Diabetes in dental patients

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  Posted by: The Probe      28th July 2021

Diabetes is a common health condition, estimated by Public Health England to affect 8.5% of the population. The vast majority of cases are Type 2 (around 90%) and occur after the age of 40, though there has been an observed increase in cases among younger people in recent decades.[1],[2] Diabetes is primarily characterised by hyperglycaemia (high blood sugar), it is a systemic condition that promotes inflammation within a patient and is associated with a wide array of complications.

Obesity is the most publicised risk factor for the disease, though not all people with diabetes are overweight or obese. We do not have a complete understanding of how diabetes develops, but insulin resistance is a known mechanism in blood sugar dysregulation and microvascular complications. Obesity is linked to developing insulin resistance, and is also associated with dyslipidaemia and hypertension, which are comorbid with Type 2 diabetes mellitus (T2DM) and provoke further complications.[3] Genetics also appear to play a substantial role with a family history of diabetes being a major risk factor, while people of black/African/Caribbean and South-Asian ancestry are at significantly greater risk of developing T2DM than other ethnic groups.2,[4]

Though diabetes is associated with aging, increasing numbers of younger people are developing the disease. As a dental care provider, you may be the first to spot some characteristic signs of the condition, and are therefore in a position to aid early detection. Uncontrolled diabetes is a progressive condition, with symptoms and complications developing and intensifying over time. The earlier detection occurs, the sooner the patient can receive treatment and make lifestyle modifications that can greatly arrest or even reverse the progression of the disease.

That said, T2DM can be difficult to detect initially, with few, if any, symptoms manifesting in the early years of the condition. Symptoms patients should be alert to are: increased thirst, a slowing in how quickly they heal, polyuria (abnormally high volume of urine), fatigue, recurrent thrush and blurred vision. The onset of diabetes can also result in significant short-term weight loss.[5] None of these symptoms are exclusive to diabetes, but do warrant a patient consulting their GP for testing.

T2DM causes immune system dysfunction, which can cause chronic inflammation, impair wound healing and increase the likelihood of developing further autoimmune diseases. In terms of oral health, patients with the condition are more susceptible to caries, periodontal disease, xerostomia (dry mouth), and oral cancer. People with diabetes are also more prone to fungal infections – such as oral thrush – which can result in oral mucosal lesions. The risk of complications is greatly increased where T2DM is poorly controlled.3 Depression is roughly twice as common in patients with T2DM, while psychological stress and sleep disruption are known to affect blood sugar stability; all three factors contribute to diabetes development and make it more difficult to keep under control.[6],[7],[8] Where depression is comorbid this could contribute to oral health concerns due to increased difficulty in maintaining oral hygiene, depression-influenced dietary choices, and immune system suppression.[9]

Numerous studies have reported that dairy consumption is inversely associated with T2DM. In other words, consuming more dairy lowers the risk of diabetes. There is still debate over whether high-fat milk is beneficial or not, but the evidence for milk generally and yogurt is promising.[10] Milk is also a rich source of calcium and appears to be anti-cariogenic, and therefore may be a favourable addition or substitution in a patient’s diet.[11] That said, many patients cannot consume dairy products for numerous dietary, ethical and religious reasons, which must be respected. Care and restraint over sugar consumption, as well as exercise, is good advice for any patient, whether they have diabetes or not.

Diabetes is a manageable condition and patients respond well to clear, practical advice. Diabetic patients are at increased risk of periodontal disease and caries, so maintaining excellent oral hygiene particularly important. The Waterpik® Water Flosser is a great recommendation that supplements toothbrushing and is easy to use, which can be particularly helpful for patients with low energy. It is clinically proven to be more effective at reducing plaque and improving gingival health than both string floss and interdental brushes,[12], [13] and it has the prestigious accreditation of the Oral Health Foundation.

While diabetes can have serious ramifications for a patient’s morbidity and mortality, it is especially important to remember that it is a controllable disease. Blood sugar can be brought under control, and complications can generally be treated. Healthcare providers must be careful not to foster feelings of helplessness or blame among diabetic patients, as this can easily lead to damaged patient-practitioner relationships and non-adherence to advice and treatments. Raising awareness and education around this common condition is important, and the focus should be on raising early detection and practical steps patients can take to better manage their condition.

