Diabetes and Oral Disease

Diabetes and Oral Disease

Wednesday, May 4, 2011

The New York Academy of Sciences

Despite the growing realization that oral disease is linked to other systemic health issues, medicine and dentistry continue to be implemented as two separate health professions. Evidence suggests that diabetes leads to worsening oral disease and in turn, the chronic inflammation and infection that results from periodontal disease has an adverse effect on glycemic control and health outcomes, thus creating a cycle that compromises diabetes management and health outcomes in affected individuals. Any improvement in glycemic control and/or oral disease has the potential to make a significant impact on the quality of life for individuals with diabetes.

This symposium will bring together physicians, physician assistants, nurse practitioners, endocrinologists, dentists, periodontists, dental hygienists, epidemiologists, public health and nursing professionals as well as basic researchers to examine the bidirectional relationship between oral disease and diabetes. This symposium aims to provide education that will enhance the quality of health-care delivery, improve patient outcomes, and serve as an impetus for medical and dental care professionals to coordinate and collaborate towards the goal of improving the health of individuals with diabetes. 

By the end of this course, participants should be able to:

  • •   Identify the demographics,  epidemiology, pathophysiology, and treatment of diabetes and periodontitis;

  • •   Explain the factors that constitute the bidirectional diabetes-oral disease link and their importance in individuals with or at risk of diabetes or periodontal disease;

  • •   Define the role of oral disease in initiating the inflammatory response, as well as the impact of hyperglycemia on oral health;

  • •   Effectively screen and counsel patients for oral disease and diabetes risk, and advise them on disease management;

  • •   Explain the necessity of including oral health as part of routine health care for the diabetic population;

  • •   Explain the critical need for and application of interprofessional patient management in the care of dental and diabetic patients;

  • •   Network with colleagues from a diverse range of health care backgrounds, increasing their professional contacts and enabling a more integrated approach to managing the health of diabetic individuals.

Read an interview with David Albert, DDS, MPH (Columbia University College of Dental Medicine) — a member of the Scientific Organizing Committee — conducted by Beth Truett, President and CEO, Oral Health America.

Read an interview with Mary Lee Conicella, DMD, Aetna's Chief Dental Officer, conducted by Beth Truett, President and CEO, Oral Health America. This symposium is supported in part by Aetna Dental®.

Organizers

David S. Albert, DDS, MPH

Columbia University College of Dental Medicine

Evie Lalla, DDS, MPH

Columbia University College of Dental Medicine

Ira Lamster, DMD, MMSc

Columbia University College of Dental Medicine

Rudolph L. Leibel, MD

Naomi Berrie Diabetes Center
Columbia University College of Physicians and Surgeons


Continuing Education Information

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the College of Physicians and Surgeons of Columbia University, College of Dental Medicine of Columbia University, Oral Health America, and the New York Academy of Sciences.

The College of Physicians and Surgeons of Columbia University is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Columbia University College of Dental Medicine is an ADA CERP recognized provider 11/09-12/2013 and Dental Board of California registered provider #3954. ADA CERP is a service of the American Dental Association to assist dental professional in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Designation Statement

The College of Physicians and Surgeons designates this educational activity for a maximum of 6.5 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Columbia University College of Dental Medicine designates this activity for 6.5 continuing education credits. Please contact your local licensing authority for CE credit hour guidelines and regulations. Credits will be awarded to dentists, dental hygienists, and allied dental health professionals.

The American College of Nurse Practitioners (ACNP) and The American Academy of Physician Assistants (AAPA) accept AMA PRA Category 1 CreditTM from organizations accredited by the ACCME. The American Nurses Credentialing Center (ANCC) accepts AMA PRA Category 1 CreditTM toward recertification requirements.

Disclosure Statement

The College of Physicians and Surgeons must ensure balance, independence, objectivity, and scientific rigor in its educational activities.  All faculty participating in this activity are required to disclose to the audience any significant financial interest and/or other relationship with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in his/her presentation and/or the commercial contributor(s) of this activity. When unlabeled uses are discussed, these will also be indicated.

Presented by

Agenda

*Presentation times are subject to change.


