabetes and, Inflammation diabetes and, 150 periodontal therapy and, 151–52 Inflammatory markers, GDM and, 18 Inflammatory mediators in saliva, 162 Inflammatory response, host, 128–30 Insulin, 206t basal, 75 for type diabetes, 76–77 bolus, 75 for type diabetes, 77–78 Candida and, 163–64 deficiency DKA and, 111 of type diabetes, 28 injections, 75–76, 76f Levemir, 215 measuring, 30 prandial, 75 preparations of, 76t for type diabetes, 30, 84–85 Insulin-dependent diabetes mellitus (IDDM), 27 Insulin detemir, 77 Insulin pump therapy, 78–79 See also Continuous subcutaneous insulin infusion Insulin resistance development of, GDM and, 18 obesity and, 12–13, 28 pregnancy and, 17–18, 30 type diabetes and, 8–9 in type diabetes, 10, 28 vitamin D and, 14 www.pdflobby.com Index  253 Insulin signaling pathway, 18 Insulin therapy, 28 diabetes type and, 29 hypoglycemia and, 111–12, 112t for type diabetes, 75–79 International Association of the Diabetes and Pregnancy Study Groups (IADPSG), 36 Intraoral conditions associated with diabetes, 245 Invasive external otitis, 48 Juvenile onset diabetes See Type diabetes Ketoacidosis, type diabetes and, Levemir insulin, 215 Levothyroxine, 215 Lichen planus, 174–75 Lifestyle change in, 234 for type diabetes, 242 glycemic management of type diabetes and, 73–74, 74f glycemic management of type diabetes and, 79–80 physical activity, 73–74 for type diabetes, 242 sedentary, as risk factor, 38 smoking CHD and, 57 periodontitis and, 196 weight loss, 39 Lipid dysregulation, 132–33 Lipid-lowering agents, 53 Lisinopril, 229 Liver infections, 47–48 Macroalbuminuria, 52 Macrovascular complications, 55t cerebrovascular disease, 59 CHD, 55–59 PAD, 59–60 Macular edema, 50–51 Masticatory function, 245–46 Maturity onset diabetes of young (MODY), classification of, 30–31 diagnosis of, 20 genetic mutations in, 19–20 Medical complications of diabetes mellitus, 45–65 See also Oral complications of diabetes mellitus acute DKA, 45–46 HHS, 46 hypoglycemia, 46 infections, 46–49 chronic macrovascular, 55–56 mechanisms of development, 49–50 microvascular, 50–55, 51t preventing, 64 Medical nutrition therapy (MNT), 73 Medications See also specific medications glucose levels and, 86–87 hypoglycemia-associated, 210, 211t noninsulin, 84 oral diabetes, 113, 113t for prevention, 39–40 side effects of, 41 Meglitinides, for type diabetes, 83 Mental illness, 62 Metabolic control dental caries and, 159 periodontitis and, xiv Metabolic goals for type diabetes, 242t Metabolic pathways, 133 Metabolic syndrome, 234 diagnosis of, 234t Metabolism, PM inhalation and, 15 Metformin, 210, 234, 241 prevention and, 39 side effects of, 41 type diabetes, 80 Methicillin-resistant Staphylococcus aureus (MRSA), 48–49 Mexican Americans, prediabetes prevalence in, 31 Microalbuminuria, 52 Microbiome periodontal, 128 type diabetes and, 6–7 type diabetes and, 13–14 Microvascular complications, 51t diabetic foot, 54–55 nephropathy, 52–53 neuropathy, 53–54 retinopathy, 50–52 www.pdflobby.com 254 Index MNT See Medical nutrition therapy MODY See Maturity onset diabetes of young Mouse models, 28 MRSA See Methicillin-resistant Staphylococcus aureus Musculoskeletal complications associated with diabetes, 62 National Diabetes Data Group (NDDG), 36 National Health and Nutrition Examination Survey (NHANES I), 144–45 National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), 143–44 NDDG See National Diabetes Data Group Necrotizing fasciitis, 49 Nephropathy, 52–53 blood pressure control and, 53 drugs and, 53 periodontitis and, 144 Neuropathy autonomic, 53–54 BMS and, 170–71 Neutral protamine hagedorn (NPH) insulin, 76–77 