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Oral Health & Diabetes

Why this? Why now?  The research based that explains the interface between oral health and diabetes has become very solid in recent years.  The reciprocal relationship between diabetes and periodontal disease distinguishes it from other chronic diseases.

The evidence:  Poor oral health in adults contributes to complications and severity of heart disease, diabetes and other chronic conditions.[i]  “…One of the major complications of diabetes is periodontal disease[ii] … Adults with diabetes have both a higher prevalence of periodontal disease and more severe forms of the disease[iii]…  In addition, periodontal disease has been associated with development of glucose intolerance and poor glycemic control among adults with diabetes.[iv]” Diabetes is a growing problem everywhere and is one of the four primary causes of death and disability among Maine residents.[v]  Established diabetes education and self-management programs operating in Maine utilize the ADA Standards, but include little if any information about oral health issues.[vi]  This is of particularly significant concern in Maine because the prevalence of diabetes is rising[vii] while the age-adjusted estimates of the percentage of dentate adults who have diabetes who had a dental visit during the preceding 12 months decreased from 64.3% in 1999 to 59.3% in 2004.[viii]  These results place Maine residents with diabetes in a tie with diabetic residents in Puerto Rico for the having the 9th worst oral health care utilization rate in the United States and its territories.

[i] Genco, Robert J., Mechanisms Proposed Linking Periodontal Infections and Diabetes, Heart Disease and Stroke, Premature Births, and Respiratory Infections.  Oral Presentation, APHA Session #4245, Boston, MA 2007

[ii] Low H. Periondal disease —the sixth complication of diabetes mellitus.  Diabetes Care 1993;16(suppl 1)329—34.  Cited in MMWR Weekly, November 25, 2005 / 54(46);1181-1183.

[iii] Tomar SL, Lester A. Dental and other health care visits among U.S. adults with diabetes.  Diabetes Care 2000;23:1505—10. Cited in MMWR Weekly, November 25, 2005 / 54(46);1181-1183.

[iv] Saito T, Shimazaki Y, Kiyohara Y, et.al. The severityof periodontal disease is associated wit the development of glucose intolerance in non-diabetics: the Hisayama Study. J Dent Res 2004;83:485—90.  AND

Taylor G. Periodontal treatment and its effect on glycemic control, 1999.  Oral Surg Oral med Oral pathol 1999;87:311-6.  Cited in MMWR Weekly, November 25, 2005 / 54(46);1181-1183.

[v] Healthy Maine 2010 accessed at http://www.maine.gov/dhhs/files/hm2010/hm2010/a05ch02.pdf  on July 13, 2007.  Published by the State of Maine, Primary author: Dr. DoraAnne Mills, State Health Officer.

[vi] Maine DHHS Division of Chronic Disease Diabetes Prevention and Control Progam.  Diabetes Self-Management Education Barrier Study, September 2006.  AND

Personal Communication, Jim Leonard, Maine Diabetes Prevention and Control Program Manager, July 10, 2007.

[vii] Maine DHHS Division of Chronic Disease Diabetes Prevention and Control Progam.  Diabetes Self-Management Education Barrier Study, September 2006, p. 6.

[viii] MMWR Weekly, November 25, 2006 / 54(46);1181-1183, Table 1 accessed at http://www.cdc.ogv/mmwr/preview/mmwrhtml/mm5446a3.htm on July 5, 2007.