7:30 AM

Registration and Continental Breakfast

8:30 AM

Welcome Remarks
Brooke Grindlinger, PhD, The New York Academy of Sciences
Ira B. Lamster, DDS, MMSc, Columbia University Collee of Dental Medicine

8:45 AM

Overview of the Audience Response System (ARS)
David A. Albert, DDS, MPH, Columbia University College of Dental Medicine

SESSION I: Current Concepts in Diabetes

Session Chair: Rudolph L. Leibel, MD, Naomi Berrie Diabetes Center, Columbia University College of Physicians and Surgeons

8:55 AM

Keynote Address
Diabetes Epidemic and Need for Collaborative Healthcare Delivery
William C. Knowler, MD, DrPH, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

9:25 AM

Current Concepts in the Pathogenesis and Treatment of Diabetes
Rudolph L. Leibel, MD, Naomi Berrie Diabetes Center, Columbia University College of Physicians and Surgeons

9:55 AM

Session I Panel Discussion with Audience Questions and ARS Survey

10:15 AM

Coffee and Networking Break

SESSION II: The Diabetes-Oral Disease Connection

Session Chair: Panos N. Papapanou, DDS, PhD, Columbia University College of Dental Medicine

10:45 AM

The Bidirectional Relationship Between Diabetes and Periodontal Disease
George W. Taylor, DMD, DrPH, University of Michigan School of Dentistry (CRSE) and School of Public Health (Epid)

11:05 AM

Diabetes and Oral Health in Children and the Elderly
Ira B. Lamster, DDS, MMSc, Columbia University College of Dental Medicine

11:25 AM

Gestational Diabetes Mellitus, Periodontitis and Negative Maternal/Fetal Outcomes: Is There a Link?
Karen F. Novak, DDS, MS, PhD, American Dental Education Association

11:45 AM

Diabetes and Dental Implant Therapy
Thomas W. Oates, DMD, PhD, University of Texas Health Science Center at San Antonio

12:05 PM

Session II Panel Discussion with Audience Questions and ARS Survey

12:30 PM

Networking Lunch with Round Table Discussions

SESSION III: Unraveling the Mechanistic Links between Periodontitis and Diabetes

Session Chair: Ira B. Lamster, DDS, MMSc, Columbia University College of Dental Medicine

2:00 PM

The RAGE/Inflammation Story in Diabetic and Periodontal Complications
Ann Marie Schmidt, MD, New York University School of Medicine

2:20 PM

Impact of Diabetes on Cell Death and Bone in Periodontal Disease
Dana T. Graves, DDS, MSc, University of Pennsylvania School of Dental Medicine

2:40 PM

Session III Panel Discussion with Audience Questions and ARS Survey

3:00 PM

Coffee and Networking Break

SESSION IV: Inter-Professional Relationships in Patient Care

Co-Chairs: David A. Albert, DDS, MPH, Columbia University College of Dental Medicine and
Pamela Allweiss, MD, MPH, Centers for Disease Control and Prevention; University of Kentucky College of Public Health

3:30 PM

Considerations for the Management of the Diabetic Patient:The Role of Dental and Medical Professionals
Evie Lalla, DDS, MS, Columbia University College of Dental Medicine

3:50 PM

Dentists' Attitudes and Orientations in the Management of the Patient with Diabetes
Carol Kunzel, PhD, MA, Columbia University College of Dental Medicine

4:10 PM

Working Across Medical-Dental Professional Boundaries in the Management of Diabetes and its Complications
Pamela Allweiss, MD, MPH, Centers for Disease Control and Prevention; University of Kentucky College of Public Health

4:30 PM

Session IV Panel Discussion with Audience Questions and ARS Survey

4:50 PM

Summary of Lunchtime Round Table Discussions and ARS Survey

5:30 PM

Adjourn

Speakers

Organizers

David A. Albert, DDS, MPH

Columbia University College of Dental Medicine

Evie Lalla, DDS, MS

Columbia University College of Dental Medicine

Ira B. Lamster, DDS, MMSc

Columbia University College of Dental Medicine

Rudolph L. Leibel, MD

Columbia University College of Physicians and Surgeons

Keynote Speaker

William C. Knowler, MD, DrPH

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Dr. William C. Knowler was educated in mathematics and liberal arts at the University of Iowa and in medicine, public health, and epidemiology at Harvard University. Since 1975, he has worked with American Indians in the Southwest. His work focuses on the risk factors for type 2 diabetes mellitus and its complications (especially diabetic nephropathy and retinopathy), obesity and its relationship to diabetes, diagnostic criteria for diabetes, and on methods in genetic epidemiology. Current activities concentrate on the genetics and prevention of diabetes and its complications. These include pedigree and genetics studies, the Diabetes Prevention Program, a multi-center clinical trial in prevention of type 2 diabetes, Look AHEAD, a multi-center clinical trial of weight loss in prevention of cardiovascular complications of type 2 diabetes, and the Family Investigation of Nephropathy and Diabetes, a multi-center genetics study. He is Chief of the Diabetes Epidemiology and Clinical Research Section of the National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona.

