Diabetic patients are usually on dental professionals’ radar. Because diabetes is so common—more than 10% of the US population has diabetes—there’s a high likelihood we’ll deal with at least one diabetic patient a day.1 All health professionals need to recognize diabetes because it’s the eighth leading cause of death in the US and the number one cause of kidney failure, lower-limb amputations, and adult blindness.2 Diabetes cases have been on the rise, with adult diabetes diagnoses doubling during the last 20 years.2
When it comes to the oral cavity, science recognizes how detrimental diabetes can be. Diabetic patients are at an increased risk for both dental caries and periodontal disease.3 In addition, they have altered salivary flow and salivary content.3 Finally, diabetic patients have been known to report higher incidences of thrush, xerostomia, burning mouth syndrome, altered taste, and bleeding.3 Some of these concerns have been blamed on the various treatment modalities for diabetes, and some stem from the body’s altered state as it fights the autoimmune disease.3
Diabetes treatment has recently become popular because a specific medication is now being used for people with and without diabetes. This medicine is so new that medical professionals and the public are not yet aware of its long-term side effects. Dental pros should always document any medications patients are taking, both prescribed and over the counter, in the patient’s medical history.4
A new diabetes classification
In addition to the new medication to treat diabetes, there’s also a new classification, or type, of diabetes. Most health-care providers recognize the two main types of diabetes. Type 1 is an autoimmune disorder where the pancreas stops making insulin or makes very little insulin.5 Type 1 diabetic patients require medications to help manage their disease. The pancreas of anyone at any age can suddenly stop producing enough insulin.5 Scientists estimate that 5%–10% of the total population of diagnosed diabetic patients are type 1.5
The second most commonly diagnosed diabetes is type 2.6 Type 2 diabetes is often not an autoimmune response but is brought on by weight gain.6 Thus, type 2 diabetics do not always need medication and can sometimes reduce their diabetes symptoms by losing weight.6 Most of the those diagnosed with diabetes, 90%– 95%, are type 2.6
The new type of diabetes that’s emerged involves characteristics of both types.7 Diabetes type 1.5 is also known as latent autoimmune diabetes (LADA).7 This diabetes is often misdiagnosed because of its tendency to have characteristics of both type 1 and type 2 diabetes.7 Type 1.5 diabetes sets in during adulthood and often starts slowly so that endocrinologists believe it can be managed with diet and exercise like type 2 diabetics.7
Unfortunately, diabetes type 1.5 is autoimmune, it starts slowly, and it requires medication as it progresses.7 A blood screening test with an overview of the patient’s symptoms will help doctors determine that a patient has diabetes type 1.5.7 Diabetic type 1.5 patients can stay in their best health by getting the correct diagnosis and managing their blood glucose levels so they can maintain a normal range.7
No matter which type of diabetes a patient has, their dental professional should help them stay in a healthy state. The dental professional should take the time to thoroughly examine the patient’s medical history to document their most recent a1C numbers and verify that they’ve eaten before their appointment. All medications, prescribed or not, should be documented in the patient’s chart. Dental pros should also document the name of the patient’s endocrinologist. Finally, dental professionals should ask patients if they need guidance about their oral health status and then educate them about how diabetes could be affecting it.
References
1. By the numbers: diabetes in America. Centers for Disease Control and Prevention. Last reviewed October 25, 2022. https://www.cdc.gov/diabetes/health-equity/diabetes-by-the-numbers.html
2. What is diabetes? Centers for Disease Control and Prevention. Last reviewed September 5, 2023. https://www.cdc.gov/diabetes/basics/diabetes.html
3. Diabetes, gum disease, and other dental problems. National Institute of Diabetes and Digestive and Kidney Disease. January 2022. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/gum-disease-dental-problems
4. Cheeseman V. Ozempic and dentistry: Implications for today’s clinicians. DentistryIQ. February 16, 2024. https://www.dentistryiq.com/dentistry/pharmacology/article/14305225/ozempic-and-dentistry-implications-for-todays-clinicians
5. What is Type 1 diabetes? Centers for Disease Control and Prevention. Last reviewed September 5, 2023. https://www.cdc.gov/diabetes/basics/what-is-type-1-diabetes.html
6. Type 2 diabetes. Centers for Disease Control and Prevention. Last reviewed April 18, 2023. www.cdc.gov/diabetes/basics/type2.html
7. Watson K. What you need to know about type 1.5 diabetes. Healthline. April 13, 2022. https://www.healthline.com/health/type-1-5-diabetes
Tracee S. Dahm, BSDH, MSDH, RDH, is an adjunct clinical instructor for the North Idaho College School of Dental Hygiene in Coeur d’Alene, Idaho. She also works in private practice. Her research interests include trends in dental hygiene and improving access to dental care for the underserved. She can be reached at [email protected].
