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Review Article

Oral health management considerations in patients

with diabetes mellitus
Sandeep Kaur, Kirandeep Kaur1, Shalu Rai2, Rajat Khajuria3
Departments of Oral Medicine and Radiology, and 3Prosthodontics, Indira Gandhi Government Dental College and Hospital, Jammu,
Jammu and Kashmir, 1Departments of Periodontology, and 2Oral Medicine and Radiology, Institute of Dental Studies and Technologies,
Kadrabad, Modi Nagar, Uttar Pradesh, India

ABSTRACT
Diabetes mellitus (DM) is one of the most serious diseases of metabolism. Long-term consequences of hyperglycemia are very
heterogeneous and affect partially all tissues and organs of the organism. A number of oral diseases and disorders have been associated
with DM, and periodontitis has been identified as a possible risk factor for poor glycemic control and the development of other clinical
complications of diabetes. In this review article, we discuss the relevant information about DM associated oral conditions and role of
dental practitioners to take the responsibility to develop programs to educate the public about the oral manifestations of diabetes and
its complications on oral health in order to promote proper oral health and to reduce the risk of oral diseases.

Key words: Blood glucose, diabetes, glycemic control, insulin, periodontitis

Introduction include long-term damage, dysfunction, and failure of

various organs.
Diabetes Mellitus (DM) is a chronic disease that occurs
DM may present with characteristic symptoms such as
when the pancreas does not produce enough insulin (a
polydipsia, polyuria, and polyphagia. In its most severe
hormone that regulates blood sugar) or alternatively,
forms, ketoacidosis or a non-ketotic hyperosmolar state
when the body cannot effectively use the insulin it
may develop and lead to stupor, coma and, in absence of
produces. The overall risk of dying among people
effective treatment, death. Often symptoms are not severe,
with diabetes is at least double the risk of their peers
or may be absent, and consequently hyperglycemia sufficient
without diabetes. [1] The term DM describes a metabolic
to cause pathological and functional changes may be present
disorder of multiple etiology characterized by chronic
for a long time before the diagnosis is made.
hyperglycemia with disturbances of carbohydrate, fat,
and protein metabolism resulting from defects in insulin
The long-term effects of DM include:[2,3]
secretion, insulin action, or both. The effects of DM
1. Retinopathy,
2. Nephropathy,
Access this article online
3. Autonomicneuropathy,
Quick Response Code:
4. Peripheral neuropathy, and
Website:
www.amhsjournal.org 5. Cardiovascular disease.

DOI: The American Diabetes Association provided the most

10.4103/2321-4848.154949 recent classification of DM, in 1974 [Table 1].[4] The most
common forms of diabetes are termed type 1 and 2. Type 1

Corresponding Author:
Dr. Sandeep Kaur, Department of Oral Medicine and Radiology, Indira Gandhi Government Dental College and Hospital,
Jammu - 180 001, Jammu and Kashmir, India. E-mail: dr.sandeepkour@gmail.com

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Kaur, et al.: Oral health and diabetes mellitus