Neutrophils, periodontitis and, 128 NHANES See National Health and Nutrition Examination Survey NIDDK See National Institute of Diabetes, Digestive and Kidney Diseases NIDDM See Non-insulin dependent diabetes mellitus Non-Hispanic blacks, prediabetes prevalence in, 31 Non-Hispanic whites, prediabetes prevalence in, 31 Non-insulin-dependent diabetes mellitus (NIDDM), 27 See also Type diabetes Noninsulin medications, 84 See also specific medications Nonproliferative retinopathy (NPDR), 50–51 NPH insulin See Neutral protamine hagedorn insulin Obesity childhood, 29 diabetes and, 31, 32f GDM and, 17 glucose dysregulation and, 134 insulin resistance and, 12–13, 28 periodontitis and, 134 as risk factor, 38 type diabetes and, 12–13, 28, 134 Obstructive sleep apnea (OSA), 61 OGTT See Oral glucose tolerance test ONJ See Osteonecrosis of the jaw Oral bacteria, 152 Oral complications of diabetes mellitus, 144 access to dental services and, 181–82 BMS, 168–72 Candida infection, 163–68 dental caries, 157–60 dental implants, 175–81 mucosal lesions, 174–75 parotid sialosis/benign parotid hypertrophy, 172–74 xerostomia, 160–62 Oral diabetes medications, hypoglycemia associated with, 113, 113t Oral evaluation, 102 Oral glucose tolerance test (OGTT), ACOG criteria, 37 Carpenter and Coustan plasma glucose criteria, 36 for gestational diabetes, 36 NDDG criteria, 36 Oral health, 181–82 Oral surgery, case study of type diabetes and, 209–14 Orlistat, 40 side effects of, 41 OSA See Obstructive sleep apnea Osteonecrosis of the jaw (ONJ), 63 PAD See Peripheral arterial disease Pain management in dental office, 117–18 Pancreas, 30–31 Pancreatic cancer, diabetes and, 20 Parotid sialosis/benign parotid hypertrophy, 172–74, 173f, 174f chronic alcoholism and, 173–74 Particulate matter (PM), 15 PDR See Proliferative retinopathy Peri-implantitis, 235 Periodontal bacteria, 152 Periodontal bone loss, diabetes and, 131, 132f www.pdflobby.com Index  255 Periodontal complications of diabetes, 144 Periodontal disease, xiii, 121–22 as complication of diabetes mellitus, 121–35 CVD and, 144 glycemic control and longitudinal observational studies of, 143–45 treatment studies of, 145–50, 146t, 149t underlying mechanisms of, 150–52, 151f infections, 150–51 progression of, 126 type diabetes and, 126, 144 Periodontal health adverse effects of diabetes mellitus on, 122–27, 123t, 124t, 125t biologic mechanisms contributing to, 127–32 children/adolescents with diabetes and, 126 GDM and, 126–27 glycemic control and, 124–26 type diabetes and, 125–26 type diabetes prediction and, 144–45 Periodontal Index, 145 Periodontal microbiome, 128 Periodontal microflora, 127–28 Periodontal re-evaluation, 110 Periodontal therapy, 109–10 anti-inflammatory effect of, 151–52 glycemic control and, 148, 149t HbA1c changes after, 147, 150 long-term studies of, 100 for periodontitis, 99–100 results of, 99–101 type diabetes and, 148 Periodontitis, 102 A actinomycetemcomitans-induced, 131–32 chronic, 121 diabetes-enhanced, 129–30 diabetes mellitus and, xiii diabetic complications and, 144 ESRD and, 144 metabolic control and, xiv nephropathy and, 144 neutrophils and, 128 obesity and, 134 periodontal therapy for, 99–100 prevalence of, 122, 122f progression of, 100 risk factors for, 196 type diabetes and, 143 Peripheral arterial disease (PAD), 55, 59–60 Pharmacological therapy for type diabetes, 81t DPP-4 inhibitors, 83–84 GLP-1 receptor agonists, 83 α-glucosidase inhibitors, 84 insulin, 84–85 meglitinides, 83 metformin, 80 SGLT2, 84 sulfonylurea drugs, 83 thiazolidinediones, 84 Physical activity, 73–74 for type diabetes, 242 Physician dentist’s communication with, 104 diabetes