Speakers

David A. Albert, DDS, MPH

Columbia University College of Dental Medicine

David A. Albert, DDS, MPH is Director of Community Health and Associate Professor of Clinical Dentistry and Public Health at the Columbia University School of Dental and Oral Surgery, and the Joseph Mailman School of Public Health at Columbia University. He has extensive expertise in the design and development of complex projects and collaborations. Dr. Albert is Principal Investigator and director of the Columbia/Aetna research project, which conducts national studies of dental clinician practice behaviors and opinions. He developed and directed the Advanced Education in General Dentistry program at Columbia University. He implemented the dental service of the Ambulatory Care Network of Presbyterian Hospital and now directs the Fort Washington Dental Service where he maintains a geriatric dental practice within the community of Washington Heights/Inwood in Northern Manhattan. Dr. Albert is course director for Dental Infectious Diseases (Cariology) and the Oral Health Care Delivery System courses at Columbia University.

Pamela Allweiss, MD, MPH

Centers for Disease Control and Prevention; University of Kentucky College of Public Health

Dr. Allweiss is an Endocrinologist who completed her residency in Internal Medicine at the LA County-USC Medical Center, a fellowship in Endocrinology at Cedars Sinai Medical Center in Los Angeles, and was the chief clinical fellow at the Joslin Clinic in Boston. She received a Masters of Science in Public Health while completing a residency in Preventive Medicine and Occupational Health at the University of Kentucky. She has been a consultant to the CDC Division of Diabetes Translation (DDT) since 1999, working on projects for DDT and for the National Diabetes Education Program (NDEP), a joint CDC and NIH program. These projects have included: NDEP Business Health Strategy Workgroup worksite wellness initiatives, reviewer of NDEP materials such as the PPOD Workgroup materials (Podiatry, Pharmacy Optometry, and Dental), CDC Business Team, and diabetes subject matter expert for CDC’s Emergency Preparedness program (including man made and natural disasters).

She is on the faculty of the University of Kentucky Medical School and has been working with the Department of Family and Community Medicine on developing the chronic care model for academic medical centers as part of the AAMC’s (Association of American Medical Colleges) Academic Chronic Care Collaborative project. She is a member of the Kentucky Diabetes Control Network, a program started by the Kentucky Department of Health and Human Resources as a public- private partnership to improve outcomes in people with diabetes. She has presented numerous educational conferences to many health professionals including primary care physicians, physicians’ assistants and nurse practitioners and was named best clinical teacher in 1992, 1999 and 2001 from the Department of Family and Community Medicine.

Dana T. Graves, DDS, MSc

University of Pennsylvania School of Dental Medicine

Dr. Graves is a Professor of Periodontics and Associate Dean for Translational Research at the University of Pennsylvania School of Dental Medicine. Dr. Graves earned his BA in Chemistry from SUNY at Binghamton (1976), DDS from Columbia University (1980), Certificate, Periodontology and DMSc, Oral Biology from Harvard University (1984). Dr. Graves’ key research interests are in the areas of inflammation and diabetes as they relate to periodontal disease and the loss and repair of connective tissue and bone. He is currently an Associate Editor of the Journal of Dental Research Critical Reviews.

Carol Kunzel, PhD, MA

Columbia University College of Dental Medicine

Carol Kunzel is an Associate Professor of Clinical Dental Community Health, within the Division of Community Health at the Columbia University College of Dental Medicine. She holds a joint appointment in the Department of Sociomedical Sciences at the Columbia University Mailman School of Public Health. She has over 20 years experience as an investigator/co-investigator on NIH-funded studies, during which time she has had extensive experience with the development of telephone and mail surveys for national, New York State, and New York City samples of dentist practitioners. These survey research projects have involved the measurement of dentists’ attitudes, knowledge, clinical behaviors and adherence to practice guidelines, and the identification of influential predictors associated with each, as well as the measurement and identification of factors associated with dentists’ willingness to treat HIV+ patients. Most recently Dr. Kunzel’s research has focused on dentists’ in-office practices in regard to management of the diabetic and pre-diabetic patient, early oral cancer detection, obesity prevention, and infection control. These differing areas of empirical investigation have generally been viewed as problems in the utilization of scientific knowledge, and because they often involved a change in practice, the diffusion of innovation.

Evie Lalla, DDS, MS

Columbia University College of Dental Medicine

Evie Lalla received her dental degree from the Aristotle University of Thessaloniki, Greece (1993) and a Masters in Periodontics from Columbia University in New York City (1997). Upon completion of her specialty training, she joined the full time faculty of the College of Dental Medicine at Columbia. She received University Tenure (2007) and is currently an Associate Professor of Dental Medicine at the Division of Periodontics. Her work involves research in the field of periodontal infections and their link with diabetes mellitus and atherosclerosis, teaching and faculty practice. Her research has been supported by the National Institutes of Health as well as industry and foundations. She is the recipient of the Antony A. Rizzo Young Investigator Award from the International Association for Dental Research (2003) and the Burton C. Borgelt Faculty Advisor Award from the American Dental Association (2005).