diabetes was previously called insulin-dependent diabetes or Table 1: Classification of diabetes mellitus
juvenile diabetes, while type 2 diabetes was formerly known Classification Etiology
as noninsulin-dependent diabetes or adult-onset diabetes. Type 1 (insulin-dependent diabetes; juvenile diabetes)
Type 2 (noninsulin-dependent diabetes; adult-onset diabetes)
• The terms type 1 and 2 should be reintroduced. The
Gestational diabetes (pregnancy diabetes)
etiological type named type 1 encompasses the majority Other types of diabetes Genetic defects affecting beta-cell function or insulin action
of cases which are primarily due to pancreatic islet beta- Pancreatic diseases or injuries (pancreatic cancer, pancreatitis,
traumatic injury, cystic fibrosis, pancreatectomy)
cell destruction and are prone to ketoacidosis. Infections (congenital rubella, Cytomegalovirus infection)
• Type 1 includes those cases attributable to an autoimmune Drug-induced diabetes (steroid hormones (glucocorticoids), thyroid
hormone)
process, as well as those with beta-cell destruction and
Endocrine disorders (hyperthyroidism, Cushing’s syndrome,
who are prone to ketoacidosis for which neither an glucagonoma, acromegaly, pheochromocytoma)
etiology nor a pathogenesis is known (idiopathic). It does Other genetic syndromes (with associated diabetes)
Reproduced with permission from American Diabetes Association[7]
not include those forms of beta-cell destruction or failure
to which specific causes can be assigned (e. g., cystic
fibrosis, mitochondrial defects, etc.). Some subjects with Table 2: Criteria for the diagnosis of diabetes
this type can be identified at earlier clinical stages than Measurement Diagnostic values Characteristics
for diabetes
“diabetes mellitus”.
Glycosylated hemoglobin ≥6.5% The test should be performed in a
• The underlying pathophysiologic defect in type 2 diabetes (HbA1c) laboratory using the standardized
does not involve autoimmune beta-cell destruction. method. It reflects average blood
glucose levels over a 2- to 3-month
Rather, type 2 diabetes is characterized by the following period of time
three disorders: Fasting plasma glucose ≥126 mg/dl (7.0 mmol/l) Fasting is defined as no caloric intake
a. Peripheral resistance to insulin, especially in muscle for 8 h
Postprandial plasma ≥200 mg/dl (11.1 mmol/l) The test should be performed as
cells; glucose (2 h after described by the World Health
b. Increased production of glucose by the liver; and caloric intake) Organization, using a glucose load
c. Altered pancreatic insulin secretion. containing the equivalent of 75g
anhydrous glucose dissolved in water
Random plasma glucose ≥200 mg/dl (11.1 mmol/l)
The American Diabetes Association’s Expert Committee Reproduced with permission from American Diabetes Association, 2010[2]
on the Diagnosis and Classification of Diabetes Mellitus
also recently approved new criteria for diagnosis of DM
[Table 2];[2]
Diabetes and Oral Health Oral
• A casual plasma glucose level (taken at any time of day) Complications of Diabetes: The
of 200 mg/dl (11.1 mM) or greater when the symptoms Sixth Complication of Diabetes
of diabetes are present. Classic symptoms of diabetes
include polydipsia, polyurea, and polyphagia. The most common oral health problems associated with
• Fasting plasma glucose level of 126 mg/dl (7.0 mmol/l) diabetes are:
or greater. • Periodontaldisease.
• An oral glucose tolerance test value in the blood of • Gum disease.
200mg/dlor greater when measured. • Salivary gland dysfunction.
• Fungal infections.
Maintenance of proper oral hygiene for good oral health • Oral burning and taste impairment.
is an accepted part of the normal recommendations for • Oral mucosal diseases including lichen planus and
a healthy lifestyle. Poor oral hygiene is associated with recurrent aphthous stomatitis.
gingivitis, which can progress to more severe infection and • Dental caries.
inflammation leading to periodontitis. Infectious disease is • Traumatic ulcers and irritation fibroma.[5]
known to be more common in people with diabetes if blood
glucose control is poor, and inflammation is known to be Periodontal disease
associated with a decrease in insulin sensitivity, and thus Periodontitis has been referred to as the sixth complication
potentially a worsening of blood glucose control. The dentist of diabetes. Diabetes is believed to promote periodontitis
plays a major role with other members of the health team through an exaggerated inflammatory response to the
in helping a patient maintain glycemic control by achieving periodontal microflora. The subgingivalmicroflora in patients
optimal oral health; and by referring undiagnosed patients with periodontitis who have DM generally is equivalent to
with complications suggestive of diabetes to physicians for that observed in patients with periodontitis who do not have
further evaluation. a diagnosis of diabetes[6,7] [Figure 1].