management and, 203 glycemic control determination and, 107–8 questions for, 203–4 glycemic control level information from, 108 Pioglitazone, 39–40, 210 side effects of, 41 PKC See Protein kinase C PM See Particulate matter Polydipsia, 103, 111 Polyphagia, 103 Polyuria, 103, 111 Porphyromonas gingivalis, 129 Pramlintide therapy for type diabetes, 79 Prandial insulin, 75 Prediabetes, 37 detecting, models for, 199, 200f diagnosis of, 35 prevalence of, 31 screening for, 38 syndromes, vitamin D and, 14 Pregnancy See also Gestational diabetes insulin resistance and, 17–18, 30 type diabetes developing after, 30 prevention for, 40, 41f vitamin D in, 19 Prevention bariatric surgery and, 40 of diabetes, 21 www.pdflobby.com 256 Index Prevention (cont’d) of GDM, 40 of hypoglycemia, 114 medical complications of diabetes mellitus, 64 medications for, 39–40 side effects of, 41 of type diabetes, 39 glycemic treatment and, 88 of type diabetes, 39, 41 glycemic treatment and, 88–89 pregnancy and, 40, 41f Probiotics, Proliferative retinopathy (PDR), 50–51 Prosthodontic rehabilitation, case study of diabetes diagnosis after, 229–35, 230f, 231f, 232f Prosthodontic treatment, case study of type diabetes and, 237–46, 238f, 239f, 240f, 244 Protein kinase C (PKC), 133–34 Pseudomonas aeruginosa, 48 PTPN22, Race/ethnicity diabetes and, 31 risk factors and, 37–38 RAGE, 130–31 Random plasma glucose, 3, 33–34 Receptor activator of nuclear factor κB ligand osteoprotegerin ratio (RANKL:OPG), 129 Respiratory infections, 47 Retinopathy, 34, 50–52 HbA1c and, 34–35, 34f NPDR, 50–51 treatment of, 51 two-hour plasma glucose and, 34, 34f Rhinocerebral mucormycosis, 48 Risk factors dental, 102 environmental, 38 for GDM, 37–38 genetic, 38 periodontitis, 196 racial/ethnic, 37–38 for type diabetes, 37 for type diabetes, 37–38, 191, 192t Root caries, xiii, 157–58, 160f Root planing, 110 Rosiglitazone, 39–40 side effects of, 41 Saliva, 160 diabetes and chemistry of, 162 inflammatory mediators in, 162 Salivary flow, 161–62 Salivary hypofunction, 160–61 Scaling, 110 Screening See also specific screening tests medical models for diabetes, 191–92 for prediabetes, 38 for type diabetes, 38 for type diabetes, 38–39, 192 Sedentary lifestyle, as risk factor, 38 Self-monitoring of blood glucose (SMBG), 70 Sexual dysfunction, 61–62 SGLT2 See Sodium-glucose cotransporter Sick day management, 87 Single nucleotide polymorphisms (SNPs), Skin and soft tissue infections, 48–49 Skin diseases associated with diabetes, 63, 64f SMBG See Self-monitoring of blood glucose Smoking CHD and, 57 periodontitis and, 196 SNPs See Single nucleotide polymorphisms Sodium-glucose cotransporter (SGLT2), 84 SOS study See Swedish Obese Subjects study Staphylococcus aureus, 47–48 Stomatitis, 165, 165f Streptococcus pneumoniae, 47 Subgingival microflora, altered, 127–28 Sulfonylurea drugs, 210 for type diabetes, 83 Surgery bariatric, 40 glycemic treatment and, 87–88 oral, type diabetes and, 209–13 type diabetes and, 88 type diabetes and, 88 Surgical site infections, 49 Susceptibility genes in type diabetes, 4–5 in type diabetes, 10–11 Swedish Obese Subjects (SOS) study, 40 www.pdflobby.com Index  257 T1DGC See Type Diabetes Genetics Consortium Tachycardia, 111 Tetracyclines, 110 Thiazolidinedione, 39 side effects, 41 Thiazolidinediones for type diabetes, 84 TIA See Transient ischemic attack TNF-α dysregulation, 131 TNF-α inhibition, 131 Tooth loss progression of, 100 type diabetes and, 144 Transient ischemic attack (TIA), 59 Troglitazone, 39–40 Two-hour plasma glucose, diabetes diagnosis and, 34 retinopathy and, 34, 34f Type diabetes autoimmunity and, 5–6 β cell