Feature ArticleOral Health: An Untapped Resource in Managing Glycemic Control in Diabetes and Promoting Overall Health
Introduction
Periodontal diseases (gum diseases) are a greatly underemphasized complication of poorly controlled diabetes mellitus that all health care providers need to be aware of and address when assessing and counseling their patients. Prevention, early diagnosis, and intervention can reduce the impact of this “sixth complication of diabetes”1 and greatly improve diabetes management.2, 3 The American Diabetes Association recommends providers ask about “dental disease” as part of a patient’s medical history as well as refer for comprehensive periodontal examination.4 Nonetheless, oral health is not routinely addressed in patients with diabetes. Traditionally, nursing and medical providers have perceived oral health issues like periodontitis as outside of their realm and, at best, advise patients to see a dentist without further explanation or attention.5 Unfortunately, patients often do not follow through for multiple reasons, including lack of access to dental care or understanding its significance.2, 3 Reports by the Institute of Medicine,2, 3 as well as nursing, medical, and dental organizations, call for integration of oral and primary care to prevent disease and improve health, particularly for the chronically ill.5, 6, 7, 8
The purpose of this study is to provide nurse practitioners and other primary care providers with information needed to efficiently and effectively address oral health issues during routine care of diabetes patients. Diabetes, the oral-systemic relationship, and the development of periodontal problems and their treatment are reviewed. We describe some brief additions to the medical history that can clue the provider to risks for periodontitis, common conditions in the mouth seen in patients with diabetes, and related common physical exam findings. Finally, we present recommendations to facilitate referral to dental health professionals as well as resources for patients and providers.
Section snippets
Diabetes
The prevalence of diabetes is increasing worldwide. By 2030, diabetes is projected to be the seventh leading cause of death globally.9, 10 In the United States, 9.3% (29.1 million) of the population are affected by diabetes and almost 30% of them (8.1 million) are unaware of their diabetes (undiagnosed).11 Of people with diabetes, 90%-95% have type 2 diabetes (T2DM) and approximately 5% have type 1 diabetes. African Americans, Latinos, and Native Americans are at higher risk for T2DM and its
Periodontal Disease, Its Prevalence, and Links to General Health
Periodontal disease refers to diseases in the soft and hard tissues surrounding the teeth and is the sixth most prevalent chronic condition worldwide.17 Up to 90% of any population have gingivitis, which is a reversible inflammation in the gums.18 Untreated, gingivitis can lead to periodontitis and permanent damage to the bone and supporting tissues around the tooth.19 Periodontitis is found in almost 50% of the US population age ≥ 30 and in two thirds of those with lower socioeconomic status,
Early Identification of Oral Health Issues: The Patient Visit
Providers’ early identification of those at risk for diabetes and introduction of health promotion strategies, as well as self-management for diabetes patients, is well accepted. However, it is critical to include oral health assessment as an integral component of overall patient assessment.12, 19 Primary care providers have identified insecurity in their oral history and exam skills as barriers to doing a more thorough oral exam.5, 6 The following describes specific additions to the history
Clinician Recommendations, Patient Education, and Dental Referral
It is critically important for providers to educate diabetes patients about the oral implications of diabetes and need for proper preventive care as well as regular assessment and follow-up oral health. Likewise, collaboration between primary care and dental providers can help identify those at risk early on and promote better disease detection and management.
Conclusion
Greater recognition of oral health issues and collaboration between dental and medical health care providers involved in the management of the diabetic patient can greatly impact the diabetes public health crisis and improve long-term outcomes. Awareness of the “2-way street” between oral and systemic health is important to promote health and prevent complications of these diseases. Early identification of those at risk and introduction of health promotion strategies that address oral health
Cynthia S. Darling-Fisher, PhD, FNP-BC, is a clinical assistant professor in the School of Nursing at the University of Michigan in Ann Arbor. She can be reached at [email protected].
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Cited by (0)
Cynthia S. Darling-Fisher, PhD, FNP-BC, is a clinical assistant professor in the School of Nursing at the University of Michigan in Ann Arbor. She can be reached at [email protected].
Preetha P. Kanjirath, BDS, MS, is associate dean of preclinical education at the College of Dental Medicine-Illinois of Midwestern University in Downers Grove, IL.
Mathilde C. Peters, DMD, PhD, is a professor emerita in the Department of Cariology, Restorative Sciences & Endodontics of the School of Dentistry at the University of Michigan.
Wenche S. Borgnakke, DDS, PhD, is an adjunct assistant clinical professor in the Department of Periodontics and Oral Medicine of the School of Dentistry at the University of Michigan.
In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.
AANP members may receive 0.69 CE hours from AANP by completing the online posttest and evaluation at cecenter.aanp.org/program?area=JNP.