8/10/2019 Diabetes Article Physiology
1/3
c A u s t i n
R i s b e c k
R D H
O ral H ealth arefor the Medical ly
om prom ised Pa tient w ith D iabetes
D i a b e t e s M o r b i d i t y a n d M o r t a l i t y
Diabetes af fec ts 20.8 mi l l ion chi ldren and adul ts in the
Uni ted
States. Whi le an est imated 14.6 mi l l ion have been diagnosed
w i th
diabetes, 6.2 mi l l ion people are unaware that they have the
disease.
There are 54 mi l l ion Amer icans who have pre-diabetes. '
Adul ts w i th type 2 d iabetes are two to four t imes more l i
ke ly to have
hear t d isease or suf fer a s t roke than those w i thout d
iabetes.
Cardiovascular d isease is the major cause of death for peo ple
w i th
diabetes. They are a lso at r i sk for other c om pl icat ions,
such as
bl indness, k idney disease, amputat ions, nervous system
disease, and
oral compl icat ions, inc luding per iodontal d isease.^
Dental profess ionals can play an impor tant ro le in d iagnos
ing and
managing pat ients w i th d iabetes. Since diabetes may be
present for
a number of years before i t i s d iagnosed, the dental hygienis
t may be
the f i r s t heai thcare prov ider to detect a pat ient 's d
iabetes by
recogniz ing ear ly s igns of the d isease in the mouth and rev
iewing the
pat ient 's heal th h is tory . Ident i fy ing those who h ave a
fam i ly h is tory ,
a parent or s ib l ing w i th d iabetes, i s an impor tant
component leading
to a phys ic ian refer ra l and a poss ib le ear ly d iagnos is
of d iabetes.
Pat ients who have s igns and symptoms of d iabetes should
be
refer red to a medical prov ider .
P e r i o d o n t a l D i se a s e a n d D i a b e t e s
Adul ts w i th d iabetes have a h igher prevalence of per
iodontal d isease
and m ore severe forms of the d isease. Per iodontal d isease
has been
assoc iated w i th the development of insul in res is tance and
poor
glycmie contro l among adul ts w i th d iabetes. '
Research suggests that a person w i th d iabetes, who has
severe
per iodontal d isease, may have greater mor ta l i ty f rom
diabet ic
compl icat ions such as cardiovascular d isease and k idney
problems
compared to d iabet l w i th l i t t le to no per iodontal d
isease.
The ev idence cont inues to suggest that contro l of per
iodontal
infec t ion has an impact on improvement of g lycmie contro
l
ev idenced by a decrease in demand for insul in and
decreased
hemoglobin Ale levels .^
In add i t ion to pe r i odon ta l i n fec t ion a nd g i ng i
va l i n f l am m a t i on , a
number of other oral compl icat ions have been repor ted in pat
ients
wi th d iabetes such as, dental car ies , xerostomia, tas te
dysfunct ion,
g lossodynia, candid ias is , l i chen planus, burning mouth
syndrome,
and poor w ound h ea l i ng . ' P r oper m anagem ent o f t hese
com p l i ca -
t ions requi res that they f i r s t must be proper ly d
iagnosed through a
comprehens ive oral examinat ion at each dental or medical v is
i t .
M u l t i d l s c i p l i n a r y T e a m a r e
I n teg r a ted , m u l t i d i sdp l ina r y team car e Is key
to success fu l d i abe tes m ana gem e nt , a
coordinat ion of care can be fac i l i ta ted by set t ing up a
system of refer ra ls for an oral
exam i na t i on as w e l l as fo r .
urgent needs. Medical prov iders
should inc lude oral screening
examinat ions as par t of thei r
com pr ehens ive eva l ua t i on ,
inc luding the assessment of
sym ptom s tha t r equ i r e u r gen t
refer ra l to a dental prov ider .
Rec iprocal ly , dental prov iders
should consul t w i th phys ic ians
to adv ise of the presence of
per iodontal in fec t ion and
pr oposed t r ea tm ent .
