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Test Your Diabetes Knowledge
1. Practicing dental professionals are not likely to encounter patients with undiagnosed diabetes mellitus.
An estimated 40.1 million people in the United States live with diabetes mellitus, including approximately 11 million who remain undiagnosed. Additionally, nearly 115.2 million U.S. adults are prediabetic.1 As a result, dental professionals are likely to encounter patients with undiagnosed diabetes mellitus.2
Patients with diabetes mellitus, particularly when uncontrolled or undiagnosed, are susceptible to multiple oral manifestations and complications. Although these oral manifestations and complications may overlap with other conditions, dental professionals play an important role in recognizing them and referring patients for appropriate screening and medical care.2
References
1. National Diabetes Statistics Report. (2026, March 11). Centers for Disease Control and Prevention. https://usdss.cdc.gov/diabetes/report.html
2. Diabetes. (2022, January 24). American Dental Association. https://www.ada.org/resources/ada-library/oral-health-topics/diabetes
2. Which type of diabetes is believed to be an autoimmune response?
Type 1 diabetes mellitus is believed to be caused by an autoimmune response in which the body attacks the pancreatic beta cells, inhibiting the pancreas's ability to produce insulin.1,2 Although symptoms may not be evident early in disease development, they can manifest suddenly and severely. Type 1 diabetes mellitus is most commonly diagnosed in children and young adults, though it can develop at any age.1
Currently, no strategies exist to prevent the onset of type 1 diabetes mellitus.1 However, disease-modifying therapies (anti-CD3 monoclonal antibodies) can delay progression to clinical stage 3 disease by approximately 3 to 5 years when administered in Stage 2, while also preserving residual beta-cell function and reducing insulin requirements for up to 2 years or longer when initiated in newly diagnosed Stage 3 disease.2
References
1. Diabetes Basics. (2026, January 2). Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/about/index.html
2. Mathieu, C., Sims, E.K., Chatenoud, L., et al. Toward Disease-Modifying Therapies in Type 1 Diabetes: Focus on Teplizumab. Diabetes Care. 2026; 49(3): 365-374. https://pmc.ncbi.nlm.nih.gov/articles/PMC12925991/
3. Morning appointments are recommended for patients with diabetes mellitus. If the patient has skipped a meal, confirming they took their insulin is sufficient to prevent a hypoglycemic emergency.
Morning appointments are recommended for patients with diabetes mellitus because endogenous cortisol levels are typically higher in the morning, which increases blood glucose levels and reduces the risk of hypoglycemia.1 Additionally, for patients who use insulin, appointments should be scheduled around their insulin routine to avoid peak insulin levels, which can vary by insulin brand and type from 30 minutes to 12 hours.1,2
Ensuring patients eat normally and take scheduled diabetes medications as prescribed before their appointment helps prevent hypoglycemic emergencies. If a procedure requires patients to alter their normal eating habits before treatment or post-operatively, dental professionals should consult the patient's physician or endocrinologist to determine whether medication doses need to be adjusted. Additionally, monitoring blood glucose chairside with a glucometer provides clinically relevant information on the patient's glycemic status. Dental professionals should be trained and familiar with glucometer use to avoid errors and ensure patient safety.1
References
1. Diabetes. (2022, January 24). American Dental Association. https://www.ada.org/resources/ada-library/oral-health-topics/diabetes
2. Types of Insulin. (2024, May 15). Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/about/how-to-use-insulin.html
4. Type 2 diabetes mellitus does not require insulin for management.
Adults with type 2 diabetes mellitus may need insulin when their A1C is >10% or blood glucose levels are ≥300 mg/dL. For these patients, insulin may be prescribed in addition to other glucose-lowering medications. When insulin is used, combination therapy with a GLP-1 RA is recommended, as it provides better glycemic control while reducing the risk of hypoglycemia. However, for patients without severe hyperglycemia, GLP-1-based therapy is preferred to insulin for initial or add-on therapy.1
Reference
1. American Diabetes Association Professional Practice Committee for Diabetes. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes–2026. Diabetes Care. 2026; 49(Suppl 1): S183-S215. https://pmc.ncbi.nlm.nih.gov/articles/PMC12690185/
5. Which of the following is an oral manifestation of diabetes mellitus?
Oral manifestations, most often associated with poorly controlled or undiagnosed diabetes mellitus, may include:
- Salivary gland enlargement
- Xerostomia
- Hypogeusia
- Dental caries
- Oral infections
- Periodontal disease
- Impaired wound healing
- Trigeminal neuropathy1
Reference
1. Alqadi, S.F. Diabetes Mellitus and Its Influence on Oral Health: Review. Diabetes Metab Syndr Obes. 2024; 17: 107-120. https://pmc.ncbi.nlm.nih.gov/articles/PMC10785684/
6. Dental caries is not a primary oral manifestation of diabetes mellitus. Instead, diabetes mellitus-associated salivary dysfunction, oral hygiene, and diet influence the risk of dental caries.
Dental caries is not a primary oral manifestation of diabetes mellitus. Rather, its association with the condition is multifactorial and influenced by dietary choices, oral hygiene practices, and salivary dysfunction. Studies show that patients with diabetes often exhibit altered salivary composition, reduced buffering capacity, and elevated salivary glucose levels. Additionally, xerostomia is reported more frequently in individuals with poorly controlled blood glucose (higher HbA1c), where reduced salivary flow may increase caries risk. However, research demonstrates that patients with diabetes who maintain good glycemic control do not have a higher caries risk than the general population.1
Reference
1. Alqadi, S.F. Diabetes Mellitus and Its Influence on Oral Health: Review. Diabetes Metab Syndr Obes. 2024; 17: 107-120. https://pmc.ncbi.nlm.nih.gov/articles/PMC10785684/
7. The association between periodontal disease and diabetes mellitus is unidirectional, meaning managing one disease does not affect the other.
Periodontal disease is a well-documented complication of diabetes mellitus.1 Periodontitis was first coined the "sixth complication" of diabetes mellitus in a 1993 paper by Dr. Harald Löe.1,2 Studies indicate that altered subgingival flora in periodontally involved patients with diabetes mellitus can cause an exaggerated host immune response and impair tissue repair mechanisms, leading to increased inflammation and tissue degradation. Poor glycemic control can further increase gingival inflammation and alveolar bone loss. The inflammatory response and presence of pathogenic bacteria are reciprocal, suggesting a bidirectional association between diabetes mellitus and periodontal disease, where managing one condition can improve the outcome of the other, and vice versa.1
References
1. Alqadi, S.F. Diabetes Mellitus and Its Influence on Oral Health: Review. Diabetes Metab Syndr Obes. 2024; 17: 107-120. https://pmc.ncbi.nlm.nih.gov/articles/PMC10785684/
2. Löe, H. Periodontal Disease. The Sixth Complication of Diabetes Mellitus. Diabetes Care. 1993; 16(1): 329-334. https://pubmed.ncbi.nlm.nih.gov/8422804/
