Type 2 diabetes mellitus (T2DM) has been described as a new epidemic. Approximately 285 million people worldwide suffer from diabetes, and this number is predicted to increase by about 50% by year 2030.This article will review oral health manifestations of diabetes, and discuss associations between periodontal disease and diabetes. Although there is a strong body of evidence that supports the relationship between oral health and T2DM, oral health awareness is lacking among patients with diabetes and other health professionals. There is a need for the treating physician to be educated about the various oral manifestations of diabetes so that they can be diagnosed early and timely referrals to oral health specialists can be made. The established link between periodontitis and diabetes calls for an increased need to study ways to control both diseases, particularly among populations with health disparities and limited access to oral and health care.

Purpose To examine the effect of a home orofacial exercise program on increasing oral aperture among adults with systemic sclerosis (SSc). Method Forty-eight adults with SSc were assigned randomly to the multi-faceted oral health intervention or usual dental care control group. Participants with an oral aperture of < 40 mm in the intervention group received an orofacial exercise program, which included daily manual mouth-stretching and oral augmentation exercises twice a day with a total of 6 minutes for 6 months. The outcome measure was oral aperture which was measured at baseline, 3-months, and 6-months intervals. Results A significantly larger increase in oral aperture for participants received the orofacial exercise program was found when compared to those in the usual care at 3 months (P=0.01), but not at 6 months evaluation. Participants’ adherence rate to the exercise program was low (48.9%). Conclusions The orofacial exercise program intervention for adults with SSc and microstomia did not show significant improvement at 6 months. In addition to the low exercise adherence rate, insufficient frequencies, repetitions, and durations of the orofacial exercises may contribute to these results.

Synopsis Periodontal diseases are initiated by subgingival periodontal pathogens in susceptible periodontal sites. The host immune response towards periodontal pathogens helps to sustain periodontal disease and eventual alveolar bone loss. Numerous adjunctive therapeutic strategies have evolved to manage periodontal diseases. Systemic and local antibiotics, antiseptics, and past and future host immune modulatory agents are reviewed and discussed to facilitate the dental practitioner’s appreciation of this ever-growing field in clinical periodontics.

Aim-To evaluate associations between glycaemic control and periodontitis progression among Gullah African Americans with type-2 diabetes mellitus (T2DM). Materials and Methods-From an ongoing clinical trial among T2DMGullah, we extracted a cohort previously in a cross-sectional study (N 5 88). Time from baseline (previous study) to followup (trial enrollment, before treatment interventions) ranged 1.93-4.08 years [mean 5 2.99, standard deviation (SD) = 0.36]. We evaluated tooth site-level periodontitis progression [clinical attachment loss (CAL) worsening of ≥ 2 mm, periodontal probing depth (PPD) increases of ≥ 2 mm and bleeding on probing (BOP) from none to present] by glycaemic control status (well-controlled = HbA 1c < 7%, poorly-controlled = HbA 1c ≥ 7%) using multivariable generalized estimating equations logistic regression, nesting tooth sites/person.Results-Poorly-controlled T2DM (68.18%) was more prevalent than well-controlled T2DM (31.82%). Proportions of tooth sites/person with CAL progression between baseline and follow-up ranged 0.00-0.59 (mean = 0.12, SD = 0.12), while PPD and BOP progression ranged 0.00-0.44 (mean = 0.09, SD = 0.11) and 0.00-0.96 (mean = 0.24, SD = 0.18), respectively. Site-level PPD at baseline was a significant effect modifier of associations between poorly-controlled T2DM and sitelevel CAL and PPD progression [adjusted odds ratios (OR) according to poorly-controlled T2DM among PPD at baseline = 3, 5 and 7 mm, respectively: CAL progression = 1.93, 2.64, and 3.62, PPD progression = 1.98, 2.76, and 3.84; p < 0.05 for all]. Odds of site-level BOP progression were increased (OR = 1.24) for poorly-controlled T2DM, yet the results were not significant (p = 0.32).Conclusions-These findings from a distinct, homogenous population further support the clinical relevance of identifying patients with poor glycaemic control and periodontitis, particularly among those with disparities for both diseases. There is evidence that periodontal disease can worsen diabetic control capabilities and (vice versa) that proper management of periodontal disease can improve diabetic control (Soskolne & Klinger 2001). The host inflamma-tory response appears to be the critical determinant for the susceptibility to and the severity of marginal periodontitis, especially in systemically compromised individuals (Williams & Offenbacher 2000, Takeda et al. 2006, including those with type-2 diabetes mellitus (T2DM). Results from three independent studies that examined the role of periodontal disease as a factor complicating the severity of diabetes consistently indicate that those subjects with severe periodontitis exhibit more diabetes complications compared with those with no or mild periodontitis, suggesting that severe periodontitis confers a significant risk for these complications (Grossi 2001). Also, in a longitudinal study of native Americans from the Gila River Reservation, the Pima Indians who exhibited severe periodontitis at baseline subsequently had a worse glycated α-haemoglobin (HbA 1c ) leve...

Background Given the regular use of immediate release opioids for dental pain management, as well as documented opioid misuse among dental patients, the dental visit may provide a viable point of intervention to screen, identify, and educate patients regarding the risks associated with prescription opioid misuse and diversion. The aims of this statewide survey of dental practitioners were to assess: (a) awareness of the scope of prescription opioid misuse and diversion; (b) current opioid prescribing practices; (c) use of and opinions regarding risk mitigation strategies; and, (d) use and perceived utility of drug monitoring programs. Methods This cross-sectional study surveyed dentists (N=87) participating in statewide professional and alumni organizations. Dentists were invited via email and listserv announcement to participate in a one-time, online, 59-item, self-administered survey. Results A majority of respondents reported prescribing opioids (n=66; 75.8%). A minority of respondents (n=38; 44%) reported regularly screening for current prescription drug abuse. Dentists reported low rates of requesting prior medical records (n=5; 5.8%). Only 38% (n=33) of respondents had ever accessed a prescription drug-monitoring program (PDMP), and only 4 (4.7%) consistently used a PDMP. Dentists reporting prior training in drug diversion were significantly more likely to have accessed their PDMP, p<0.01. Interest in continuing education regarding assessment of prescription drug abuse/diversion and use of drug monitoring programs was high. Conclusions Although most dentists received training related to prescribing opioids, findings identified a gap in existing dental training in the assessment/identification of prescription opioid misuse and diversion. Findings also identified gaps in the implementation of recommended risk mitigation strategies, including screening for prescription drug abuse, consistent provision of patient education, and use of a PDMP prior to prescribing opioids.