Page 24 - NYSAGD GP Fall 2018

How Dental Practitioners Can Help Prevent Diabetic Complications

By Michelle Routhenstein, MS, RD, CDE, CDN

Scientific research has predicted that the most prevalent complication of DM, peri- a downward trend of salivary flow rates
prevalence of type 1 and type 2 diabetes odontal disease. as HgA1c, a 3 month average blood sugar
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mellitus (collectively “diabetes”, or “DM”) level that gauges management of DM and
will increase by 54% to more than 54.9 mil- DM is a risk factor for developing tooth glycemic control, increased. The oral mu-
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lion Americans between 2015 and 2030. decay, gum disease, and other oral health cosa is normally protected by saliva which
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Dentists and dental practitioners have the problems. The risk of developing periodon- provides lubrication, cleansing, pH buffer-
ability to positively impact peoples’ lives by titis in patients with DM has been reported ing, antimicrobial proteins, and clearance of
identifying DM early on and referring them to be 3x higher than the general population. bacteria. Lack of adequate saliva leads to an
to the proper healthcare professional for fur- Periodontitis is more frequent and severe in increased risk of oral yeast and periodontal
ther guidance to control blood sugar levels patients with DM who have poor glycemic infections, increased rate of dental caries,
and prevent diabetic complications. control. Chronic periodontal disease results and difficulty with maintaining oral hy-
in progressive destruction of the supporting giene, as well as a decrease in quality of life
In 2015, an estimated 30.3 million people in tissues of the teeth as well as pocket forma- due to discomfort when eating, swallowing,
the United States aged 18 and older had DM, tion, recession, or both, which may lead to and talking.
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of which 1.5 million were newly diagnosed tooth loss from extensive destruction of alve-
cases. Of the 30.3 million American adults olar bone. Furthermore, severe periodontal Early identification and management of the
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living with DM, nearly one in four (about disease may be a strong predictor of various aforementioned oral manifestations may
7.2 million) did not know they had DM and diabetic complications, including nephropa- help in the early diagnosis of DM and in at-
only 11.6% of adults with prediabetes knew thy, stroke, transient ischemic attack, angi- taining better glycemic control to help miti-
they were prediabetic. It is predicted that na, myocardial infarction, and heart failure. gate oral manifestations and avoid the other
by the year 2030, annual deaths attributed People with DM have an increased risk of complications associated with DM. Dentists
to DM will climb by 38% to approximately severe periodontitis because diabetes affects can identify DM in their patients based on
385,800, and annual medical and societal the periodontal flora, decreases the immune a thorough examination of their periodon-
costs related to DM will increase by 53% to response due to neutrophil impairment and tal tissues, gums, oral site, and mucosa of
more than $622 billion. phagocytosis defect, and decreases produc- the tongue. Fissured tongue can be present
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tion of bone matrix osteoblasts due to a col- due to low salivary function. Candida and
DM occurs when blood sugar levels rise lagen defect and impaired wound healing. candida lesions can appear due to increased
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above normal levels and is highly influ- Controlling high blood sugar within a tight salivary glucose promoting Candida over-
enced by carbohydrate intake and lifestyle normal range with proper diet and medica- growth as well as decreased antifungal im-
factors. There are several types of DM, such tions (as necessary) can help to control in- munoglobulins in diabetic patients’ saliva.
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as: a) type 1 diabetes, where destruction of flammation, bacterial flora, boost immunity, Benign migratory glossitis has been shown
pancreatic function causes one’s body to not and help repair wounds quicker. to appear 4x more frequently in diabetes
produce insulin, the hormone required for and the more uncontrolled it is (with other
glucose uptake, b) type 2 diabetes, where A recent study in the Journal of Dental complications present such as retinopathy
one’s body does not utilize insulin proper- Research showed that a simple screening and neuropathy)than non-diabetics. Burn-
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ly primarily due to insulin resistance and approach, which includes periodontal find- ing mouth sensations can be present due to a
is heavily influenced by weight, behavior, ings, has an unrealized capacity to identify neuropathic basis and is frequently accom-
and lifestyle factors, c) gestational diabe- patients at risk for, or who are impacted by, panied by changes in taste (dysgeusia) or
tes, where uncontrolled blood sugar levels diabetes, and increases treatment effective- other sensory distortions. Dental caries’
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during pregnancy impact the mother and the ness by directing them to receive appropri- risk is increased due to decreased salivary
baby, d) prediabetes, where slightly elevated ate care. Researchers, Lalla et al, found that secretion, increase of carbohydrates in the
blood sugar levels due to insulin resistance the presence of >26% deep pockets or >4 parotid gland saliva, growth of oral yeasts,
and lifestyle factors, puts individuals at risk missing teeth correctly identified 73% true and increased counts of Mutans streptococci
for progressing to type 2 diabetes. Blood unrecognized prediabetes or diabetes cases. and lactobacilli. 5
sugar levels can be optimized and managed Adding the point of care A1c test, resulted
for lifelong implementation via diet, medi- in correct identification of 92% of these pa- The role of the dental practitioner is vital in
cation, and lifestyle. tients. helping to prevent complications of this sys-
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temic disease. The dentist should begin by
If DM is uncontrolled and high blood sug- Diabetic patients can also have chronic sal- collecting patient and family medical histo-
ar levels (hyperglycemia) remain above ivary hypofunction (xerostomia), and gen- ry, identifying oral manifestations that may
normal levels for extended periods of time, eralized immune dysfunction that can lead identify poor diabetic control or elude to
DM lingers in unwanted places and causes to the development of disorders of the oral first time diagnosis. If available, the dentist
weakening of the microvascular and mac- mucosa, including atrophy of the mucosa, should test for DM diagnosis/control in the
rovascular systems. Commonly known candidiasis, lichen planus, oral fungal infec- dental office. A referral to an endocrinolo-
DM complications include retinopathy, tions, and lichenoid mucositis. Studies have gist should be made if a first time diagnosis
nephropathy, neuropathy, increased risk of shown that patients with poorly controlled is suspected. If a person has diabetes which
stroke, cerebrovascular disease including type 2 diabetes have a lower stimulated appears uncontrolled, he/she should be re-
transient ischemic attack, cognitive im- parotid gland flow rate and have bilateral ferred to a Registered Dietitian who is also
pairment; peripheral vascular disease, and enlargement of the parotid salivary glands a Certified Diabetes Educator.
coronary heart disease. Oftentimes not dis- compared to well-controlled DM patients
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cussed, but equally important, is the sixth and patients without DM. Studies show
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