Diabetes & the Dental Patient
From the Newsletter “Your Valley Smile” Fall 2007
Diabetes is a disease where the body does not produce or properly use insulin, a hormone that is produced in the pancreas. Without adequate amounts of insulin, our bodies cannot properly use sugar, the primary fuel for our cells. As a result, a diabetic’s cells can become starved for energy, and over time, the presence of so much unused sugar in our blood, can cause a wide range of conditions.
There are currently 20.8 million Americans with diabetes. According to the American Diabetes Association, about 1/3 of this population is unaware that they even have the disease (undiagnosed). Moreover, for those who have been diagnosed, only about half have it under control.
In the human circulatory system, we have the centrally functioning heart. This powerful muscle pumps blood out through large arteries, which eventually branch to smaller arterioles, and ultimately to tiny capillaries, where oxygen and nutrients are exchanged. From this point forward, veins of progressively larger size return the blood back to the heart, where the whole cycle begins again.
As I have always understood it, it is the turnaround point (small capillaries) in this blood journey where diabetics can experience the greatest difficulty. In particular, it is the high level of unused sugar in the system that can lead to problems with vision (even blindness), kidney failure, nerve damage, and even heart disease. Wound healing also can prove to be difficult in areas where reconstruction processes depend heavily on oxygenated blood from capillaries.
In our line of work, diabetes has been linked to an increased risk of periodontal disease, a bacterially driven infection that initially causes inflammation of the gum tissue, causing them to bleed. Over time, the disease process will destroy the bone and the soft tissues that support and hold in the teeth. Though periodontal disease does in fact occur in non-diabetics, the condition is more common in diabetics and can be far more severe.
Here’s the kicker… New research is showing that periodontal disease can also effect a diabetic patient’s ability to control blood sugar levels. As periodontal disease is a chronic inflammatory infection which has been shown to increase risk of heart disease, pre-term and underweight babies, and strokes, it becomes glaringly obvious that paired together, diabetes and periodontal disease can prove to be a deleterious disease cocktail.
Research also shows that when patients undergo active periodontal therapy, the level of inflammation about the affected teeth diminishes and sugar levels become more manageable.
So, to summarize, let it suffice to say that diabetics can be caught in a particularly vicious cycle. Diabetes often walks hand in hand with periodontal disease, a disease process that can ultimately cost you some or all of your teeth. Moreover, active periodontal disease can contribute to diabetes.
How to treat such a potentially fragile group of patients in the dental office has become a topic of debate over the years. For “cookie cutter” offices, such patients may automatically be sent to the periodontist. Still other offices may put all of their diabetic patients on a 3-4 month cleaning schedule.
Though I am not opposed to placing patients on a more frequent cleaning (or maintenance) schedule, I believe that each patient is an individual, and that as such, we need to assess their condition at least annually, and make any necessary changes in hygiene/maintenance frequency. At a bare minimum, I still believe that every adult patient should be seen twice a year in the hygiene chair, where gum and bone health can be assessed thoroughly. If significant changes pop up, we can take note, and treat you, refer you to a specialist, or bump you back to your physician for an evaluation
Eighteen months ago, our office upgraded its management software, which included a very inclusive periodontal recording tool. We use this tool at least once a year on every adult patient with teeth, and can compare, from year to year, any changes. Moreover, when we take photographs of the teeth, we also scan the mouth for gum related changes, and plan accordingly. If you are interested in your numbers, photos, or diagnoses, don’t hesitate to ask, because your involvement (home care, brushing, flossing…) is an integral part of our goal for you...ideal oral health.
Though we are by no means perfect in our collection of data, we are far more thorough that we have ever been. As a result, we believe that we can help not only our periodontal patients, but our diabetic patients as well.
I am by no means an expert on diabetes, nor do I know even a fraction of all the knowledge about periodontal disease. Coupled with the knowledge I do have, I used an article written by Brian Mealey, from the University of Texas Health Science Center at San Antonio, to help me put together this short article. I hope that what I have provided will shine a bit more light on what I have always viewed as a very confusing disease.