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Kaur, et al.: Oral health and diabetes mellitus
Figure 1: Periodontal disease
Understanding the pathway to periodontitis is essential
because it enables clinicians, researchers, and patients to
consider the possible mechanisms by which oral–systemic
connections occur.[8] It is a microbial challenge to the host
or person with poor oral hygiene that initiates the cascade
of events that can result in periodontal breakdown. The
presence of bacterial endotoxins, antigens, and other
virulence factors stimulate the host immunoinflammatory
response. Neutrophils are recruited to the site of the infection
to address the pathogenicmicrobes, which then invoke an
antibody response. In more resistant individuals, these events
lead to the development of localized reversible inflammation,
known as gingivitis. In more susceptible individuals, very high
levels of proinflammatory mediators — known as cytokines,
prostanoids, and matrix metalloproteinases — will be
produced by the host, leading to connective tissue breakdown
and bone metabolism changes associated with the bone loss
that is pathognomonic to periodontitis. In the clinical setting,
this cascade of events presents as the signs of disease:
Increases in probing depth, loss of clinical attachment,
and radiographic evidence of bone loss. Genetics plays a
significant role in who may be susceptible. Studies have
shown that at least 50% of all cases of periodontal disease
have some genetic component.[9] In addition, there are a
number of environmental and acquired risk factors that put
patients at greater risk. Various risk factors for periodontal
disease include hereditary, smoking, poor oral hygiene,
diabetes, and certain medications like calcium channel
blockers, dilantin, and cyclosporin.
Risk assessment is important because it has been recognized
that the more risk factors a patient has, the more likely he
or she is to develop the disease. There is often more than an
additive effect, there is a synergistic effect between these risk
factors. Identification and consideration of these risk factors
is critical to successful periodontal treatment because they
74 Archives of Medicine and Health Sciences / Jan-Jun 2015 / Vol 3 | Issue 1
can affect the onset, the rate of progression, and the severity
of periodontal disease. In addition, these risk factors may
determine treatment strategies and explain variability in the
therapeutic responses of patients. Risk factor assessments
can alter the way patients are viewed by the practitioner,
leading to a decision process based on risk. The primary
goal of the practitioner would be risk reduction.
A number of studies found a higher prevalence of periodontal
disease among diabetic patients than among healthy
controls. However, a recent survey has indicated that most
patients with DM are unaware of oral health complications of
their disease.[10] In a large cross-sectional study, Grossi and
others[11] showed that diabetic patients were twice as likely
as nondiabetic subjects to have attachment loss. Firatli,[12]
followed type 1 diabetic patients and healthy controls for
5 years. The people with diabetes had significantly more
clinical attachment loss than controls. In another cross-
sectional study, Bridges and others[13] found that diabetes
affected all periodontal parameters, including bleeding
scores, probing depths, loss of attachment, and missing
teeth. In fact, one study has shown that diabetic patients
are five times more likely to be partially edentulous than
nondiabetic subjects.[14] People with type 1 and 2 diabetes
appear equally susceptible to periodontal disease and
tooth loss. Periodontitis is a clinical complication of DM.
Furthermore, approximately 30% of people with DM have
undiagnosed DM. Therefore, the dental office is a healthcare
site that can help identify undiagnosed DM, which can lead
to better management of the care of patients with diabetes.
A recent study found that smoking increases the risk of
periodontal disease by nearly 10 times in diabetic patients.[15]
According to these results, the management of diabetic
patients should include strong recommendations to quit
smoking. For both type 1 and 2 diabetes, there does not
appear to be any correlation between the prevalence or
the severity of periodontal disease and the duration of
diabetes.[14,16]
Gum disease
This is a chronic bacterial infection that affects the gum
