Current statistics state 34.2 million Americans have diabetes, the chronic, life-altering disease that affects the process of converting food into energy. There are three types of diabetes.
Type 1 diabetes:
Believed to be caused by an autoimmune response, this response causes the body to cease making insulin, inhibiting the body’s ability to absorb glucose into the cells for energy. This is the least common type of diabetes.
Type 2 diabetes:
Type 2 diabetes develops over the course of several years and is the most common type of diabetes. It can be managed with a healthy diet and lifestyle. It is commonly referred to as ‘weight controlled’ or ‘adult onset’ diabetes.
Occurring in expectant mothers who have never had diabetes, gestational diabetes may increase the baby’s risk for health complications. It usually resolves after delivery, however, these individuals are found to be more susceptible for type 2 diabetes in later years.
There is an alarming increase in patients with prediabetes. Eighty-eight million adults show markers for prediabetes. For these individuals, lifestyle changes should be immediate to avoid progression into Type 2 diabetes. In addition, the long-term damaging effects of diabetes on the blood vessels, kidneys and heart may already be occurring.
November is National Diabetes Month and it grants the dental professional an opportunity to educate and screen your patients for factors that put them at risk for diabetes. In addition, it provides teaching opportunities to educate those already diagnosed with diabetes about the role the disease plays in oral health.
Diabetic patients often receive little, if any information on oral health care and its relationship to their diagnosis from their physicians and practitioners. A study performed across 14 countries and involving 27,894 participants concluded that people with diabetes have limited oral health knowledge along with, poor oral hygiene habits and behaviors. This is an opportunity to educate your patients while promoting interdisciplinary care. The result is overall healthier patients.
As we are aware, diabetes, especially if un-monitored and untreated, can ravage a person’s body. The oral cavity may display several notable symptoms:
● Reduction in salivary flow
● Gingival inflammation
● Elevated caries risk
● Increased susceptibility to dental infections
● Prolonged wound healing time
● Increased risk for periodontal disease
● Suppressed taste
Periodontal disease is the most common dental disease affecting individuals with diabetes. In fact it affects approximately 22% of those diagnosed with diabetes. As stated above, individuals with diabetes are more susceptible to infections. Uncontrolled blood sugar increases inflammation. In turn, the inflammation elevates blood sugar levels. Chronic inflammation can destroy the gingival tissue and surrounding bone.
This bidirectional relationship between inflammation and blood sugar levels reinforces the need for close monitoring of their A1C. The A1C score is a blood test that monitors the patient’s blood sugar and provides an average measure over a period of approximately 3 months. Medical physicians use the test to diagnose diabetes. Post diagnosis, the test is used to monitor disease maintenance, and to determine if alternative treatment modifications are needed. Patients with a higher A1C, and thus suspected of uncontrolled diabetes, require more aggressive periodontal treatment. Likewise, patients with periodontal disease find it more difficult to stabilize glucose levels.
Smokers are about 40% more likely to develop Type 2 diabetes than non-smokers. In addition, it is more difficult for smokers to manage blood sugar levels and regulate its effects. The chemicals in cigarette smoke damage cells causing inflammation and interfering with the cells ability to perform its normal functions. In addition, toxins from cigarette smoke combine with the oxygen in the bloodstream, causing oxidative stress. This damages cells leading to an increased risk for diabetes and other diseases such as heart disease, peripheral artery disease, retinopathy, and peripheral neuropathy.
What can we do to raise awareness about diabetes awareness and prevention in the dental practice?
Have flyers, posters, and educational materials in plain view
Emphasize diabetes management (know your A1C, dietary recommendations)
Educate patients at risk for Type 2 diabetes about a healthy diet and physical activity
Promote good oral hygiene habits
Recommend increased protocols for those with or at risk of diabetes
Customize oral health recommendations (flossing, water flossers, more frequent recalls)
Provide smoking cessation materials
Educate on diabetes and its relationship to periodontal disease, gingivitis & periodontitis
For more information or resources about diabetes and National Diabetes Month visit:
Her clinical and support team experiences are the inspiration for her writing and the motivation for coaching clients to success. She is a regular contributor to various publications within dentistry and beyond. In addition to feeding the homeless, starting a non-profit, and being involved in her church and other community organizations, she sings professionally and enjoys several creative outlets. She resides in Florida where she enjoys the company of her husband, three children, and four beautiful grandchildren.