This revised grant submission describes a collaborative follow-up study of the oral health complications of Type 1 diabetes and the potential interrelationships between diabetes complications and oral diseases. This revision includes progress since the March 2000 submission and responses to study section's concerns and recommendations (INTRODUCTION: Response to Study Section). Since 1985, the NIH supported Epidemiology of Diabetes Complication Study (EDC) at the University of Pittsburgh Graduate School of Public Health (R0l-DK34818; TJ Orchard, PI) has been evaluating the medical complications of type 1 juvenile onset diabetes mellitus. In 1991, the Oral Health Science Institute (OHSI) of the School of Dental Medicine initiated a collaboration with the EDC to perform a comprehensive oral health examination of these patients (NIH-NIDR-l-91-R4; PA Moore, PI). The demographics, oral physiology and health behaviors of this unique population were characterized and the point prevalence rates for tooth loss, edentulism, periodontal disease, dental caries, soft tissue pathologies, salivary functions and Candida infections have been published. Analyses of associations between oral diseases and diabetic complications (nephropathy, neuropathy, retinopathy, vascular disease) within this insulin dependent population have also been completed. Advanced age, disease duration, glycemic control and smoking appear to be significant factors in many of the analyses performed to date and our initial results suggest that the oral health complications associated with Type 1 diabetes are likely to become even more clinically significant as the age of these patients increases. The ability to continue our collaboration with the EDC and collect longitudinal oral health data is an extraordinary opportunity. Our plan for this NIDCR resubmission is to continue our collaboration with the EDC by providing a second oral health examination of this unique population. The goals of this follow-up oral health evaluation are: 1) to determine the prevalence, incidence and disease progression rates for tooth loss, periodontal disease, coronal and root caries, soft tissue pathologies, salivary dysfunctions and oral health behaviors of this type 1 diabetic cohort, and 2) to assess the interrelationships between oral health complications and systemic diabetic complications to evaluate possible mechanisms for these interrelationships and to develop strategies for control and prevention. This overall plan will permit us to understand the etiology of these complications and to define specific subpopulations and risk factors appropriate for future prospective oral health prevention and intervention trials.