tissue and bone that supports the teeth [Figure 2]. If left
untreated, gum disease can result in abscesses or the
complete destruction of the tooth’s supporting tissues and,
ultimately, tooth loss. Gum disease tends to be more severe
among people who have diabetes because the disease lowers
the ability to fight infection and slows healing. An infection
causes blood sugar level to rise, which makes diabetes more
difficult to control. Preventing and treating gum disease can
help improve blood sugar control.[17]
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Kaur, et al.: Oral health and diabetes mellitus
The principles of treatment of periodontitis in diabetic
patients are the same as those for nondiabetic patients and
are consistent with our approach to all high-risk patients who
already have periodontal disease [see Table 3].
Salivary gland dysfunction
Dry mouth, or xerostomia, has been reported in 40–80%
of diabetic patients. Salivary dysfunction, however, can be
difficult to diagnose.[18] Salivary flow may be affected by
a variety of conditions, including the use of prescription
medications and increasing age, and it appears to be
affected by the degree of neuropathy and subjective
feelings of mouth dryness that may accompany thirst.[19]
Diabetic patients with poorly controlled disease have been
found to have lower stimulated parotid flow rates than
people with well-controlled DM and nondiabetic control
subjects. [20] Asymptomaticbilateral enlargement of the
parotid glands has been reported in 24-48% of patients
with DM, and patients with uncontrolled DM have exhibited
a greater propensity for enlargement.[18,21] Uncontrolled
diabetes can decrease the saliva flow and cause dry
mouth. A lack of saliva in the mouth allows bacteria to
accumulate. This increases the risk of developing halitosis
(bad breath), tooth decay, and gum diseases. The most
common complications of dry mouth or xerostomia
include difficulty in chewing, speaking, swallowing, and
the ability to taste. To help relieve dry mouth, sip water
throughout the day, chew sugarless gum or suck on
sugarless mints, or use a mouth moisturizer available
over the counter.[17]
Fungal infections
Several authors have reported that diabetic patient have
increased predisposition to manifestation of oral candidiasis,
including median rhomboid glossitis, denture stomatitis and
angular cheilitis. Candidiasis has been found to be associated
with poor glycemic control and use of dentures.[16,22,23] It could
Figure 2: Gum disease
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be due to xerostomia, increased salivary glucose levels or
immune dysregulation.
Mucormycosis is a rare but serious systemic fungal infection
that may occur in patients with uncontrolled DM which
appears as palatal ulceration or necrosis. Treatment usually
includes systemic antifungal therapy.[24] Oral fungal infections
are treated with special mouthwashes and antifungal
medication and by controlling blood sugar levels.[17]
Oral burning and taste disturbances
Clinician should consider DM in the diagnosis of problems
like burning mouth or tongue. The burning may be due to
peripheral neuropathy, xerostomia, or candidiasis. Good
glycemic control may alleviate burning sensation. Reports
have indicated that clonazepam may be beneficial in some
patients with complain of oral burning sensation.[25] Taste
disturbances have been reported in patients with DM,[26]
but all investigators have not observed this finding. Perros
and colleagues[27] reported that some diabetic patients
have a mild impairment of the sweet taste sensation.
This may be related to xerostomia or disordered glucose
receptors.
Oral mucosal diseases
A number of types of oral mucosal lesions, including lichen
planus and recurrent aphthous stomatitis, have been
reported in people with DM [Figure 3]. Not all study results
have showed this association, and these are relatively
common disorders that often are observed in patients who
do not have diabetes. Petrou-Amerikanou and colleagues[28]
reported that the prevalence of oral lichen planus is
significantly higher in patients with type I DM and slightly
higher in patients with type 2 DM than in control subjects.
However, this may be side effect of oral hypoglycemic agents
or antihypertensive medicines.
Figure 3: Reticular lichen planus
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Kaur, et al.: Oral health and diabetes mellitus

