Diabetes mellitus: a review of the literature and dental implications.

Diabetes mellitus consists of a group of disorders, which are characterized by a lack of insulin production or insulin resistance. There can be various oral manifestations of diabetes, such as xerostomia and an increased incidence of dental caries. Recently, it has been suggested that periodontitis be added as the sixth complication of diabetes mellitus. It has been shown that uncontrolled or poorly controlled diabetics have a greater incidence of severe periodontal disease compared with those patients who are well controlled or have no diabetes mellitus. This has been found for both type 1 and type 2 diabetics. In addition, the diabetic patient may be predisposed to periodontal disease based on the production of advanced glycation end products, which bind to receptors on specific cells such as the monocyte. The success of periodontal treatment appears to be dependent on the control exhibited by the diabetic patient. The well-controlled diabetic will respond well to periodontal treatment, while the uncontrolled or poorly controlled will often not respond well or be stable in the long-term. Because of the large number of diabetics in the US population, dental therapists should be aware of the interactions of the patient's diabetic status, the proposed treatment, and the possible treatment outcomes as well as complications.