Here is a fact: oral health and blood sugars are inter-related and regular dental care for people living with diabetes is critical.

A close look at the 2015 ADA Standards of Care, reveal that referral to a “Dentist for comprehensive periodontal examination” is situated right under referral to a “RD for MNT,” and referral for “DSME/DSMS” within the “Components of the comprehensive diabetes evaluation,” on page s18.

As diabetes educators, we have an opportunity to learn more about the dynamic relationship between these two conditions and encourage patients to be active participants in their oral health.

Here are the questions we posed to our expert contributor, Jerry Brown, DMD, CDCES.  His responses appear below.

1)  What is the relationship between hyperglycemia and oral health?

Wow! That is normally a 60 – 90 minute presentation! Diabetes and periodontal disease have what we call a “bi-directional” relationship.

Simply put, in one direction, diabetes contributes to an inflammatory environment within the oral cavity and an exaggerated, destructive host response. In the other direction, the infectious process of periodontal disease, coupled with pervasive inflammation, can make glycemic control more difficult.

2) As diabetes educators, what questions can we ask the patient to find out about their oral health status? What should we include in our visual assessment?

The patient health history, or interview should include the following questions:

• When was the last time you visited the dental office for a cleaning?
• Do your gums generally bleed when you brush?
• Have you ever been told that you have “gingivitis”, or “gum disease?”
• Have you noticed any areas on your gums that get red, or swell?
• Do you notice, or have others noticed, that your breath has a consistently foul odor?
• Have you noticed any looseness or shifting of your teeth?
• Have you had dental extractions in the past?
• Have your parents or your siblings lost teeth because of gum disease?

    As part of a visual assessment, look for:

• Missing teeth, teeth with obvious tooth decay (disruption of the enamel surface with staining), dry mouth, raspberry-red tongue surface with yellowish-white patches, generalized exposed root surfaces of teeth, and mobile teeth. These findings indicate need for prompt dental referral.

3) What steps can patients take to maintain oral health?

Promote Preventive Oral Care/Maintenance includes:

• Professional Dental Hygiene visits with periodontal probing every 3 – 6 months.
• Brushing with soft toothbrush at least twice per day using a triclosan/copolymer-containing toothpaste (Colgate Total).
• Flossing- at least once daily.
• Antimicrobials, when necessary via sub gingival or systemic delivery.

4) If a patient has gum disease and diabetes, what steps can we take?

 As with any disease, the goal is to treat gum disease early, when gingivitis is first discovered.  More often than not gingivitis is reversible, with a dental cleaning, good oral hygiene instruction, and thorough homecare.

Periodontitis results when continued inflammation leads to detachment of the epithelial junction beneath the gum (pocketing) resulting in resorption of the alveolar bone supporting the teeth.

5). For patients who have no dental insurance, what are resources we can provide?

Unfortunately, for patients without dental insurance, resources are limited. Medicaid dental providers are rare and Medicaid coverage for necessary treatment is limited. State and local dental societies, as well as private dental providers, will generously offer free dental treatment for indigent patients in need of dental treatment. The Florida Dental Association for example, has an “Access To Care Resource Guide” on their website floridadental.org

6.  What is YOUR one take home message regarding diabetes and oral health that we can pass on to our patients and community?
Be diligent about your daily oral healthcare regimen and don’t underestimate the importance of visiting your dental healthcare professional, at minimum, every 6 months. A significant number of people with diabetes have moderately inflamed (or worse) gum tissue and will require visits every 3 months.
In addition, elevated blood sugars cause dry mouth and increase the amount of sugar in the saliva. Both of which can contribute to worsening gum disease, tooth decay and thrush.

The bi-directional relationship of periodontal disease and diabetes make regular and effective dental care absolutely essential.

Bottom line:  Glycemic control improves oral health and good oral health improves glycemic control.

7.   Any website resources you recommend?

• The American Dental Association has a patient information website: mouthhealthy.org
• The American Academy of Periodontology has a patient information page: perio.org
• State and local dental societies have patient information websites; i.e., The Florida Dental Association (floridadental.org).
• Diagnosing Diabetes at the Dentist – Medscape Article

Special thanks to our guest contributor, Jerry A. Brown DMD, CDCES who is the first, and currently, the only dentist who is a CDCES! Dr. Brown lives in Florida and spent nearly three years volunteering at the University of South Florida’s Diabetes Center. He is a member of the American Diabetes Association’s Advocacy Committee and Community Leadership Board. He’s lived with diabetes for 45 years.