Ira B. Lamster, DDS, MMSc

Columbia University College of Dental Medicine

Dr. Lamster received his DDS from the State University of New York at Stony Brook (1977), his MMSc from Harvard University (1980) and a Certificate of Special Training in Periodontology from the Harvard School of Dental Medicine (1980). Dr. Lamster is currently Dean and Professor of Dental Medicine at Columbia University College of Dental Medicine. In December 2006, Dr. Lamster was also named as a Vice President of Columbia University Medical Center.

Dr. Lamster's research efforts have focused on diagnostic testing and risk assessment for periodontal disease, the interrelationship of periodontal disease and systemic disease, and oral health care needs of older adults. His research is supported from NIH, corporations and foundations.

Dr. Lamster is the author of more than 150 manuscripts and book chapters. He is the editor of "Improving Oral Health for the Elderly," published by Springer U.S. in February 2008.

Rudolph L. Leibel, MD

Columbia University College of Physicians and Surgeons

Dr. Leibel is Christopher J. Murphy Professor of Diabetes Research, Professor of Pediatrics and Medicine at Columbia University Medical Center, and Head of the Division of Molecular Genetics in the Department of Pediatrics. He is also Co-Director of the Naomi Berrie Diabetes Center and Executive Director of the Berrie Program in Cellular Therapies of Diabetes, Co-Director of the New York Obesity Research Center and the Columbia University Diabetes and Endocrinology Research Center. The latter two are NIH-funded Centers.

Dr. Leibel has worked in obesity research for over 25 years. His research has related to adipose tissue biochemistry and cellular physiology, the molecular genetics of control of body weight in rodents and humans, the bioenergetics of body weight regulation in humans and the role of leptin in these processes, and the molecular genetics of type 2 diabetes. His recent work includes the use of human stem cells to elucidate the molecular/developmental processes related to diabetes and obesity.

He is a member of the Institute of Medicine of the National Academy of Sciences, and has served as a member of the Federal Advisory Council for NIDDK and as an Associate Editor of the Journal of Clinical Investigation. His research is supported by the NIH, ADA, the New York State Stem Cell Science Program, the Russell Berrie and Helmsley Foundations, and AstraZeneca.

Karen F. Novak, DDS, MS, PhD

American Dental Education Association

Dr. Karen Novak is the Senior Director for Research and Analysis at the American Dental Education Association (ADEA). In this role she provides leadership in developing and carrying out research related to educational policy initiatives primarily in the areas of curriculum change and innovation and faculty development. She also is involved in developing and conducting broad and in-depth analyses related to various current and emerging dental educational policy issues.

Dr. Novak received her dental degree from the University of North Carolina at Chapel Hill, her MS degree in Dental Research from the University of Rochester and her Ph.D. in Microbiology and Certificate in Periodontics from the University of Texas Health Science Center at San Antonio. Dr. Novak has been a dental educator since 1994 and has served as a faculty member at the University of Texas Health Science Center at San Antonio, the University of Pittsburgh and the University of Kentucky College of Dentistry. In each of these institutions she has been involved in clinical and translational research related to oral health issues. Dr. Novak’s clinical research has focused on gestational diabetes mellitus and inflammatory bowel disease and their links to inflammation and periodontal disease. In addition to her teaching and research duties she has served several key administrative positions at these institutions: Director of Predoctoral Periodontics, Associate Director of Student Services, Director of Graduate Studies and Associate Dean for Academic Affairs. An active member of several dental associations, Dr. Novak has held positions in the American Dental Education Association (ADEA), the American Dental Association, the American Association for Dental Research (AADR), and the International Association for Dental Research (IADR). In 2008, Dr. Novak was awarded the ADEA/William J.Gies Foundation Education Fellowship.

Thomas W. Oates, DMD, PhD

University of Texas Health Science Center at San Antonio

Dr. Thomas Oates currently serves the UTHSCSA Dental School as Assistant Dean for Clinical Research, and the Department of Periodontics as Vice Chair and Professor. He received his DMD degree and completed a general practice residency at the University of Pennsylvania. He received certification in periodontics and his PhD in Biochemistry and Molecular Biophysics at Virginia Commonwealth University. His research interests focus on the intersection of oral and systemic health, with current efforts directed toward patients with diabetes mellitus. Dr. Oates currently has several active research grants from the National Institutes of Health, as well as industry and foundation support, evaluating the impact of diabetes on oral health and implant therapy. Dr. Oates is a member of the NIH/CDC National Diabetes Education Program PPOD work group.

