Friday, October 03, 2008

Diabetes and its impact on oral care

Deborah Lyle looks at how the dental professional is the key to a patient’s overall health

Diabetes mellitus is a group of metabolic diseases that are characterized by high blood glucose levels resulting from insufficient insulin production, insulin action or both. People with diabetes fall into one of four classifications.

The World Health Organization (WHO) estimates that currently more than 180 million people worldwide have diabetes and, by 2025, that number will be more than 330 million people. The rapid increase in the incidence of diabetes makes it a global epidemic and healthcare crisis. In the UK diabetes is one of the biggest healthcare issues where more than two million people suffer from diabetes with another 500,000 who are unaware they have the condition.[1]

Complications from diabetes can be devastating and are the cause of death in approximately one in ten (11.6%) 20-79 year olds in England. It is estimated that by the year 2010, this number could increase to one in eight deaths (12.2%) caused by complications of diabetes.[2]
One of the fastest growing risk factors for type 2 diabetes is obesity. In the UK, approximately one in five adults is overweight and one in fifteen is obese. Lifestyle changes such as exercise and diet can reduce weight and prevent the onset of type 2 diabetes or if already diagnosed, can reduce the complications such as cardiovascular, disease, kidney failure, nerve damage and blindness.[3]

Oral implications

The association of diabetes and oral health is well documented. Several studies have shown a relationship between diabetes and the incidence and severity of periodontal disease. Other oral complications include burning mouth syndrome, taste disturbances, xerostomia, candidiasis, lichen planus or recurrent aphthous stomatitis. Xerostomia increases the risk for dental caries but no studies to date have demonstrated a relationship between diabetes and an increase incidence of dental caries. Children with diabetes have been shown to have a higher prevalence of gingival inflammation affecting more sites compared to non-diabetic children with similar plaque accumulation. Periodontal disease starts earlier in life for diabetic children and can become more severe in late adolescence and early adulthood, especially in those with poor glycemic control.[4]

Adults with diabetes have also shown an increase in the gingival inflammation and extent and severity of periodontitis.[4] It has been reported that diabetics with severe periodontal disease were four times more likely to have poor glycemic control. Conversely, reduction in periodontal disease has shown better glycemic levels.[5]

Role of the dental professional

Dental professionals are in a unique position to have a positive impact on patient health. Many patients with diabetes are unaware of their risk for periodontal disease. It is important to discuss and document the type, duration, medication, and self-monitoring frequency. Record the latest blood glucose test scores and any history of complications. Based on this information and the oral assessment, develop a comprehensive treatment plan for that incorporates the patients values and specific needs.

Based on research findings, it is extremely important that the patient has a self-care plan that is effective and accepted. They may need to do more than the average patient due to their risk of infection and potential impact on blood glucose control. Traditional aids can work well such as toothbrushing, interdental cleaners and mouthwash. A dental water jet is also effective and has been tested on diabetic patients. The study showed that people with diabetes had a 44% better reduction in bleeding compared people with diabetes who performed routine oral hygiene that included brushing and flossing. There was also a significant reduction in serum inflammatory mediators associated with inflammation.[6]

The rise in the number of people with diabetes in the UK means that they will also increase in the dental office. The dental professional is a key component to the team of healthcare professionals that support and treat people with diabetes significantly impacting their quality of life.

References :

1.Global Diabetes – The scale of the

2.Shocking New

3.Losing weight post diabetes diagnosis can stem

4.Mealey BL, Oates TW. Diabetes Mellitus and Periodontal Diseases. J Periodontol 2006;77:1289-1303.

5.Taylor GW, Burt BA, Becker MP, et al. Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus. J Periodontol 1996;67:1085-1093.

6.Al-Mubarak S, et al. Comparative evaluation of adjunctive oral irrigation in diabetes. J Clin Periodontol 2002;29:295-300.