U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Friday, September 30, 2016

Division of Diabetes Treatment and Prevention - Leading the effort to treat and prevent diabetes in American Indians and Alaska Natives

Standards of Care and Clinical Practice
Recommendations: Type 2 Diabetes

Last updated: July 2012

Oral Care

Clinical Practice Recommendations

Oral Care

recommendations icon Recommendations for Oral Care

  • Examine the patient’s mouth as part of routine diabetes care:
    • Examine teeth and gums for plaque, gingival inflammation, and caries.
    • Inquire about pain and look for problems, including sores, swollen or bleeding gums, loose teeth, mouth ulcers or growths, candidiasis, or decayed teeth.
    • If a patient uses oral tobacco, be sure to examine gums and oral mucosa, especially where the patient usually places the tobacco.
  • Refer for professional dental care:
    • Annually for routine dental examination.
    • More often for people with periodontal disease as determined by the dental care professional.
    • As needed for evaluation of oral health problems.

People with diabetes frequently have problems with their teeth and gums, especially when they have poor glycemic control. The higher the blood glucose, the greater the risk for developing periodontal disease. AI/AN people with diabetes have two to three times more advanced periodontal disease than people who do not have diabetes.

Periodontal disease results in the loss of all teeth in approximately one-third of AI/AN people with diabetes. People without teeth can suffer emotionally and nutritionally because they may not be able to eat many important types of foods. Every attempt should be made to replace missing teeth with dental prosthetics when there is significant loss of chewing function.

Periodontitis can negatively affect diabetes control and development of diabetes complications. The infection and inflammation associated with periodontitis can aggravate blood glucose control and increase risk for many of the complications of diabetes such as CVD and CKD.

In addition to periodontal disease, other oral health issues observed in people with diabetes include: dental caries, burning mouth syndrome and potential difficulty in wearing dental prosthetics, salivary gland dysfunction/dry mouth, fungal infections, lichen planus and lichenoid reactions, delayed healing, and taste disorders.

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Tools for Clinicians and Educators

tools and resources icon Key Tools and Resources

IHS Division of Diabetes Treatment and Prevention. Indian Health Diabetes Best Practice—Oral Health Care, 2011. [PDF - 328KB]

Lamster IB, et al. The Relationship Between Oral Health and Diabetes Mellitus. J Am Dent Assoc. 2008;139 Suppl 5:S19-24.

National Diabetes Education Program. Redesigning the Health Care Team: Diabetes Prevention and Lifelong Management. Exit Disclaimer: You Are Leaving www.ihs.gov [PDF]  Centers for Disease Control and Prevention and National Institutes of Health. 2013. 48 p.

  • The Team Care guide provides practical resources to help health care professionals and organizations implement team care for people with diabetes.

additional resources icon Additional Resources

IHS Division of Diabetes Treatment and Prevention. IHS DDTP Webinar – Advancements in Diabetes Seminar: The Diabetes-Oral Health Connection. Exit Disclaimer: You Are Leaving www.ihs.gov Feb. 22, 2012.

Patient Education Materials

National Diabetes Information Clearinghouse. Prevent Diabetes Problems: Keep Your Mouth Healthy. Exit Disclaimer: You Are Leaving www.ihs.gov [PDF]  NIH Publication No. 12–4280. Feb. 2012.

  • Easy-to-read illustrated booklet on oral care for people with diabetes (available in large or standard format).

Division of Diabetes Treatment and Prevention | Phone: 1-844-IHS-DDTP (1-844-447-3387) | diabetesprogram@ihs.gov