ADA explores opportunities to educate dentists on Type 1 diabetes

House of Delegates refers resolution to council for further study

Families of children with Type 1 diabetes know dangerous hypoglycemic episodes can occur anytime. If a glucose monitor alarm goes off in the middle of the night, parents need to feed a sleepy child immediately to increase their blood glucose level, often with juice, crackers or candy.

“In those moments, brushing teeth is the last thing on their mind. Understanding this lived experience is important for our profession,” said Samira Shafaee, D.D.S., whose daughter and husband, a fellow dentist, have Type 1 diabetes.

In response to a resolution Dr. Shafaee brought to the ADA House of Delegates in October 2025, the American Dental Association is exploring opportunities to educate dentists on the oral health implications of Type 1 diabetes.

Her resolution called for the ADA to recognize children and adolescents with Type 1 diabetes as a distinct high-risk group to help potentially pave the way for professional guidance. While the House did not pass the resolution, delegates did refer it to the ADA Council on Advocacy for Access and Prevention for further study, with a report to be given to the 2026 House of Delegates next October.

“Although it did not pass as a yes vote, it was appropriately referred, and more importantly, I was heard,” Dr. Shafaee said. “I cannot overstate how meaningful it was to be heard at the national level.”

In January 2025, Dr. Shafaee launched the T1D Oral Health Foundation to support families affected by Type 1 diabetes and provide practical oral health guidance. Through the foundation, she has created pamphlets for patients with Type 1 diabetes and gathered information from families through an online questionnaire.

“As the data emerged and I spoke with more families and practitioners, it became clear that the gap extended beyond patient education. It was bidirectional and present within our own profession,” she said. “Many providers lacked an understanding of the lived experience of Type 1 diabetes, not from a lack of care, but from a lack of clear guidelines. As a result, the mission evolved to include educating our own and advocating at the state and national levels to bring this gap in knowledge and clinical guidance to light.”

The ADA Council on Advocacy for Access and Prevention is reviewing the ADA’s patient education materials on Type 1 diabetes from a health literacy perspective and working with the ADA Council on Scientific Affairs to develop an educational tool for dental professionals.

Type 1 diabetes is a chronic autoimmune disease in which the beta cells in the pancreas create little to no insulin, according to the ADA’s Oral Health Topics webpage on diabetes. This type of diabetes accounts for 5%-10% of all diabetes cases and is typically diagnosed before patients turn 21.

The more common Type 2 diabetes is usually diagnosed later in life. It is defined by insulin resistance and commonly associated with obesity.

Both patients with Type 1 diabetes and those with Type 2 diabetes appear equally susceptible to periodontitis and subsequent tooth loss, according to a 2002 article on the relationship between diabetes and periodontal disease published in the Journal of the Canadian Dental Association. Large prospective studies have indicated that glycemic control rather than diabetes type is the primary factor associated with tooth loss.

Similarly, gingivitis is associated with diabetes in general, and poor metabolic control rather than diabetes type dictates severity, according to an article on oral health disease prevention in people with diabetes published in 2000 in The Journal of the American Dental Association.

Research has shown both types are also associated with xerostomia. Reduced salivary flow rates and altered saliva composition are known risk factors for dental caries, according to a 2008 article on the relationship between oral health and diabetes published in JADA. Hyperglycemia also increases glucose concentrations in saliva, which can encourage oral bacteria to grow and dental plaque to form, according to a 2003 JADA article on dental considerations for treating patients with diabetes.

“The oral health risks for patients with Type 1 diabetes are significant, as frequent glucose intake increases the risk of dental caries and enamel decalcification. Orthodontics can compound the risk of decay and gum inflammation,” Dr. Shafaee said. “Beyond these, children and adolescents with Type 1 diabetes are at increased risk for eating disorders, as food and insulin are forever linked, which can further impact oral health. Add these risks to families already struggling with access to dental care, cost barriers or the challenges of navigating dental insurance benefit limitations, and you can see how this risk compounds rapidly.”

A 2008 JADA article on diabetes-related considerations for dentistry advises every dental office to have a protocol for managing hypoglycemia in conscious and unconscious patients. While patients with diabetes often recognize the signs and symptoms of hypoglycemia and self-intervene, a hypoglycemic event could arise without any initial signs from patients. Training staff to recognize the signs, which can include mood changes, unusual behavior or profuse sweating, and to use a glucometer to test a diabetic patient’s blood glucose levels can help prevent hypoglycemic episodes, according to the article.

Dr. Shafaee advises dentists to encourage families to have children with Type 1 diabetes sip water after a sugar correction, if possible, to help rinse away sugars and acids. She said dentists should emphasize the importance of fluoride for strengthening enamel and try to schedule dental visits on a three‑month recall so that patients receive consistent monitoring and oral hygiene instructions tailored to their unique needs and dentition.

In New Year’s Resolutions: Checklist for Your Patients’ Health — a new continuing education course from the ADA on how dentists can support patients’ health-related goals — Dr. Shafaee addresses considerations when offering oral health recommendations to patients with Type 1 diabetes and their parents. The course covers a wide range of topics, including both Type 1 and Type 2 diabetes.

“Ultimately, I hope as dentists we approach patients with Type 1 diabetes with empathy, compassion and a commitment to evidence‑based care,” Dr. Shafaee said. “By understanding the unique realities of living with this condition, we can be better care providers and have a place in this whole-system condition.”