Panos N. Papapanou, DDS, PhD

Columbia University College of Dental Medicine

Panos N. Papapanou, DDS, PhD is Professor of Dental Medicine, Director of the Division of Periodontics, and Chairman of the Section of Oral and Diagnostic Sciences, Columbia University College of Dental Medicine, New York, USA. He received his DDS from the University of Athens, Greece, his PhD from Göteborg University, Sweden, and his post-doctoral training at the Forsyth Institute, Boston, MA. His research includes studies of the epidemiology of periodontal disease, the assessment of microbial and host-derived risk factors, the pathobiology of periodontitis and its role in systemic health outcomes. He is the recipient of the Jens Waerhaug Research Prize (1988, Scandinavian Society of Periodontology); the Anthony A. Rizzo Young Investigator Award (1996, IADR); the Walther-Engel Award (1998, Academy for Graduate Dental Education, Karlsruhe, Germany); the Clinical Research Award (2007, American Academy of Periodontology); and the Global Award in Periodontal Medicine (Sunstar, 2009). He is Associate Editor of the Journal of Clinical Periodontology and board member of several journals, a Fellow of the American College of Dentists, and a Past President of the Periodontal Research Group of the IADR.

Ann Marie Schmidt, MD

New York University School of Medicine

Ann Marie Schmidt earned her BA in biology and history summa cum laude from NYU’s Washington Square College and her MD degree with honors from NYU School of Medicine. She remained at NYU to complete her medical residency and chief residency, as well as fellowship in hematology and medical oncology, then moved to Columbia University, joining the department of physiology and cellular biophysics. From 2003 to 2010, she was the Chief of the division of surgical science and the Gerald and Janet Carrus Professor of Surgical Science. Effective July 1, 2010, Dr. Schmidt became the Director of the Diabetes Research Program at New York University Langone Medical Center, New York and the first Iven Young Professor of Endocrinology at NYU.

Dr. Schmidt’s basic and translational research has focused on the contribution of “RAGE,” (receptor for advanced glycation end-products), a cell-surface receptor that exacerbates inflammation and damage when activated, to heart disease-related vascular injury, particularly in type 1 diabetes and its complications. She has studied RAGE and its relationship to inflammatory and immune disorders, peripheral nerve injury and regeneration, neurodegenerative diseases, and tumors. Dr. Schmidt and her team were just awarded a Multi-project grant from the JDRF to identify new small molecules for the prevention and treatment of diabetic complications.

Dr. Schmidt has served on advisory committees and chaired conferences for the National Institutes of Health, the American Heart Association, the Juvenile Diabetes Association, the American Diabetes Association, and other national and international scientific organizations. Dr. Schmidt received the David Rumbough Research Award from the JDRF in 2010.

George W. Taylor, DMD, DrPH

University of Michigan School of Dentistry (CRSE) and School of Public Health (Epid)

George W. Taylor, DMD, DrPH, is Professor at the University of Michigan in the School of Dentistry and the School of Public Health. His research focuses on relationships between oral and systemic health, particularly periodontal infection and diabetes. He and his team conduct observational epidemiological studies, clinical trials, health services research, and secondary analysis of complex survey data. Dr. Taylor is a member of the Board of Directors of the American Board of Dental Public Health and the Council on Scientific Affairs of the American Dental Association.

Abstracts

SESSION I: CURRENT CONCEPTS IN DIABETES

Diabetes Epidemic and Need for Collaborative Healthcare Delivery

William C. Knowler, MD, DrPH, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Diabetes is a serious and common chronic disease, the frequency of which is dramatically increasing in most parts of the world. Morbidity and mortality due to each major type of diabetes (type 1 and type 2) are primarily due to the long-term complications that have long been recognized to affect the eyes, kidneys, heart, blood vessels, and nerves. More recently, periodontitis has been recognized as a complication of both types of diabetes. Type 1 diabetes is due to autoimmune or idiopathic destruction of the pancreatic beta cells. Prevention research has focused on immune modulation, but so far has not met with reproducible success. By contrast, prevention research in type 2 diabetes has focused on its major causes including a combination of insulin resistance and impaired insulin secretion. Prevention or delayed onset of type 2 diabetes has been successful to varying degrees in a number of studies using either lifestyle modification aimed at weight loss or drugs affecting insulin resistance or secretion. Because of its complex set of causes, diabetes prevention research requires a multidisciplinary scientific approach, and because diabetes affects many organ systems, preventing and treating diabetes complications requires collaboration among many health care professionals.

