Periodontal Disease and Diabetes Mellitus- The link
We have known for some time that medical conditions affecting other areas of the body often reflect in the oral cavity.
One of the conditions which we have been focusing on, as it is on the increase, is Diabetes Mellitus.
Diabetes is on the increase globally and the World Health Organisation figures indicate that as many as 180 million people world-wide have Diabetes. This equates to 5% of the worlds population. Numbers are on the increase and by 2030 they estimate that this will increase by 103%!
When we look at the factors leading to the increase, they include obesity and inactivity, an increase in the ageing population and a reduction in the mortality rate of diabetics as we are living longer and medical science moves forward in treatment regimes.
Why are we concerned and what are we doing about this at Absolute Dental?
A large body of evidence exists that suggests diabetes can be linked to an increased prevalence, extent and severity of periodontal disease and that uncontrolled glycaemic levels can increase an individual’s susceptibility to the disease and the inflammation associated with oral diseases can trigger a number of systemic changes in the body that can result in insulin resistance.
There are lots of reasons why diabetics are more prone to developing periodontal disease. However, the good news is that conversely, periodontal therapy, and its associated reduction in oral inflammation have been linked to an improvement in metabolic control as well as limiting the progression of other complications associated with diabetes.
How we help you at Absolute. There are many key points to managing our diabetic patients which depend both on the information patients give us and what we find in the mouth.
Information from our patients
- Medical history. This is paramount for us as some changes to your health might have an impact on your dental health and also affect some aspects of the treatment we provide for you. We often ask for you to complete a written medical history to help us keep up to date with you. For diabetic patients, the details of the classification of diabetes and how it is controlled are particularly important.
- How long had the patient had diabetes? It appears that the earlier onset, the more susceptible the patient is to diabetes.
- Is the diabetes well controlled? Patients with poor metabolic control are more susceptible to periodontal disease.
- Oral Hygiene. Good oral hygiene is imperative for diabetic patients and we need to find out how the patient cleans, both tooth brushing and inter-dental cleaning.
- Appointment times. It helps us if patients tell us when good times of day for them are to attend and does not interfere with their eating and insulin routines.
How do we look after our patients in the surgery and what are we particularly looking for.
- Patient positioning. Diabetes can cause orthostatic neuropathy and so we raise the chair slowly to an upright position.
- Intra-oral examination. Thoroughly examining the mouth is imperative as there are many oral side effects including xerostomia, where there is a reduction in saliva production. This can contribute to an increase in caries and plaque accumulation. Glossitis, which is inflammation of the tongue, taste disturbance and burning mouth syndrome.
- Assessing the periodontal health. We complete this every time we by carrying out a Basic Periodontal Examination. This helps us to identify by a general screening, areas of bleeding, calculus formation and pocketing. We can then compare these to past charts and identify if there have been increases in any of these criteria, despite patients good efforts with their oral hygiene.
- A further full mouth pocket chart is also completed by the hygiene team providing in depth pocket depths, bleeding and recession.
- Monitoring patients during treatment is important as sweating, confusion, nausea and mood changes may indicate diabetic complications e.g. hypoglycaemia.
- Maintenance and monitoring. At each appointment we consistently assess and check medical history and oral health as if we can identify subtle changes early, these may be key in identifying early signs of diabetes. Helping not only your dental health but general health as well!
written by Maureen Milne
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