Table 3: Periodontal maintenance for diabetic patients

*Type 1 or type 2 diabetes OHI = Oral hygiene instruction

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Kaur, et al.: Oral health and diabetes mellitus
Dental caries
Some studies have demonstrated that diabetic patients
have more active dental caries than control subjects[29]
[Figure 4]. Furthermore, a reduction in salivary flow has been
reported in people with diabetes who have neuropathy,[19]
and diminished salivary flow is a risk factor for dental caries.
The literature presents no consistent pattern regarding the
relationship of dental caries and diabetes.[30] However, low
carbohydrate diabetic diets should theoretically reduce
caries prevalence.
Traumatic ulcers and irritation fibroma
Guggenheimer and colleagues,[5] recently reported that
people with type 1 diabetes have a higher prevalence of oral
traumatic ulcers and irritation fibromas than do nondiabetic
control subjects. These findings may be related to altered
wound healing patterns in these patients.
Dental Management Consideration
To minimize the risk of intraoperative emergency, clinicians
need to consider a number of management issues before
initiating dental treatment.
Medical history
Prior to dental treatment, the dentist must obtain a good
medical history which indicates the type of diabetes suffered
and frequency of hypoglycemic episodes or complications.
Antidiabetic medications, dosages times of administration,
and status of diabetes control should be determined.
According to the recent consensus of the American Diabetes
Association (2010),[2] glycosylated hemoglobin, that is, HbA1c
≥6.5%, a preprandial glycemia of ≥126 mg/ dl and a
postprandial glycemia ≥200 mg/dl are suggestive diagnostic
values of diabetes.
Scheduling of visits
In general, morning appointments are advisable since
endogenous cortisol levels are generally higher at this time
Figure 4: Dental caries
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(cortisol increases blood sugar levels). For patients receiving
insulin therapy, appointments should be scheduled so that
they donot coincide with peaks of insulin activity, since that
is the period of maximal risk of developing hypoglycemia.
Diet
It is important for clinicians to ensure that the patients has
eaten normally and taken medications as usual. If the patient
skips breakfast owing to the dental appointment but stills
takes the normal dose of insulin, the risk of a hypoglycemic
episode is increased. For certain procedures (e. g., conscious
sedation), the dentist may request that the patients alter his
or her normal diet before the procedure. In such cases, the
medication dose may need to be modified in consultation
with patient’s physician.
Blood glucose monitoring
Depending on the patient’s medical history, medication
regimen and procedure to be performed, dentists may
need to measure the blood glucose level before beginning a
procedure. This can be done using commercially available
electronic blood glucose monitors, which are relatively
inexpensive and have a high degree of accuracy. Patients
with low plasma glucose levels (<70 mg/dl for most people)
should be given an oral carbohydrate before treatment to
minimize the risk of a hypoglycemic event. Clinician should
refer patients with significantly elevated blood glucose levels
for medical consultation before performing elective dental
procedures.
Type 1 diabetic patients undergoing a dental procedure
Follow the considerations previously described.
Noninvasive dental procedures
Well-controlled patients can be treated similarly to nondiabetic
individuals. Be aware of the increased susceptibility of these
patients to infections and delayed wound healing. In poorly
controlled patients, delay the dental treatment if possible
until they have achieved good metabolic control.
Invasive dental procedures
Patients should ask their doctor for instructions concerning
their medication (normally, if they have metabolic stability,
they should take half their daily dose of insulin the morning
of the treatment; then, after the intervention, the whole dose
should be taken with a supplement of rapid-acting insulin).
Blood glucose should be measured preoperatively. If it is
between 100 and 200 mg/dl, the invasive dental procedure can
be performed. If blood glucose is >200 mg/dl, an intravenous
infusion of 10% dextrose in half-normal saline is initiated,
and rapid-acting insulin is administered subcutaneously. If
the treatment lasts more than 1 h, blood glucose should
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Kaur, et al.: Oral health and diabetes mellitus
be measured hourly. If blood glucose is >200 mg/dl, rapid-
acting insulin should be administered subcutaneously. Type
1 DM is considered a risk factor with regard to suffering
infection. For that reason, when invasive dental procedures
are going to be performed (as intraligamentous anesthesia,
teeth extractions, biopsies, etc.), the usual guidelines for the
antibiotic prophylaxis should be followed.[31]
Type 2 diabetic patients undergoing a dental procedure
Follow the considerations previously described.