Dental profess ionals are wel l
versed in prov id ing appropr iate
care for the contro l of ora l
d isease. Careful management of
pat ients w i th d iabetes is c r i t i ca l
t o m a i n ta i n i ng op t i m a l o r a l
heal th. Oral heath care s t rate-
gies should inc lude:
1 . Preven t ion, ear iy detect ion
and t r ea tm ent o f pe r i odon-
ta l d isease.
2 . Con sul tat ion w i th phys ic ian
to adv ise of the presence of
pe r i odon ta l i n fec ti on and p r oposed t r ea tm ent
.
3. Cons iderat ion of d iagnos is and du rat ion of d iabetes;
level of g lycmie contro l
(Ale) ; medicat ions and t reatment h is tory ; and r i sk fac
tors for per iodontal d iseas
which may inf luence diab et ic compl icat ions ( i .e. tobacco
use and obe s i ty ) .
4 . Educate pat ient regarding the poss ib le nega t ive imp act
of per iodo ntai in fec t ion
on g l ycm ie con t r o l.
5. In i t ia te per iodontal therapy and pat ient mo t ivat ion
to establ i sh
nd m int in
per i odon ta l hea l th .
6 . M on i to r r esponse to pe r iodon ta l t he r apy 4 to 6 w
eeks pos t - tr ea tm e nt ; r eques t
value to measure c l in ical outcome.
7. Schedule per iodon tal maintenance 2 to 4 t imes a year or
more f requen t ly .
8. Assess diabetes symptoms that requi re refer ra l to pr imary
care prov ider .
P r i m a r y a r e M e d i c a l P r o v i d e r s
In
an
e f f o r t
to
f o c u s a t t e n t i o n
on the
n e e d
f o r
b e t
o r a l h e a l t h c a r e f o r p a t i e n ts w i t h d i a b
e t e s nd
p e r i o d o n t a l d i s e a s e or o t h e r o r a l c o m p
l ic a t i o n s ,
p h y s i c i a n s , n u r s e p r a c t i t i o n e 5 a n d p
h y s i c ia n
a s s i s t a n t s s h o u l d t a k e t h e f o l l o w i n g
a c t i o n s t e p s :
I n c lu d e o r a l e x a m i n a t io n a s a p a r tof
the
c o m p r e h e n s i v e d i a b e t e s e v a i u a t i o r i
-
I n q u i r e i n t o th et im e o f l a s t o r a l e x a m i n
a t i o n .
E x a m i n e t h e l e e t h a n d g u m s f o r p l a q u e an
d
g i n g i v a l i n f l a m m a t i o n .
U r g e d a i ly b r u s h i n g a n d fl o s s i n g .
A s s e ss o r a l s y m p t o m s t h a t r e q u i r e u r g e
n t re f e r r
A d v i s e p a t i e n t t h e y n e e d p e r io d i c o r a l
e x a m i n a t
a t l e a s t t w i c e y e a r l y or m o r e f r e q u e n t l
y )
A d v i s e p a t i e n t to do a m o n t h l y s e l f- e x a m
an d
c o n t a c t t h e i r d e n t a l c a r e p r o v i d e r
if
t h e y n o t i c e
s i g n s o f i n f e c t i o n s u c h a s s o r e , s w o l l
e n , o r b l e e d
g u m s ; lo o s e te e t h ; m o u t h u l c e r s ;o rp a i n
.
E x p l a i n t h e l i n k b e t w e e n p e r i o d o n t a l
d i s e a s e a
p o o r g l y c m i e c o n t r o l .
R e f e r
a ll
p a t ie n t s w i t h d i a b e t e s w i t h
or
w i th o u t
d e n t a l c a r e p r o v i d e r , r e g a r d l e s s o r o
r a l f in d i n g s
o r c o m p l a i n ts .
