Oral Health: An Untapped Resource in Managing Glycemic Control in Diabetes and Promoting Overall Health  Cynthia S. Darling-Fisher, PhD, FNP-BC, Preetha P. Kanjirath, BDS, MS, Mathilde C. Peters, DMD, PhD, Wenche S. Borgnakke, DDS, PhD  The Journal for Nurse Practitioners  Volume 11, Issue 9, Pages 889-896 (October 2015) DOI: 10.1016/j.nurpra.2015.08.001 Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure Health Team Referral Form That Promotes Interprofessional Communication. Modified from: Wisconsin Diabetes Prevention and Control Program 2012.28 This document is in the public domain and may be downloaded, copied, and/or reprinted. The Journal for Nurse Practitioners 2015 11, 889-896DOI: (10.1016/j.nurpra.2015.08.001) Copyright © 2015 Elsevier Inc. Terms and Conditions

Supplementary Figure 1 Development of periodontitis from health (A) through reversible inflammation of soft tissue (B, gingivitis) to irreversible breakdown of soft and hard tissues surrounding the tooth (C, D, periodontitis). The distance from the gingival margin (gum line) to the bottom of the healthy “sulcus” (A, B) or diseased periodontal “pocket” (C, D) is measured with a periodontal probe. The attachment is the surrounding soft tissues connecting the tooth root to the alveolar bone. Without good oral hygiene, dental plaque (blue in panels B-D,) hardens over time (brown in D,) forming “calculus” (tartar). This accumulates both above and below the gum line and cannot be brushed away. “Deep cleaning” involves scraping off the plaque and calculus (scaling) and smoothing the root surface (root planing) to reduce the bacterial load and the inflammation it creates in the local gum tissue (redness in B-D) and in places far from the mouth. Source: Modified after Kanjirath PP et al. 2015. Available at: http://hdl.Handle.Net/2027.42/110802 The Journal for Nurse Practitioners 2015 11, 889-896DOI: (10.1016/j.nurpra.2015.08.001) Copyright © 2015 Elsevier Inc. Terms and Conditions

Supplementary Figure 2 Healthy pale, pink gingiva (gums) form a tight seal to the underlying healthy sulcus (0-3mm deep space between the teeth and the gingiva) without swelling, redness, bleeding, or pus. The surface of the gingiva is stippled, which is a sign of health and absence of swelling due to inflammation. Source: Photo by dozenist, June 10, 2006/ Available in public domain at: http://commons.wikimedia.org/wiki/File:06-10-06smile.jpg. Accessed March 28, 2015. The Journal for Nurse Practitioners 2015 11, 889-896DOI: (10.1016/j.nurpra.2015.08.001) Copyright © 2015 Elsevier Inc. Terms and Conditions

Supplementary Figure 2B Healthy gingival tissue in dark skinned individuals can be pigmented (evident here). However, this can camouflage redness. Source: Kanjirath PP et al. 2015. Available at: http://hdl.Handle.Net/2027.42/110802 The Journal for Nurse Practitioners 2015 11, 889-896DOI: (10.1016/j.nurpra.2015.08.001) Copyright © 2015 Elsevier Inc. Terms and Conditions

Supplementary Figure 3 Severe gingivitis before (TOP) and after treatment (BOTTOM): TOP) Gingivitis with calculus and plaque and inflamed, swollen gums that bleed easily; BOTTOM) Nine days after scaling and root planing (“deep cleaning”), the gums are healthy, snug and tight up against the teeth. Source: Onetimeuseaccount. Available in public domain at: http://commons.wikimedia.org/wiki/File:Gingivitis-before-and-after-3.jpg. Accessed March 28, 2015. The Journal for Nurse Practitioners 2015 11, 889-896DOI: (10.1016/j.nurpra.2015.08.001) Copyright © 2015 Elsevier Inc. Terms and Conditions

Supplementary Figure 4 Clinical signs of severe periodontitis: 1. Calculus (hardened plaque or “tartar”); 2. Plaque (bacterial biofilm); 3. Gingivitis (inflamed gingiva); 4. Gum recession (gum line has pulled back so part of the root is visible so tooth looks longer) with caries on the root; 5. Pocket with pus oozing; 6. Periodontal pocket with loss of bone support; 7. Coronal caries lesion (cavity on the crown); 8. Space after teeth extracted; 9. Loss of attachment (soft tissue and bone around the tooth is gone). Source: Kanjirath PP et al. 2015. Available at: http://hdl.Handle.Net/2027.42/110802 The Journal for Nurse Practitioners 2015 11, 889-896DOI: (10.1016/j.nurpra.2015.08.001) Copyright © 2015 Elsevier Inc. Terms and Conditions