Noninvasive dental procedures
People who control their disease well by diet and exercise
require no special perioperative intervention. As in type
1 diabetic patients, be aware of their susceptibility to
infections and delayed wound healing. In poorly-controlled
patients, delay the dental treatment if possible until they
have achieved good metabolic control.
Invasive dental procedures
Patients should ask their doctor for instructions regarding
their medication (normally, those patients being treated with
oral hypoglycemic agents should take their normal dose in
the morning and eat their regular diet).
Hypoglycemia is the major issue that confronts dental
practitioners when treating diabetic patients, particularly if
patients are fasting. The clinical presentation of hypoglycemia
is very similar to hyperglycemia. If in doubt, it should be
treated as a hypoglycemia. The characteristics and treatment
of this complication are showed in Table 2.[3] Hypoglycemia
usually appears in response to the stress experienced
before, during, or after the treatment, and has been shown
to cause a significant increase in perioperative morbidity
and mortality.[3,32]
Recommendations on Clinical Care
for People with Diabetes
1. Education of people with diabetes should include
explanation of the implications of diabetes, particularly
poorly controlled diabetes, for oral health, especially.
2. Look for early signs of gum disease:
Report any signs of gum disease — including redness,
swelling, and bleeding gums — to a dental hygienist.
Also mention any other signs and symptoms such as dry
mouth, loose teeth, or mouth pain. In those people with
possible symptoms of gum disease, advise them to seek
early attention from a dental health.
3. Maintain good oral hygiene:
• Brush twice a day for 2 min with a soft toothbrush
and fluoridated toothpaste.
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• Clean or floss between teeth once a day to remove
food and plaque.
• Clean or scrape the tongue daily.
• Avoid mouth rinses with alcohol, as they tend to make
dry mouth worse.
• Remove and clean dentures daily.
Implementation
Professional education and awareness within the diabetes
community will need to be enhanced before these
recommendations are likely to be widely adopted. Healthcare
professionals should be empowered to explain the need for
oral hygiene and the background to their enquiries about
gum disease. They should be aware that certain medications
(notably calcium channel blockers, tricyclics) may result
in dry mouth (xerostomia), which is likely to increase
the accumulation of plaque and the risk of oral diseases.
Communication between diabetes and oral healthcare
professionals could facilitate this empowerment.
Dental hygienists involved in diabetes care should:
• Update the client’s medical history and any changes in
medication.
• Devise a treatment plan and develop a customized
homecare program.
• Give advice on the various types of oral care products
and how to use them.
• Instruct clients on the most effective way to brush and floss.
• Provide information and counseling on tobacco cessation
and dietary measures to support diabetic management.
• Refer clients to a physician/nurse practitioner if diabetes
is suspected but not diagnosed.
Conclusion
DM is a disease of which the general public and practicing
dentists and dental hygienists should be aware. On the
basis of the available data, we can conclude that practicing
dentists and dental hygienists can have a significant,
positive effect on the oral and general health of patients
with DM. It is important for the dentist to be aware with
the medical management of the patients with DM, and to
recognize the signs and symptoms of the undiagnosed or
poorly controlled disease. By taking an active role in the
diagnosis and treatment of oral conditions associated with
DM, dentist may also contribute to the maintenance of
optimal health in patients with this disease. Periodontal
disease is the main oral clinical manifestation in diabetic
patients. Periodontal treatment may eventually be covered
by medical insurance, which could include consultations,
diagnostics, and therapeutics. These patients should be
aware of their increased susceptibility to infections and
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Kaur, et al.: Oral health and diabetes mellitus
delayed wound healing. Well-controlled diabetics can be
treated in the dental office similarly to nondiabetic patients,
but morning appointments are preferable, and patients
should be instructed not to fast, in order to reduce the risk
of the occurrence of hypoglycemia.
References
1. Diabetes Fact Sheet, WHO, November 2008. Available from:
http://www.who.int/mediacentre/factsheets/fs312/en/ [Last
accessed on 2014 Feb 10].
2. American Diabetes Association. Diagnosis and classification
of diabetes mellitus. Diabetes Care 2010;33:62-9.
3. Kidambi S, Patel SB. Diabetes mellitus: Considerations for
dentistry. J Am Dent Assoc 2008;139:8-18S.
4. Report of the Expert Committee on the Diagnosis and
Classification of Diabetes Mellitus. Diabetes Care
1997;20:1183-97.
