The Joseph L. Henry Oral Health Fellowship Practicums 2001-2003 | Hodge

Cynthia E. Hodge, DMD, MPH, MPA
Joseph L. Henry Oral Health Fellow in Minority Health Policy

Enhancing Management of Diabetes Mellitus and Periodontal Diseases among Community Health Center Populations


The purpose of this project was to develop a strategy to manage diabetes and periodontal diseases among low-income and minority populations.  Disparities in oral and systemic health occur within and between ethnic and racial groups and low-income populations throughout the United States.  In fact, minority populations, particularly African Americans, Hispanics and Native Americans, who are also low-income, suffer a layering effect due to the combined health risks associated with their racial/ethnic background and their economic status.  

Among African Americans, seven causes of excess deaths have been identified: heart disease and stroke, cancer, cirrhosis, diabetes, unintentional and intentional injuries, infant mortality and HIV/AIDS. Excess deaths are additional deaths experienced by a minority population beyond what would be expected if their rates were the same as those for the non-Hispanic White population.  Excess deaths also occur for Hispanics and Native Americans.    

African Americans and Hispanics also suffer disproportionately from common oral diseases such as dental caries, periodontal diseases and oral cancer. Current research is investigating plausible biological associations between oral and systemic diseases, and the synergy between oral and system health.  If strategies are developed to address both disease categories, periodontal diseases and diabetes mellitus, and bi-directional health interventions for low-income minority populations, multiple benefits are probable.


Peer reviewed basic and clinical science literature were reviewed.  Other articles, reports and popular press manuscripts were collected and evaluated. Secondary data from federal electronic reporting systems were also analyzed. Interviews with experts in the field of diabetes and periodontal diseases were completed.


There is ample evidence that periodontal infection adversely affects glycemic control in diabetics.  The literature also provides evidence that diabetes is a risk factor for the occurrence and progression of periodontal diseases. This bi-directional association provides opportunity for primary, secondary and tertiary interventions that will enhance both the management of diabetes mellitus and prevent and control periodontal diseases.  This strategy will reduce the burden of diabetes and periodontal diseases and improve the quality of life for community health center populations.


George W. Taylor, D.M.D., M.P.H., Dr.P.H., Associate Professor, Department of Cariology, School of Dentistry, University of Michigan