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Wednesday, June 16, 2010 http://health.utah.gov/diabetes/telehealth/telehealth.htm Steven Steed, DDS, is the Dental Director at the Utah Department of Health, and President of the Association of State and Territorial Dental Directors (ASTDD). Dr. Steed has championed efforts in Utah, as well as nationally, in early detection and prevention of dental disease in children. He helped to author the ASTDD “Best Practice Approach to School-based Dental Sealant Programs”, which has become the standard of dental sealant prevention programs nationwide. Dr. Steed works directly with the Utah Dental Association and Utah State Legislature on advancing oral health initiatives. Dr. Steed organized and oversees the Utah Oral Health Coalition, whose mission is to increase community awareness of oral health needs. Dr. Steed is also a member of the Utah Diabetes Advisory Board and seeks to provide awareness on the links between oral health conditions and diabetes. For this program, Dr. Steed will discuss connections between oral health care and diabetes prevention and care. Program Description: The Utah Diabetes Telehealth Series is a monthly continuing education program for professionals with interest in the field of diabetes and related conditions. The program is free of charge, always held on the 3rd Wednesday from 12-1pm MDT, and participation is available by video conference, webstreaming, or telephone (as a live, distance learning format).
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Oral Health Care and Diabetes
Utah Department of HealthOral Health Program
June 16, 2010
Oral Health isPart of General Health
Cannot be completely healthy without oral health
Association between chronic oral infections & Diabetes Heart disease Lung disease Stroke Low-birth-weight Premature births
Periodontal (gum) disease is one of
the most common, yet least
recognized complications of
diabetes.
Periodontal (gum) disease is one of
the most common, yet least
recognized complications of
diabetes.
Why the least Why the least recognized?recognized?
Oral cavity not viewed as a Oral cavity not viewed as a human human organorgan
UnfamiliarityUnfamiliarity with the oral cavity with the oral cavity
Little focus in Little focus in educational educational literatureliterature
AmbiguousAmbiguous provider role in oral provider role in oral health carehealth care
WhatWhat
exactly is
periodontalperiodontal
disease?
In a nutshell, it includes In a nutshell, it includes gingivitisgingivitis and and periodontitisperiodontitis….both serious ….both serious infectionsinfections that if left that if left untreated can lead to tooth untreated can lead to tooth loss.loss.
Gingivitis can Gingivitis can progress to…progress to…((reversiblereversible))
PERIODONTITISPERIODONTITIS((not reversiblenot reversible))
Periodontal Disease Red or swollen gums that bleed
during brushing and flossing and are tender to the touch
Gums that have pulled away from the teeth, exposing the roots
Milky white or yellowish plaque deposits
Pus between the teeth and gums A consistent foul odor from the mouth
What to What to looklook for? for?
Periodontal Disease
Periodontal Disease and Diabetes
Nearly 64 percent of adults with diabetes have periodontal disease
Diabetics are 3 to 4 times more likely to develop periodontal disease
Periodontal Disease: Exacerbation of Diabetes and Potential Initiator
PD disrupts glycemic control in diabetics associated with pre-diabetic conditions (impaired
fasting glucose and impaired glucose tolerance) causes insulin resistance (via cytokines) impairs glycemic control (increased serum glucose
and HbA1c levels)
Periodontal infections contribute to elevated systemic C-reactive protein (CRP) level
Periodontal Disease (Periodontitis) 35% of all Americans have some form of
PD (~ 13% have severe disease)
75% of all Americans have gingivitis
Progression of gingivitis to PD pockets form around the teeth pockets gradually deepen and ulcerate cumulative surface area of ulcerated pockets
increases in size to the palm of a hand
Periodontitis-Induced Hyperglycemia is Reversible
Treatment of PD improves glycemic control in diabetics
• ~ 1% reduction in HbA1c levels
• ~ 50mg/dL reduction in serum glucose
• reduces insulin requirements
• improvements more pronounced in patients with severe PD
Recent Oral Care Guidelines and Screening Tools
Primary care provider• determine date of last oral examination• emphasize importance of oral hygiene • educate about diabetes/PD links and effect of PD on
glycemic control• perform oral examination with referral to dentist if PD
symptoms present• advise self-monitoring of oral health and importance of
dental visit if symptoms are noted• promote healthy lifestyle (diet, exercise) and “ABC”
goals (A1c, blood pressure, cholesterol levels)
Recent Oral Care Guidelines and Screening Tools
Dental provider• determine date of last medical visit, referral to physician if
diabetes symptoms present or if level of control is in doubt• prevention, early detection, and treatment of PD• emphasize importance of oral hygiene and provide instruction
with regular reinforcement• advise physician of PD diagnosis and care plan• monitor response to therapy 4-6 weeks post-treatment and
consult physician for reevaluation of HbA1c level• place patient on recall 2-4 times per year depending on
severity of the case
Periodontal Disease and Diabetes Infections affect glucose levels in
the blood. Diabetes makes periodontal disease
worse. Treatment of periodontal disease
can influence diabetes. Decreases insulin needs Improves glycemic control Decreases complications
Diabetes Diabetes reduces the reduces the
body’s body’s resistance to resistance to periodontal periodontal infections.infections.
Periodontal Periodontal disease disease
affects the affects the control of control of diabetes.diabetes.
Other DentalOther Dental
ComplicationComplicationss
Candidiasis
Sore white or red areas in the mouth
Not enough saliva and too much sugar in the saliva allow the fungus to cause candidiasis or thrush
Candidiasis
Treatment for Candidiasis
Topical Rinses Topical Creams Pastilles/Troches Systemic Drugs
Lichen planus
Treatment for Lichen Planus Pain
Topical Steroid rinses/ointments
Steroid Injection
Systemic Steroids
Xerostomia/Dry Mouth
Diabetes affecting the salivary glands so they don’t produce enough saliva
Affects chewing, tasting and swallowing
More difficult to control blood sugar
Xerostomia
Xerostomia and Burning Mouth Syndrome TreatmentAlter the drug regimen: Consult with physician to change xerostomia-causing
drugs.
Salivary Substitutes
Symptomatic Treatments: Water sugar-free candies, mints, and gum Eliminate mouthwash, tobacco, acidic liquids Different toothpaste
Cholinergic agonists: Pilocarpine hydrochloride 5 mg qid Cevimeline hydrochloride 30 mg tid
Other oral manifestations
Dental caries
Gingivitis
Taste dysfunction
Oral Surgery Complications
Remind the dentist that they have diabetes
Eat before surgery Take the usual medications Plan for eating needs after surgery Wait until the blood sugar is under
control
Prevention!Prevention!
Recommended Professional Dental Care
Regular dental examinations at least 2 times each year
Periodontal evaluation and treatment (SRP), 2 to 4 times each year
Recommended Home Dental Care Brush at least 2 times a day to
remove plaque, using a soft brush Tilt the brush to a 45-degree angle against the gum and
brush gently in a circular motion Brush the front and back and chewing surfaces Brush the top of the tongue
Clean between the teeth with floss or interdental cleaner daily
Gently wrap the floss around the tooth in a C-shape
Power brushes and floss aids
http://health.utah.gov/oralhealth
