Prevention, Detection, Evaluation, and Treatment of Dental Decay and its Sequelae in Patients with Diabetes Mellitus

Publication ID Published Version
9252 October 12, 2012 8


While dental decay is not recognized as a complication of diabetes mellitus (DM), individuals with diabetes are not immune to dental decay and its sequelae. Dental decay and its sequelae, although mostly chronic with mild symptoms, are infections which can become acute at any time and cause more serious maxillofacial space and deep neck space infections. Studies have shown that diabetes patients, due to their impaired immunity, are more susceptible to Ludwig angina and extended deep neck space infections of odontogenic origin. These conditions require extensive antibiotic therapy, surgical drainage, intensive glycemic control, and longer hospitalization in patients with DM. Even with such extensive medical care, the conditions are likely to recur unless the infection source is removed.

Prevention and early treatment of dental decay in patients with diabetes can avoid serious dental abscesses and life-threatening deep head and neck infection, septicemia and death. It will also reduce healthcare expenditure and improve the quality of life (Q of L) of DM patients.

Management of patients with diabetes is an essential part of the undergraduate and graduate curriculum of oral health professional education. However, it is important for all members of the diabetes patient care team to work together to optimize the outcome of oral healthcare in patients with DM. Teaching and learning the oral health care in patients with diabetes will take planning and resources. This resource provides an overview of dental decay and its sequelae, the current understanding of its aggressive progression and inadequate response to the treatment in DM patients, strategies of prevention and early treatment. This resource not only serves as fundamental knowledge of diabetes and dental decay, it also provides mechanisms of interdisciplinary communications and team-based oral health care in DM patients.

This resource is composed of four documents, a PowerPoint presentation, clinical cases discussions, a clinical manual, as well as this instructor’s guide. The PowerPoint presentation and case discussions are mainly to be used as a tutorial in the health care professional school curriculum (medical, dental, nursing, and others) of dental decay and its sequelae. They emphasize infection sources of head and neck abscess in diabetes patients and how removing these infection sources by oral health care professionals (dentists) can spare patients from costly treatment and morbidity or mortality. Other health professional educators can also be benefit from it.

This resource was initially developed to assist dental students and faculty in managing the oral health care of patients with diabetes mellitus (DM) in accordance with scientific evidence.

The lecture material is foundation knowledge that students are required to have before entering the clinic as observers or operators. The clinic manual (online, updated yearly) serves as a quick reference for students, faculty members, and dental auxiliaries to be consistent and current in patient management. Many of our emergency clinic patients presented with acute dental infection and diabetes. They were treated effectively and efficiently, all based on the foundation knowledge and clinic manual submitted in this resource. Our positive results in teaching prevention and management of hypoglycemic episodes were presented at the American Dental Education Association (ADEA) annual meeting in 2011.

Our senior dental students are required to participate in service learning where they rotate to medical facilities to have experience outside dental school. Our students present oral health information to diabetes patients and medical care providers in diabetes patient education classes. Their presentation material is based on the foundation knowledge and clinic manual submitted in this resource.

Many requests have been received from outside the school, and have led to the publications listed below.

  1. Geist SMRY, Geist JR. Improvement in medical consultation responses with a structured request form. J Dent Educ 2008;72(5):553-61
  2. Powell V et al. eds. Integration of Medical and Dental Care and Patient Data. Springer-Verlag London 2012 ISBN 978-1-4471-2184-8 
     Chapter 2, Section 2.3: Physicians’ Dental Data Needs and Oral Health Care Providers’ Medical Data Needs: The Clinical Rationale, Pp 77 – 85.
     Chapter 2, Section 2.4: Standardized/Structured Messages Facilitate Efficient Information Sharing and Benefit Patient Care, pp 85 – 96.
     Chapter 2, Section 2.5: Designing and Implementing Efficient Structured Communication Among Patients’ Medical and Dental Providers, pp 96 – 99.
  3. Geist SMR, Geist JR, Sordyl CM, LeBow J. Benefits of casual random blood glucose assessment of diatetic dental patients in an urban dental school clinic.J Dent Educ. 2011 75:212-3

This resource has been updated and tailored for the Building Oral Health in Medicine Model Curriculum project in MedEdPORTAL, AAMC


Geist R, Geist J. Prevention, Detection, Evaluation, and Treatment of Dental Decay and its Sequelae in Patients with Diabetes Mellitus. MedEdPORTAL Publications; 2012. Available from:

Contains Information Suitable for Patient Education

Educational Objectives

  1. To provide an overview of dental decay and its sequelae.
  2. To identify the symptoms and signs of each stage of the process of dental caries and its sequelae.
  3. To identify the importance of early detection and treatment of dental decay, especially in patients with diabetes.
  4. To address diabetes as a risk factor in aggressive progression and inadequate response to the treatment of dental decay and its sequelae.
  5. To describe the importance of removal of the infection source in the treatment of dental decay-related infections in diabetes patients.
  6. To critically apply the evidence in making clinical decisions on managing dental decay-related infections in diabetes patients.
  7. To present the evidence of the need for oral health promotion in the population of diabetes patients.
  8. To manage diabetic dental patients based on current evidence.
  9. To prevent or manage hypoglycemic episodes.


  • Diabetes Mellitus, Odontogenic Infection, Maxillofacial Space Infection, Deep Neck Space Infection, Glycemic Control, Tooth Decay, Caries, Hypoglycemia, Building Oral Health Capacity (BOHC) Collection


  • Medical
    • Internal Medicine
      • Endocrinology, Diabetes & Metabolism
  • Dental
    • Oral and Maxillofacial Pathology
    • Oral and Maxillofacial Radiology
    • Preventive Dentistry


  • Interpersonal & Communication Skills
  • Interprofessional Collaboration
  • Knowledge for Practice
  • Patient Care
    • Promote health prevention
  • Practice-based Learning & Improvement
  • Systems-based Practice

Professional Interest

  • Oral Health

Instructional Methods

  • Case-based Instruction/Learning
  • Independent Learning
  • Lecture
  • Problem-based Learning (PBL)
  • Tutorial

Academic Focus

  • Basic Sciences
    • Immunology
    • Microbiology
    • Pathology
  • Clinical Sciences
    • Clinical Skills/Doctoring

Intended Audience

  • Professional School
    • Dental Student
    • Medical Student
    • Nursing Student
  • Professional School Post-Graduate Training
    • Resident


  • Presentation
  • Reference
  • Virtual Patient

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ISSN 2374-8265