Page 28 - GP Fall 2022_Neat

The Oral Healthcare Providers’ Responsibility in

Treating the Patient with Diabetes

Authors: Debra M. Ferraiolo, DMD, FAGD and Analia Veitz-Keenan, DDS

Introduction Type 2 Blood sugar levels using a glucometer can
Diabetes has reached epidemic proportions also be used by the patient to monitor con-
in the United States. In 2020, 37.3 million • 90 - 95% of all diagnosed diabetics trol on a day-to-day basis. A dentist can
people were afflicted. Of these, 8.5 million • Occurs due to insulin resistance or maintain a glucometer in the office to check
were undiagnosed and discovered on rou- relative insulin deficiency levels on the day of a surgical procedure, for
tine exams or when symptoms developed. • Usually diagnosed in adults but an hypo/hyperglycemic events or screening if
In the US, 38% of the population have been increased number of children, teens you have concerns your patient may be an
diagnosed with prediabetes. Additionally, and young adults are being diag- undiagnosed diabetic.
1.4 million Americans receive a diabetes di- nosed
agnosis every year and it is the 7 leading • Managed with lifestyle
th
cause of death in the United States. 1 changes and/or medi-
cations that stimulate
Why is it important for the oral healthcare insulin release or insu-
provider to be familiar with diabetes and lin sensitizers (may in-
its management in the dental setting? Oral clude insulin)
healthcare providers will encounter patients
with diabetes frequently in their practice. Gestational
Therefore, it is important to have an under- • Occurs in the second
standing of the disease itself, as well as the
signs and symptoms in the undiagnosed pa- half of pregnancy in
women who have never
tient, including the oral manifestations of di-
had diabetes
abetes. Dentists should also be well versed in • Caused by placental
assessing the patient’s glycemic control and hormones causing insu-
how to manage the poorly controlled patient
and, if and when modifications are needed, lin resistance and rela-
tive insulin deficiency
and what those modifications should be. Di-
abetes impacts oral health and vice versa. 2. • Child is at increased
risk of obesity and dia-
Background 3 betes later in life
Diabetes is a chronic metabolic disease • Resolves after baby is
born, but increases the
that leads to hyperglycemia as a result of Figure 1. American Diabetes Association - Diabetes control. 4
the body’s inability to produce or process mother’s risk of diabe-
tes later in life
insulin properly. Insulin, produced by pan-
creatic beta cells, is used for processing Oral Manifestations
carbohydrates, proteins and lipids as well as Other types Oral manifestations of uncontrolled/undi-
glucose storage in the liver. Hyperglycemia • Drug/chemical induced (steroids) agnosed diabetes can include xerostomia,
develops when the beta cells lack the abili- • Exocrine pancreatic disease burning sensation, impaired wound healing,
ty to produce insulin or if the cells become • Infections increased risk of post-op and candida infec-
insensitive to insulin. Key symptoms in the tions, and enlargement of the parotid gland.
non-diagnosed or poorly controlled diabetic The term prediabetes is used when glucose Much has been reported in regard to the con-
are thirst, hunger and/or frequent urination. levels are elevated but not to the point of nection between diabetes and gingivitis and/
Hyperglycemia can cause dysfunction of diabetes. This patient is at high risk of de- or periodontitis. Diabetes results in an en-
the immune system and, as a result, undi- veloping diabetes, as well as heart disease hanced inflammatory response and narrow-
agnosed or poorly controlled diabetics are and stroke. Patients with this diagnosis will ing of the microvasculature, which puts the
at increased risk of infection. Long-term ef- be recommended for lifestyle changes and/ patient at higher risk for periodontitis. As a
fects of poorly controlled diabetes include or prescribed Metformin with the goal of result, it should be no surprise that a patient
cardiovascular events, retinopathy, chronic delaying the progression or preventing the with uncontrolled diabetes would present
kidney disease (CKD), amputation of ex- diagnosis of diabetes. with a greater manifestation of periodon-
tremities, and diabetic neuropathy. tal disease. Also, the hyperglycemic state
How is Glycemic Control Assessed? impacts chemotaxis of WBCs and causes
Diabetes Classification The hemoglobin A1C blood test measures increased risk of infections, which is listed
as a comorbidity along with other health is-
Type 1 the amount of glycosylated hemoglobin in sues that develop over time or progress more
the patient’s RBCs. Since it assesses the av-
5
• 5 – 10 % of all diabetics erage blood sugar levels over the past three rapidly in patients with diabetes. There has
been mention of a bidirectional association
• Believed to be autoimmune months, it is considered the “gold standard” between periodontal disease. Some diabetic
in assessing glycemic control. A result > 6.5
• No insulin production due to loss of patients with a good response to non-surgi-
pancreatic tissue indicates diabetes. Patients with diabetes are cal periodontal treatment also had an A1C
considered well controlled with an A1C <7.
• Usually diagnosed in children, teens Those patients with an A1C >9 are consid- indicating better diabetic control. This has
6,7
and young adults led to some discussion that in patients with
• Managed with insulin ered poorly controlled and will require den- diabetes, treatment of periodontal disease
tal modifications, depending on the treat-
• No prevention may slightly improve glycemic control.
• Genetic predisposition ment being performed.
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