Medical Professionals Treating Children with Type 1 Diabetes

Oral Health Fact Sheet for Medical Professionals Treating Children with Type 1 Diabetes

Diabetes type 1 is a disease in which the body does not produce insulin, resulting in a high level of sugar in the blood. (ICD 9 code 250.0)

Oral Manifestations and Considerations

Oral

• Increased risk of dental caries due to salivary hypofunction
• Accelerated tooth eruption with increasing age
• Gingivitis with high risk of periodontal disease (poor control increases risk)
• Salivary gland dysfunction leading to xerostomia
• Impaired or delayed wound healing
• Taste dysfunction
• Oral candidiasis

Other Potential Disorders/Concerns

• Ketoacidosis, kidney failure, gastroparesis, diabetic neuropathy and retinopathy
• Poor circulation, increased occurrence of infections, and coronary heart disease

Oral Side Effects of Commonly Prescribed Medications

Medication

Insulin injections – none

Parent/Caregiver Support and Guidance

• Discourage consumption of cariogenic foods and beverages.
• Prescribe sugar-free medications, if available.
• Recommend preventive measures, such as topical fluoride and sealants.
• Advise the use of fluoridated toothpaste twice daily and support the family in following dental care instructions.
• Instruct caregiver on appropriate protocol following dental trauma (locate/preserve missing tooth and put in cold milk; seek immediate professional care).
• Review safety issues appropriate to the age of the child, such as mouth guards to prevent oral-facial trauma.
• Discuss habits that may harm the child’s teeth, such as propping baby bottles, putting child to bed with bottle.
• Refer to dentist any oral developmental abnormalities.

References

• Skamagas, M., Breen, T.L., LeRoith, D. (2008) Update on diabetes mellitus: prevention, treatment, and association with oral diseases. Oral Dis, 14(2):105-114.
• Lalla, E., Cheng, B., Lal, S., Tucker, S., Greenberg, E., Goland, R., Lamster, I. (2006) Periodontal changes in children and adolescents with diabetes: a case-control study. Diabetes Care, 29(@): 295-299.
• Vernillo, AT. (2003) Dental considerations for the treatment of patients with diabetes mellitus. J Am Dent Assoc, 134: 245-335.

Additional Resources

• NIH Institute for Diabetes
• Special Care: an Oral Health Professionals Guide to Serving Young Children with Special Health Care Needs
• Bright Futures Oral Health Pocket Guide
• American Academy of Pediatric Dentistry: 2011–2012 Definitions, Oral Health Policies and Clinical Guidelines
• MCH Resource Center
• ASTDD – Special Needs
• Block Oral Disease, MA
• Free of charge CDE courses: MCH Oral Health CDE (4 CDE hours) NIDCR CDE (2 CDE hours)