 

For more information on Waterpik® products please visit www.waterpik.co.uk. Waterpik® products are available from Amazon, Asda, Costco UK, Argos, Boots, Superdrug online and in stores across the UK and Ireland.

 

 

[1] PHE. Diabetes overview. Public Health England. 2021. https://fingertips.phe.org.uk/profile/diabetes-ft/data April 8, 2021.

[2] Candler T., Mahmoud O., Lynn R., Majbar A., Barrett T., Shield P. Continuing rise of type 2 diabetes incidence in children and young people in the UK. Diabetic Medicine. 2018; 35(6): 737-744. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5969249/ April 8, 2021.

[3] Verhulst M., Loos B., Gerdes V., Teeuw W. Evaluating all potential oral complications of diabetes mellitus. Frontiers in Endocrinology. 2019; . https://doi.org/10.3389/fendo.2019.00056 April 9, 2021.

[4] Lascar N., Brown J., Pattison H., Barnett A., Bailey C., Bellary S. Type 2 diabetes in adolescents and young adults. The Lancet – Diabetes & Endocrinology. 2018; 6(1): 69-80. https://doi.org/10.1016/S2213-8587(17)30186-9 April 8, 2021.

[5] NHS. Diabetes. NHS. 2021. https://www.nhs.uk/conditions/diabetes/ April 9, 2021.

[6] Darwish L., Beroncal E., Sison M., Swardfager W. Depression in people with type 2 diabetes: current perspectives. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2018; 11: 333-343. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6044353/ April 9, 2021.

[7] Zamani-Alavijeh F., Araban M., Koohestani H., Karimy M. The effectiveness of stress management training on blood glucose control in patients with type 2 diabetes. Diabetology & Metabolic Syndrome. 2018; 10: 39. https://doi.org/10.1186/s13098-018-0342-5 April 9, 2021.

[8] Khandelwal D., Dutta D., Chittawar S., Kalra S. Sleep disorders in type 2 diabetes. Indian Journal of Endocrinology and Metabolism. 2017; 21(5): 758-761. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628550/ April 9, 2021.

[9] Warren K., Postolache T., Groer M., Pinjari O., Kelly D., Reynolds M. Role of chronic stress and depression in periodontal diseases. Periodontology 2000. 2014; 64(1): 127-138. https://doi.org/10.1111/prd.12036 April 9, 2021.

[10] Alvarez-Bueno C., Cavero-Redondo I., Martinez-Vizcaino V., Sotos-Prieto M., Ruiz J., Gil A. Effects of milk and dairy consumption on type 2 diabetes: overview of systematic reviews and meta-analyses. Advances in Nutrition. 2019; 10(suppl. 2): 154-163. https://doi.org/10.1093/advances/nmy107 April 8, 2021.

[11] Woodward M., Rugg-Gunn A. Chapter 8: milk, yoghurts and dental caries. In Zohoori F., Duckworth R. (eds): Monographs in Oral Science: the impact of nutrition and diet on oral health. Basel, Karger. 2020; 28: 77-90. https://doi.org/10.1159/000455374 April 8, 2021.

[12] Barnes, C. M., Russell, C. M., Reinhardt, R. A., Payne, J. B. and Lyle, D. M. Comparison of irritation to floss as an adjunct to toothbrushing: effective on bleeding, gingivitis and supragingival plaque. J Clin Dent. 2005; 16(3): 71-77. https://pubmed.ncbi.nlm.nih.gov/16305005/ April 8, 2021.

[13] Goyal, C. R., Lyle, D. M., Qaqish, J. G. and Schuller, R. Comparison of water flosser and interdental brush on reduction of gingival bleeding and plaque: a randomized controlled pilot study. J Clin Dent. 2016; 27: 23-26. https://pubmed.ncbi.nlm.nih.gov/28390208/ April 8, 2021.

 


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