Continuedonpage
8/10/2019 Diabetes Article Physiology
2/3
Medical ly omprom ise d Pa t ie n t
w i t h D i a b e t e s
Contimied)
P r e v e n t i n g C o m p l i c a t i o n s
Per iodontal d isease is of ten refer red toas the s ix th com
pl icat ion o fd i abe tes ' ,
a l ong w i th r e t i nopa thy , nephr opa thy . neur opa thy ,
and m i c r o - and m ac r ovascu la r
diseases. All heal th care prov iders should adv ise persons w i
th d iabetes to brush
thei r teeth af ter eat ing and to f loss a t least onceaday to
r educe the fo r m a t i ono f
bacter ia l p laque biof i lm. Spec ia l cons iderat ion should
be given tor e c o m m e n da
power too thbru sh, such as the S onicare F lexCare. The F
lexCare iscl inical ly
proven to remove more bacter ia l p laque and reduce gingiv i t
i s . Dai ly brushing
wi th the F lexcare has also been proven to help shr ink per
iodontal pockets . '
C o n c l u s i o n
Studies have suggested
a
l ink between per iodontal in fec t ion and systemic
disease. Prov id ing proper oral heal th care and refer r ing
pat ients who have s igns
and sym ptom s o f per iodont i t i s and gingiv i t i s , may
be impor tant s teps inreduc ing
the bur den o f diabetes, cardiovascular d isease, and other
systemic morbid i t ies .
b o u t t h e u t h o r
C. Aust in R isbeck, RD H, is on the G uidel ines C om mi t tee
of the D iabetes C oal i t ion
of Cai i forn ia. He has rev iewed and u pdated the B as ic
Guidel ines for D iabetes
Care toinc lude more abo ut pe r iodontal care andtourge pr im
ary care prov iders
to i nc l ude an o r a l exam i na t ion as a com ponen t o f t
he com pr ehens i ve d i abe tes
evaluat ion, and to establ i sh a refer ra l sys tem to help
create col labo rat ive
relat ionships w i th dental care prov iders . Aust in ispres i
den t and found er o f
Dental Hygienis ts Against Hear t D isease, a coal i t ion that
ra ises awareness of the
relat ionships among per iodontal d isease and systemic d
iseases. He can
b e
reached at ; Aust inRDH@Prevent ionSpec ia l i s t .com
R E F E R E N C E S
A m e r ic a n D i a b e te s A s s o c ia t io n ( 2 0 0 5 ) .
A ll a i ) o u t d i a b e t e s . R e t r ie v e d o n M a r c
h
1 , 2 0 0 8 ,
f r o m , w w w . d i a b e t e s . o r g
2 . C e n t e r s
f or
D i s e a s e C o n t r o l a n d P r e v e n t i o n ( 2 0 0 5
) . N a t io n a l d i a b e t e s f a c t s h e e t : G e n e r a
l
i n fo r m a t io n a n d n a t io n a i e s t im a t e s o n d
i a b e t e s i n t h e U n i te d S t a t e s . R e t ri e v e d o
n M a r c h
1 ,
2 0 0 8 , l ro m , w w w . c d c .g o v / d i a b e t e s /p u b
s / p d f / n d s _ 2 0 0 5 . p i f
3 . S a i t o J . , S h i m a z a k i . Y . K i y o h a r a ,Y -
. K a t o ,
I ,.
K u b o , M . , L i d a . M . ,
K o g a . I ( 2 0 0 4 ,
J u n e ) .
T l i e
s e v e r i t y of p e r i o d o n t a l d is e a s e i s a s s
o c ia t e d w i th t h e d e v e l o p m e n t of g lu c o s e i n
t o le r a n c e in
n o n - d i a b e t ic s : t h e H i s a y a m a s t u d y . J o
u r n a l o f D e n t a l R e s e a r c h , 8 3 { 6 ) , 4 8 5 - 4 9
0 ,
4 . S a r e m i ,
A . , N e l s o n , R . G . J u l I o c h - R e i d , M . . H a
n s o n , R . L ., S i e v e rs , M l . . T a y l o r , G .W .,
S h i o s s m a n , M . , B e n n e t t , P H . , G e n c o , R
., K n o w le r , W .C . ( 2 0 0 5 ) . P e r io d o n t a l d is e
a s e a n d
m o r t a l i t y in t y p e 2 d i a b e t e s . D i a b e t e
s
O re
2 8 1 ) , 2 7 - 3 2 .
