Oral Manifestations of Diabetes

Betsy Hardin, RDH, MS

NC Oral Health Section

February 3, 2012

Teeth Aren’t Important…..

Are they????

No one ever dies from bad teeth…

A sad story…..

Early 2007, 12 year old Maryland resident, Deamontes Driver died from a tooth infection

The infection went to his brain Two brain surgeries were unsuccessful An extraction would have cost only $80

The 6 Complications of Diabetes

Retinopathy

Nephropathy

Neuropathy

Cardiovascular Disease

Stroke

Periodontal Disease

Importance of Teeth

Chewing

Talking

Smiling

Shape the face

Aid Digestion

Periodontal Disease

Chronic inflammation of the bone and tissue that surround the teeth.

Could Dentists Aid in Diagnosing Diabetes?

screen for risk factors – i.e. overweight; high risk ethnic group, high

cholesterol, high BP, family member with diabetes, given birth to a 9 lb. baby or having had gestational diabetes

Use blood from infected gum area for a glucometer test strip

Number of missing teeth and percentage of deep pockets in the gums

Periodontal Risk Factors Poor oral hygiene Inflammation Long history of diabetes Other diabetic complications Poorly controlled diabetes Parents Pregnancy Obesity Ethnicity Stress Age

The Importance of Good BS Control Prevent oral fungal infections Prevent ongoing inflammation in the mouth Prevent further destruction of bone Prevent congenital dental defects in infants

The Kiss of Disease

Poor Oral Hygiene

Leads to the formation of plaque which is the same plaque that has been found inside the walls of blocked arteries.

Is this ?

Caused by this?

Infection from Uncontrolled Diabetes

Prevalence of Periodontal Disease

50% of ALL adults develop periodontal disease. 70% of the people who have diabetes will

develop periodontal disease. 10% of adults have lost ALL their teeth, 25% of

adults over 65 have lost their teeth. One-third of people who have diabetes will have

SEVERE periodontal disease.

Symptoms of Periodontal Disease

Red, sore, swollen gums Teeth that s e p a r a t e Persistent BAD breath Loose or sensitive teeth Yellow/white biofilm between teeth Pus around the gums Ill fitting dentures Gums pulling away from the teeth

Mouth with Normal Bone

The Importance of Vitamin D

Low serum levels of Vitamin D may result in insulin resistance

Insufficient Vitamin D leads to osteopenia and/or osteoporosis

A lack of Vitamin D can lead to Periodontal Disease and tooth loss

Diabetes patients should have a blood test to check Vitamin D levels

Oral Osteoporosis

Ravages of Dry Mouth

Treating Dry Mouth

Chewing gum Water Toothpaste Mouthrinse Oral lubricants

Prevalence of Periodontal Disease

Young adults who have an A1c above 9 are 3x more likely to develop periodontal disease than someone without diabetes

Smokers who have poorly controlled diabetes are 4.6x more likely to develop periodontal disease

Periodontitis

Chronic inflammation of the periodontal ligament, which surrounds the root of the tooth, may lead to anemia in people with diabetes. Non-surgical periodontal treatment can help improve the anemia.

Periodontal Disease Prevention

Thoroughly clean the mouth 2/day w/brush and floss

Visit the dentist at least 2/yr or as often as recommended by your dentist

People with diabetes should take their glucose meter with them to the DDS

Eat a healthy diet with fruits and vegetables

Quit smoking

Control stress

Dental Appointments

“Patients with diabetes should see their dentist every 3 months because their bodies cannot manage the challenge of the bacterial onslaught of periodontal disease as well as someone who is healthy. With the economy being so bad, everybody’s worried about if they can postpone that dental appointment or that dental hygiene appointment, or if they have the resources to get the kind of care they need.” Maria Emanuel Ryan, DDS, PhD.

Treating Gum Disease Lowers Medical Costs A report from the University of Michigan

suggests that patients who have diabetes and who receive one or two periodontal procedures per year experience a 10 – 12% drop in their medical costs annually.

Patients who don’t receive routine dental care and require immediate treatment for periodontitis, cost insurance companies more than $2,484/year.

University of Michigan School of Dentistry Dec. 2008

Easy Solution to Dental Problems

REMEMBER……..

90% of Dental Care is Self-Care

What is the single most important thing a person with diabetes can do to PREVENT periodontal disease and other oral problems?

ANSWER

Maintain blood sugar as near normal as possible

What is NORMAL? For children under age 6 (100 - 180) For children 6 – 12 (90 - 180) For teens 13-19 (90 - 130) For adults (70 - 130) For senior adults slightly higher

No ONE Answer

Good oral health is a combination of many things Good oral hygiene Regular dental visits Good diet Good overall health Most of all GOOD Blood Sugar Control

A1c <7.0

A RARE Opportunity

Diabetes educators need to become RARE health care professionals, Recognize periodontal disease as a chronic

inflammatory disease with systemic ramifications

Assume your patient with diabetes is at risk for periodontal disease

Refer for periodontal screening Educate your patients on the importance of

oral health and regular dental visits to improve patients’ health and well-being

Something to Think About

“There is a heavy burden on health-care professionals today regarding the recognition, treatment, and proactive management of a disease that has reached epidemic proportions worldwide.” As medical and dental professionals, let’s work together to help control this epidemic; our patients are depending on us!

RDH Magazine for Dental Hygiene Professionals, November, 2011