Current Concepts in the Pathogenesis and Treatment of Diabetes

Rudolph L. Leibel, MD, Columbia University College of Physicians and Surgeons

Diabetes is ultimately a failure to produce sufficient insulin to meet metabolic need. The molecular bases for such failure differs among clinical types of diabetes (autoimmune destruction, metabolic intoxication, beta cell autonomous genetic defects, etc). Also of importance are developmental processes that affect the mass of beta cells an organism develops in early life, and the ability of the constituent beta cells to respond by hypertrophy and/or hyperplasia to metabolic stresses. The advent of stem cell biological techniques applied to human cells, promises to enable elucidation of these processes in humans, and, ultimately, to provide the bases for cellular replacement strategies.

SESSION II: THE DIABETES - ORAL DISEASE CONNECTION

The Bidirectional Relationship between Diabetes and Periodontal Disease

George W. Taylor, DMD, DrPH, University of Michigan School of Dentistry (CRSE) and School of Public Health (Epid)

Diabetes mellitus and periodontal disease are two common chronic diseases that have long been considered to be biologically linked. Diabetes is an important chronic disease globally and considered an epidemic by the World Health Organization (WHO). This presentation will review the evidence regarding the adverse effects of diabetes on periodontal health, the role of periodontal infection in adversely affecting glycemic control, and the relationship of periodontal infection to the risk for developing diabetes complications and possibly diabetes itself.

The focus will be evidence derived from both epidemiological observational studies and investigations of non-surgical periodontal therapy. Longitudinal observational studies provide evidence to support both the adverse effects of diabetes on periodontal health and severe periodontitis on increased risk for poorer glycemic control and diabetes complications. The treatment studies are a heterogeneous set of reports that include randomized clinical trials (RCTs) and studies that are not RCTs. Of the RCTs reported in the literature, several report a beneficial effect for periodontal therapy although some RCTs do not. Recent meta-analyses of the intervention studies provide supporting evidence that non-surgical periodontal therapy improves glycemic control. Additionally, emerging evidence from a limited number of observational studies suggests periodontal disease is associated with increased risk for diabetes complications, including cardiovascular disease, cardio-renal mortality, and renal disease. There is also evidence that periodontal infection may be a risk factor for the development of diabetes.

Conclusion: The evidence supports the bidirectional, adverse relationship between periodontal infection and diabetes. Further rigorously conducted randomized clinical trials are necessary to unequivocally establish that treating periodontal infections can contribute to glycemic control and to the reduction of the burden of diabetes complications. However, given the current evidence, it is prudent to consider treating periodontal infection in people with diabetes as an important component of their overall management plan for diabetes care.

Diabetes and Oral Health in Children and the Elderly

Ira B. Lamster, DDS, MMSc, Columbia University College of Dental Medicine

Recent research has examined oral manifestations of diabetes mellitus in children and adolescents. For these individuals, it appears that periodontal destruction starts earlier in life than previously recognized. Evaluation of periodontal complications in cases and controls (6 to 18 years of age) revealed that patients with diabetes were at increased risk for periodontal destruction with odd ratios ranging from 1.8 to 3.7. A further analysis examining the association of diabetes variables (BMI for age, duration of diabetes, mean HbA1c) and increased risk for periodontal complications revealed an association with mean HbA1c. This is in keeping with the recognized association of HbA1c with other diabetes complications.

Periodontal complications of diabetes mellitus in elderly patients (≤ 65 years of age) have not been extensively studied. Early published data identified duration of diabetes mellitus as a risk factor for more severe periodontitis. For older adults with diabetes mellitus, the severity of periodontitis is correlated with HbA1c. Further, older adults with diabetes have been shown to have poor oral hygiene relative to controls, and have reduced utilization of dental services. The cumulative nature of periodontal disease, and the loss of teeth as individual’s age, are important complicating factors when studying periodontal manifestations of diabetes in the elderly.

Gestational Diabetes Mellitus, Periodontitis and Negative Maternal/Fetal Outcomes:  Is There a Link?

Karen F. Novak, DDS, PhD1, George W. Taylor, DMD, DrPH2, James E. Ferguson, MD3, M. John Novak, BDS, LDS, PhD4,1American Dental Education Association, Washington, DC, 2University of Michigan School of Dentistry, Ann Arbor, Michigan, 3University of Virginia School of Medicine, Charlottesville, Virginia,  4University of Kentucky College of Dentistry, Lexington, Kentucky

