In everyday clinical practice, dental practitioners are likely to encounter many patients with diabetes or pre-diabetes. As dental professionals, we have been aware for a long time of the bidirectional relationship between diabetes and periodontal disease, meaning that hyperglycaemia affects oral health while periodontal disease affects glycaemic control. 1
Our role as clinicians, is to educate and empower our patients about this two-way relationship, as improvement of their glycaemic status and oral health can provide beneficial outcomes of both diseases. 1
Diabetes mellitus is a group of chronic diseases characterised by elevated levels of glucose in the blood. The most common types of diabetes are type 1, known as insulin dependent and type 2 known as non-insulin-dependent, with type 2 more prevalent. 2
Periodontal disease is commonly seen in people with diabetes, in fact periodontal disease is recognised a complication of diabetes.3 In addition to gingivitis and periodontitis, diabetes is associated with other oral health conditions, this includes caries, candidiasis, burning mouth sensation, altered taste, xerostomia and slow wound healing.4
Dental professionals play a pivotal role in maintaining their patients' oral health, and by referring patients with signs and symptoms of oral complications suggestive of diabetes for further evaluation.
Educating patients about the oral-systemic connection
Considering the impact of periodontal disease on diabetes and benefits of good oral health practices to minimise the risk of periodontal disease, it is important to ensure that our patients with diabetes are motivated to engage in good oral hygiene behaviours.
Patients are often unaware of the two-way relationship between oral health and diabetes, let alone the potential long-term consequences of poorly controlled diabetes. The first step, then, is to educate them on the link between the two.
When educating out-patients, it is important to use non-technical language to explain the connection, e.g., “gum disease” rather than “gingivitis” or “periodontitis.” It may help to use educational tools like videos and infographics to explain the oral complications of diabetes in an accessible and engaging way.
You can also give the patients takeaway literature from peak organisations such as Diabetes Australia for them to digest in their own time and refer back to.
Improving oral self-care
We only have limited chair time with our patients, so the biggest improvements will be gained by helping them improve their oral hygiene behaviours at home. Emphasise that good oral health will make a difference, and be sure that your patient is well-equipped to perform thorough, regular oral hygiene at home.
You can also recommend oral care products to help motivate them to take control of their oral health such as electric toothbrushes and water flossers.
The Colgate Pulse Electric Toothbrush, provides real-time feedback on your patient’s brushing technique,and identify areas where they need improvement as well as provides guidance on how to correct their technique. The app also tracks their brushing progress over time, helping them stay motivated and accountable to achieve better oral health goals.
Water flossers such as Colgate Blast are a great alternative to traditional flossing, and can be recommended to your patients to encourage them to clean in-between their teeth.
Recommending a toothpaste such as Colgate Total 12 Sensitivity +Gum Health, can assist in the treatment and prevention of gingivitis.
We can also explain to patients that gingivitis is the early phase of gum disease and that it can be reversed before there is the possibility of it progressing to the more advanced form of gum disease, periodontitis when bone loss around the teeth occurs.
Finally, we should all be conscious of the fact that managing diabetes is notoriously difficult and requires a lot of learning for the patient. Rather than presenting oral healthcare as yet another job required of them, present it as a way to help reduce the potential burden of diabetes and to take control of their own long-term outcomes. When patients feel empowered, they are likely to be much more motivated to invest time and energy into their oral health, which will benefit their general health.
References:
Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, Taylor R. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012 Jan; 55(1): 21–31. DOI: https://doi.org/10.1007/s00125-011-2342-y
Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2003;26:S5–20. [PubMed]
Kidambi S, Patel SB. Diabetes mellitus: Considerations for dentistry. J Am Dent Assoc 2008;139 Suppl:8s-18s.
Lamster, I.B., Bruno, M., Touger-Decker, R. (2014). Diabetes. In: Touger-Decker, R., Mobley, C., Epstein, J. (eds) Nutrition and Oral Medicine. Nutrition and Health. Humana Press, New York, NY. https://doi.org/10.1007/978-1-60761-490-6_11
Colgate Total 12 Sensitivity + Gum Health Toothpaste
Active ingredients: Zinc Oxide, Zinc Citrate Trihydrate, Sodium Fluoride and Silicon Dioxide
Helps protect against sensitive teeth pain. Helps treat and prevent gingivitis.