5. Guggenheimer J, Moore PA, Rossie K, Myers D, Mongelluzzo
MB, Block HM, et al. Insulin dependent diabetes mellitus and
oral soft tissue pathogenesis. I. Prevalence and characteristics
non-candidial lesions. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2000;89:563-9.
6. Ebersole JL, Holt SC, Hansard R, Novak MJ. Microbiologic
and immunologic characteristics of periodontal disease in
Hispanic Americans with type 2 diabetes. J Periodontol
2008;79:637-46.
7. Lalla E, Kaplan S, Chang SM, Roth GA, Celenti R, Hinckley K,
et al. Periodontal infection profiles in type 1 diabetes. J Clin
Periodontol 2006;33:855-62.
8. Page RC, Kornman KS. The pathogenesis of human
periodontitis: An introduction. Periodontol 2000 1997;14:9-11.
9. Michalowicz BS, Diehl SR, Gunsolley JC, Sparks BS, Brooks CN,
Koertge TE, et al. Evidence of a substantial genetic basis for risk
of adult periodontitis. J Periodontol 2000;71:1699-707.
10. Moore PA, Orchard T, Guggenheimer J, Weyant RJ. Diabetes
and oral health promotion: A survey of disease prevention
behaviours. J Am Dent Assoc 2000;131:1333-41.
11. Grossi SG, Zambon JJ, Ho AW, Koch G, Dunford RG,
Machtei EE, et al. Assessment of risk for periodontal
disease. I. Risk indicators for attachment loss. J Periodontol
1994;65:260-7.
12. Firatli E. The relationship between clinical periodontal
status and insulin-dependent diabetes mellitus. Results after
5 years. J Periodontol 1997;68:136-40.
13. Bridges RB, Anderson JW, Saxe SR, Gregory K, Bridges SR.
Periodontal status of diabetic and non-diabetic men: Effects
of smoking, glycemic control, and socioeconomic factors. J
Periodontol 1996;67:1185-92.
14. Moore PA, Weyant RJ, Mongelluzzo MB, Myers DE, Rossie K,
Guggenheimer J, et al. Type 1 diabetes mellitus and oral
health: Assessment of tooth loss and edentulism. J Public
Health Dent 1998;58:135-42.
15. Moore PA, Weyant RJ, Mongelluzzo MB, Myers DE, Rossie K,
Guggenheimer J, et al. Type 1 diabetes mellitus and oral
health: Assessment of periodontal disease. J Periodontol
1999;70:409-17.
16. Sandberg GE, Sundberg HE, Fjellstrom CA, Wikblad KF.
Type 2 diabetes and oral health. A comparison between
Archives of Medicine and Health Sciences / Jan-Jun 2015 / Vol 3 | Issue 1
diabetic and non-diabetic subjects. Diabetes Res Clin Pract
2000;50:27-34.
17. Dental Hygienists: Your partners in oral health. Available
from: www.odha.on.ca [Last accessed on 2014 Mar 18].
18. Quirino MR, Birman EG, Paula CR. Oral manifestation of
diabetes mellitus in controlled and uncontrolled patients.
Braz Dent J 1995;6:131-6.
19. Moore PA, Guggenheimer J, Etzel KR, Weyant RJ, Orchard T.
Type 1 diabetes mellitus, xerostomia, and salivary flow
rates. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2001;92:281-91.
20. Chavez EM, Taylor GM, Borell LN, Ship JA. Salivary
function and glycemic control in older persons with diabetes
control. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2000;89:305-11.
21. Russotto SB. Asymptomatic parotid gland enlargement
in diabetes mellitus. Oral Surg Oral Med Oral Pathol
1981;52:594-8.
22. Guggenheimer J, Moore PA, Rossie K, Myers D, Mongelluzzo
MB, Block HM, et al. Insulin dependent diabetes mellitus
and oral soft tissue pathogenesis, II: Prevalence and
characteristics of candida and candidial lesions. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod 2000;89:570-6.
23. Hill LV, Tan MH, Periara LH, Embil JA. Association
of oral candiasis with diabetic control. J Clin Pathol
1989;42:502-5.
24. Jones AC, Bentsen TY, Freedman PD. Mucormycosis of the
oral cavity. Oral Surg Oral Med Oral Pathol 1993;75:455-60.
25. Grushka M, Epstein J, Mott A. An open-label, dose escalation
pilot study of the effect of clonazepam in burning mouth
syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 1998;86:557-61.
26. Ship JA. Diabetes and oral health: An overview. J Am Dent
Assoc 2003;134:4-10S.
27. Perros P, Mac Farlane TW, Counsell C, Frier BM. Altered
taste sensation in newly-diagnosed NIDDM. Diabetes Care
1996;19:768-70.
28. Petrou-Amerikanou C, Markopolous AK, Belazi M,
Karamitsos D, Papanayotou P. Prevalence of oral lichen
planus in diabetes mellitus according to the type of diabetes.
Oral Dis 1998;4:37-40.
29. Lalla Rajesh V, D’Ambrosio Joseph A. Dental management
considerations for the patients with diabetes mellitus. J Am
Dent Assoc 2001;132:1425-32.
30. Taylor GW, Manz MC, Borgnakke WS. Diabetes, periodontal
diseases, dental caries, and tooth loss: A review of the
literature. Compend Contin Educ Dent 2004;25:179-84,
186-8.
31. Gutiérrez JL, Bagán JV, Bascones A, Llamas R, Llena J,
Morales A, et al. Consensus document on the use of antibiotic
prophylaxis in dental surgery and procedures. Med Oral Patol
Oral Cir Bucal 2006;11:E188-205.
32. Bergman SA. Per ioperative management of the diabetic
patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2007;103:731-7.
How to cite this article: Kaur S, Kaur K, Rai S, Khajuria R. Oral health
management considerations in patients with diabetes mellitus. Arch Med
Health Sci 2015;3:72-9.
Source of Support: Nil, Conflict of Interest: None declared.
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