Gestational Diabetes Mellitus (GDM) complicates approximately 5% of pregnancies. Substantial evidence documents the association between GDM and adverse pregnancy outcomes but limited data are available on the effects of periodontitis on pregnancy outcomes in women with GDM. Objective:  To test the hypothesis that a combination of GDM and periodontitis is more likely to result in adverse pregnancy outcomes than GDM alone or periodontitis alone. Methods:  This prospective study consisted of 320 pregnant women, ages 17-46, classified into four groups based on the presence or absence of GDM and the presence or absence of periodontitis. Women with GDM were matched with non-GDM controls for race, age, and gestational age; women with type 1 or type 2 diabetes were excluded.  Prior to delivery, participants received a comprehensive periodontal evaluation documenting plaque index, probing pocket depths (PD), clinical attachment loss (LOA), bleeding on probing (BOP) and calculus.  Periodontitis was defined as participants having at least 4 teeth with PD >4mm, LOA >2mm, and BOP.  The adverse maternal outcome was a composite measure that included having at least one of the following: pre-eclampsia, premature labor, premature rupture of membranes, urinary tract infections, chorioamnionitis/funisitis, induction of labor, operative vaginal deliveries or unplanned cesarean delivery.  Multivariable logistic regression, accounting for the matching variables and controlling for calculus index, and cigarette smoking, was used for analysis. Results:  Women with GDM and periodontitis were 2.3 times more likely to have an adverse pregnancy outcome than women without GDM and without periodontitis (OR=2.3; 95% CI=1.06, 4.84).  Women with periodontitis only or GDM only had no greater risk for adverse maternal outcomes than women with neither of these diseases. Conclusion:  GDM and periodontitis combined, significantly contribute to increased risk for adverse pregnancy outcomes.  Supported by:  NIH/NCRR Center of Biomedical Research Excellence P20 RR020145 and UK CR-DOC.

Diabetes and Dental Implant Therapy

Thomas W. Oates, DMD, PhD, University of Texas Health Science Center at San Antonio, Texas

Diabetes mellitus is one of the most commonly encountered contraindications to dental implant therapy. As a result, well-controlled diabetes patients may be considered appropriate for implant therapy, while diabetes patients lacking good glycemic control may be denied the benefits of implant therapy. With increasing prevalences of type 2 diabetes, periodontal disease and tooth loss with age, the need to understanding the appropriate use of dental implant therapy for patients with diabetes becomes critical, especially so for individuals critically dependent on dietary management for their condition.

This review will highlight our current understanding of the relationship between diabetes and dental implant therapy as we look to optimize the benefits of dental implant therapy in meeting the needs of our patients with diabetes.

SESSION III: UNRAVELING THE MECHANISTIC LINKS BETWEEN PERIODONTITIS AND DIABETES

The RAGE/Inflammation Story in Diabetic and Periodontal Complications

Evanthia Lalla, DDS, MS1, and Ann Marie Schmidt, MD2, 1Columbia University College of Dental Medicine, New York, New York and 2 New York University School of Medicine, New York, New York

The Receptor for Advanced Glycation Endproducts was discovered as a cell surface receptor for the advanced glycation endproducts (AGEs), the products of nonenzymatic glycation and oxidation of proteins and lipids that accumulate in diabetes (driven by high glucose), oxidative stress, renal failure and inflammation. The discovery that RAGE was a multi-ligand receptor capable of interacting with non-AGEs such as S100/calgranulins and high mobility group box1 (HMGB1), which were upregulated in inflammation settings, led to the discovery that RAGE played key roles in autoimmune/inflammatory disorders. RAGE is expressed on T cells, B cells, dendritic cells, monocytes and macrophages and in T cells plays key roles in T cell priming; in monocytes/macrophages RAGE mediates upregulation of inflammatory cytokines and promotes cellular migration. In human diabetic periodontal disease tissue, RAGE expression was increased and in parallel, expression of AGEs was higher vs. non-diabetic tissues, and compared to uninfected periodontal tissue. To test the potential relevance of RAGE in the pathogenesis of diabetes-accelerated periodontal disease and alveolar bone loss in diabetes, C57BL/6 mice were rendered diabetic with streptozotocin. In these animals, oral/anal exposure of diabetic mice to Porphyromonas gingivalis resulted in increased alveolar bone loss vs. that observed in non-diabetic mice. Consistent with roles for RAGE ligand-RAGE interaction in the pathogenesis of diabetes accelerated periodontal disease, in animals treated with the RAGE ligand decoy soluble RAGE, bone loss and alveolar inflammation were attenuated in a dose-dependent manner. Recent studies have identified that the cytoplasmic domain of RAGE interacts with the formin mDia1 (diaphanous1), and that mDia1 is essential for RAGE-mediated signaling and cellular migration in transformed cells and macrophages. Future studies will dissect the potential roles of mDia1 in diabetes and periodontal complications. Our findings reveal that RAGE may be an effective target in diabetes and periodontal disease for the reduction in alveolar bone loss and inflammation that accompanies chronic hyperglycemia.