destruction and, 5, 28 classification of, 28 contributory factors to development of, 9, 10f dental care case study for, 205–8 dental caries and, 159 diabetes management in dental office and, 105–6 DKA in, 45 genetics of, 4–5, 5t glycemic management of home glucose monitoring and, 75 insulin therapy for, 75–79 lifestyle and, 73–74, 74f pramlintide therapy for, 79 GWAS in, 4–5 HbA1c values and, 108–9 host inflammatory response and, 128–29 hypoglycemia unawareness, 114 incidence of, 29f infectious agents and, insulin deficiency of, 28 insulin resistance and, 8–9 microbiome and, 6–7 non-HLA loci associated with, 4–5, 5t pathogenesis of, 3, 5–8 periodontal health and, 125–26 prevention of, 39 glycemic treatment and, 88 rise of, 21 risk factors for, 37 screening for, 38 surgery and, 88 susceptibility genes in, 4–5 type distinguished from, 29–30 vitamin D and, 7–8 Type Diabetes Genetics Consortium (T1DGC), Type diabetes, 9–16, 41–42 age and, β cell function in, 10, 28 classification of, 28 contributory factors to development of, 16, 16f dental caries and, 158–59 diabetes management in dental office and, 105–6 DKA in, 45 environmental pollution and, 15 GDM and, 9–10 genetics of, 10–11, 12t, 15–16 glycemic management of lifestyle and, 79–80 pharmacological therapy for, 80–85 GWAS in, 11 HbA1c values and, 108–9 HHS in, 46 host inflammatory response and, 128–29 hypoglycemia unawareness, 114 incidence of, 29f insulin and, 30, 84–85 insulin resistance in, 10, 28 lifestyle changes for, 242 loci associated with, 11, 12t metabolic goals for, 242t microbiome and, 13–14 obesity and, 12–13, 28, 134 oral surgery and, case study of, 209–14 pathogenesis of, 3, 11–15 periodontal disease and, 126, 144 periodontal health and predicting, 144–45 periodontal therapy and, 148 periodontitis and, 143 pharmacological therapy for, 80–85, 81t post-pregnancy development of, 30 preventing, 40, 41f prevalence of, www.pdflobby.com 258 Index Type diabetes (cont’d) prevention of, 39, 41 glycemic treatment and, 88–89 pregnancy and, 40, 41f prosthodontic treatment and, case study of, 237–46 rise of, 21 risk factors for, 37–38, 191, 192t screening for, 38–39, 192 surgery and, 88 oral, 209–14 susceptibility genes in, 10–11 testing for, 241 tooth loss and, 144 treatment of, 241 type distinguished from, 29–30 vitamin D and, 14–15 Uncoupling of bone resorption and bone formation, 131–32 Undiagnosed diabetes dental office evaluation and management of, 101–4, 103f identification of dental patients with, 191–200, 195t diabetes testing in dental settings and, 196–99 medical history and, 102 medical models for diabetes screening, 191–92 signs and symptoms of, 102 VDR See Vitamin D receptor Vitamin D GDM and, 18–19 insulin resistance and, 14 levels of, 14 prediabetes syndromes and, 14 in pregnancy, 19 supplementation, 8, 14 type diabetes and, 7–8 type diabetes and, 14–15 Vitamin D receptor (VDR), 7–8 Weight loss, 39 Wound healing, impaired, 132–33 Xerostomia, xiii, 160–62 candidiasis and, 226 dental caries and, 226 diabetes and, case study of, 221–26, 222f, 223f www.pdflobby.com ...www.pdflobby.com Diabetes Mellitus and Oral Health www.pdflobby.com www.pdflobby.com Diabetes Mellitus and Oral Health An Interprofessional Approach Edited by Ira... patients demands that health care providers cooperate, and ? ?diabetes provides an excellent example of the importance of interprofessional practice The result will be improved oral health, and health, ... type and type diabetes Types and diabetes constitute the vast majority of diabetes cases Interestingly, both of these types of diabetes are on the rise worldwide [2, 3] In addition to types and diabetes,