5 . G r o s s i , S . ( 2 0 0 1 ) . T re a t m e n t of p e r i
o d o n t a l d is e a s e a n d c o n t r o l o f d i a b e t e s
; A n a s s e s s m e n t
o f t h e e v i d e n c e a n d n e e d f o r f u t u r e r e s
e a r c h . A n n a l s o f P e r i o d o n t o i o g y . 6 ( 1 ) ,
1 3 8 - 1 4 5 .
6 . S h i p ,
J .A . ( 2 0 0 3 ) . D i a b e t e s a n d o r a l h e a l th ,
a n o v e r v i e w . J o u m a i o f t h e k n e r i c a n D e n t
a l
A s s o c i a t i o n . 1 3 4 . 4 S - 1 0 S .
7 . L o w e , G . D , ( 2 0 0 1 ) , T h e r e l a ti o n s h i p
b e t w e e n i n f e c t io n , i n f la m m a t i o n , a n d c a
r d io v a s c u l a r
d i s e a s e ; a n o v e r v i e w . A n n a l s o f P e r i o
d o n t o i o g y , 6 ,1 - 8 .
8 . S c h a e k e n , M . , S t u r m , D . , M a s t e r , A ,
, J e n k i n s , W . , S c h m i tt , P ( 2 0 0 7 ) , A r a n d o
m iz e d ,
s i n g l e - u s e s t u d y
t o
c o m p a r e t h e p l a q u e r e m o v a l a b i l it y
of
tw o p o w e r t o o t h b r u s h e s , t h e
S o n i c a r e * F l e xC a r e a n d t h e O r a l - B T r i u
m p h P r o f e s s io n a l C a r e .C o m p e n d iu m o f
C o n t i n u i n g E d u c a t i o n in D e n t i s tr y . 28 R
e t r i e v e d o n M a y 3 , 2 0 0 8 f r o m ,
w w w , s o n i c a r e . c o m / d p / d i n i c a l _ 5 t u d
i e 5 / c l i n i c a l _ s t u d y _ 6 . a s p
Prof i le o a
Registered Dental
Hygien is t
Q - What are the passions in your life
A - M y p a ss io n s a r e b e in g w i t h m y h u s b a n d ,
fa m i ly ,
g r a n d k i d s a n d t h e AAT v i s i ts . H e l p in g i n
t h e c o m m u n i t y
g i v e s m e e n e r g y . I r e a l ly lo v e C a n i n e F r
e e s ty le d a n c e -
d o n ' t a s k .
Q - If you were not a hygienist what would you be
A - 1 t h i n k I w o u l d h a v e s o m e k i n d o f f o re n
s ic jo b ,
b e c au s e I w o u l d d e s c rib e m y s e l f a s m o t i v
a t e d , a d v e n t u r -
ous,
a n d a p r o b le m s o lv e r .
Q - Are you a member of the professional dental
hygiene association and what do you see happening
in the profession
A - I a m a m e m b e r o f AD H A , C D H A a n d t w o lo c a
l
c o m p o n e n t s . I a m c o n c e r n e d a b o u t b u r n
- o u t . H y g i e n is t s
n e e d t o ta k e t i m e f o r t h e m s e l v e s a n d f i n
d d a i ly w a y s t o
r e - e n e r g i ze t h e i r l iv e s .
Q - What do you like most and least about working
as an RDHAP
A - I li k e t h e d a i l y c h a l l e n g e s . I f e e l l i
k e I c a n m a k e a
d i f f e r e n c e .T h e mo s t d i f f i c u l t p a r t o f
w h a t I d o i s t r y i n g t o
f i n d a n O r a l Su r g e o n o r H o s p i t a l D e n t i s
t r y s p e c i a l i s t s
w i l li n g t o p r o v i d e c a r e t o M e d i c a i d p a t
ie n t s . I u n d e r s ta n d
th i s i s a b o u t mo n e y b u t my h e a r t i s s t i l l s
a d d e n e d th a t
p e o p l e a r e w a i t i n g s e v e r a l mo n th s t o tw o
y e a r s t o r e c e i v e
th e s e d e n ta l s e r v i c e s .
