November 2016 Issue

Editor's Spot: Diabetes and Oral Health
By Judith Riddle
Today's Dietitian
Vol. 18, No. 11, P. 4

People with diabetes are more likely to know that uncontrolled blood glucose can lead to complications such as heart disease, stroke, renal disease, retinopathy, and neuropathy. But they're less likely to know that poor glycemic control can lead to poor oral health and that poor oral health can lead to poor glycemic control. Much research has demonstrated the link between diabetes and oral health, yet more work must be done to educate dietitians and certified diabetes educators (CDEs) and develop additional resources to improve counseling sessions, patient examinations, and referrals.

In April, the American Association of Diabetes Educators (AADE) hosted a meeting, "Thought Leader Summit: Diabetes and Oral Health," during which a panel of CDEs and various oral health professionals convened to discuss ways to improve patient screening and education as well as referrals, among other issues.

One of the oral health care panelists was Jerry A. Brown, DMD, CDE, the first and only dentist in the United States to obtain CDE certification. Brown presented on diabetes and oral health at the AADE 2016 annual conference in San Diego where he described diabetes' impact on oral health, discussed how oral diseases affect glycemic control, offered strategies for counseling and examining patients, and outlined criteria for making referrals.

Given the importance of this topic, I was surprised to see how few dietitians and CDEs attended this session. According to the American Diabetes Association, almost 30 million children and adults in the United States have diabetes. It's estimated that 86 million Americans have prediabetes, and 1.4 million Americans are diagnosed with diabetes each year.

Some of the most common oral health problems associated with diabetes include dry mouth, which increases cavity risk, thrush, gingivitis, and periodontal disease (PD), which can cause permanent tooth loss. Currently, 47% of US adults aged 30 and older have PD, and 60% of children with diabetes aged 6 to 11 are twice as likely to have early signs of gingivitis. So equipping RDs and CDEs to address oral health is paramount. Brown said dietitians can inquire whether patients have had a dental exam within the last six months and have a history of PD. They can assess patients for missing teeth and inflamed and bleeding gums; ask whether they have loose teeth, pain, burning, or swelling in their mouths; provide resources and education; and determine when to make referrals. If you've been doing these things consistently, that's great. If you haven't, please make it a point this month to extend discussions on the importance of oral health with patients, perform oral evaluations, and make referrals. For more information and resources, visit and

This month you'll learn about the pathophysiology and the role of medications in type 2 diabetes management in "Diabetes Bootcamp," on page 26, and how prickly pear cactus can lower blood sugar in Dynamics of Diabetes. Please enjoy the issue!

Judith Riddle