Impact of Diabetes on Cell Death and Bone in Periodontal Disease

Dana T. Graves, DDS, MSc*, Jun Kang+, Oelisoa Andriankaja*, *University of Pennsylvania School of Dental Medicine and +Peking University

We investigated the response of normal and diabetic mice to bacteria-induced tissue destruction by inoculating the scalp of control or diabetic mice, with the pathogen P.gingivalis. The diabetic group had significantly impaired ability to produce new connective tissue and bone, which was linked to her fibroblast and bone-lining cell apoptosis. When apoptosis was blocked with a caspase inhibitor the repair of tissue was significantly improved. Diabetes-enhanced apoptosis was shown to be due to greater levels of inflammation. Similar events occur in experimental periodontitis in the rat where diabetic animals had an increased inflammatory infiltrate, greater osteoclast activity and a decreased capacity to form new bone following bone resorption. These deficits were reversed when the higher degree of inflammation was blocked in the diabetic group.

SESSION IV: INTER-PROFESSIONAL RELATIONSHIPS IN PATIENT CARE

Considerations for the Management of the Diabetic Patient: The Role of Dental and Medical Professionals

Evie Lalla, DDS, MS, Columbia University College of Dental Medicine

Patients with diabetes mellitus present a challenge when treated for oral/periodontal conditions in dental care settings. Key components of their proper management by the dental team will be presented. Moreover, patients with type 2 diabetes or pre-diabetes often remain undiagnosed for years. The role of dental professionals in the early identification and referral for formal diagnosis and medical care of those affected will be discussed. Finally, similarly to diabetes, periodontal infections often go undiagnosed and remain untreated and this is especially relevant to diabetic individuals. The role of medical professionals in increasing awareness about the oral complications of diabetes among their diabetic patients and in providing guidance about prevention and treatment strategies for periodontal infections will be discussed.

Dentists' Attitudes and Orientations in the Management of the Patient with Diabetes

Carol Kunzel, PhD, MA, Columbia University College of Dental Medicine

Given the linkages that have been identified between oral infection and systemic diseases, the dental office is an appropriate place to screen for and evaluate certain systemic disorders. Diabetes is an established risk factor for periodontitis, and periodontitis has been called the “sixth complication of diabetes.” The role of the dentist in the management of patients at risk for diabetes or pre-diabetes can be categorized into three phases of involvement: assessment, discussion, and active management. Information published about the practices and attitudes of general dentist and periodontists with respect to diabetes management found that few dentists are engaged in proactive management behaviors. A majority of surveyed dentist did not agree with the notion that patients and colleagues expect them to perform such activities. This presentation will consider these findings from a comparative and international perspective, assessing dentists’ perceived barriers in managing these patients, perceived expectations on the part of patients and colleagues, and self-assessed knowledge and competence in these areas. It will further consider dentists’ attitudes and orientations within the context of an expansion of primary health care activities in the dental office to include screening to identify undiagnosed diabetes, with the ultimate goal of improving health care outcomes for patients in the dental office.

Working Across Medical-Dental Boundaries in the Management of Diabetes and its Complications

Pamela Allweiss, MD, MPH, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA

Oral health care professionals are vital components of the health care team that provides comprehensive care for the person with diabetes. Integrated care among many health professionals (including but not limited to: oral health professionals, primary care providers, podiatrists, pharmacists, eye care professionals etc) can help to improve the delivery of evidence based interventions to improve outcomes in people with diabetes. The National Diabetes Education Program, a joint CDC/NIH, program has developed materials for providers and has established partnerships to promote the collaboration of health care professionals. These tools are in the public domain and will be presented.


Travel & Lodging

Our Location

The New York Academy of Sciences

7 World Trade Center
250 Greenwich Street, 40th floor
New York, NY 10007-2157
212.298.8600

Click here for directions.

Hotels Near 7 World Trade Center

Recommended partner hotel:

The New York Academy of Sciences is a part of the Club Quarters network. Please feel free to make accommodations with Club Quarters on-line to save significantly on hotel costs.

Club Quarters Reservation Password: NYAS

Club Quarters, World Trade Center
140 Washington Street
New York, NY 10006
Phone: (212) 577-1133

Located on the south side of the World Trade Center, opposite Memorial Plaza, Club Quarters, 140 Washington Street, is just a short walk to our location.

Other hotels located near 7 WTC:

Millenium Hilton

212.693.2001

Marriott Financial Center

212.385.4900

Club Quarters, Wall Street

212.269.6400

Eurostars Wall Street Hotel

212.742.0003

Wall Street District Hotel

212.232.7700

Wall Street Inn

212.747.1500

Ritz-Carlton New York, Battery Park

212.344.0800

Special Needs and Additional Information

For any additional information and for special needs, including child/family care resources available to conference attendees, please e-mail Renee Wilkerson-Brown at rwilkerson@nyas.org or call 212.298.8618.