Smile! Dentists and Doctors Can Both Help With Diabetes

A framework for physician-dentist collaboration in diabetes and periodontitis, by Elangovan and colleagues. Clinical Diabetes 2014;32:188–192

What is the problem and what is known about it so far?

People with diabetes have a higher risk for dental problems such as gum disease. Poor blood glucose (sugar) control makes such problems even more likely. When you have gum disease, germs can hurt your gums and the bone around your teeth. Plaque—a sticky film of food, saliva, and germs—forms and makes gums tender and likely to bleed (a condition called gingivitis). If plaque is not removed by good brushing, it hardens into tartar, which can only be removed at the dentist’s office. Without dental care, a more severe form of gum disease called periodontitis can develop. Gums pull away from the teeth, and pockets form between the teeth and gums. Surgery is sometimes needed to save the teeth. If nothing is done, the teeth may fall out or need to be pulled.
Most people with diabetes get their health care in a primary care setting. Primary care doctors are trained to be the first line of contact for patients who have a wide range of symptoms or health concerns. However, in the United States, there are not enough primary care doctors. Other health care workers such as nurses, pharmacists, and physicians’ assistants are needed to help provide primary care. Some people think dentists could also help to fill this gap.

Why did the authors write this article?

The authors wanted to explain the link between diabetes and dental problems and to suggest ways that doctors and dentists can work together to help patients with diabetes.

What were the main points of the article?

  • It is equally important for dentists to learn about health conditions such as diabetes and for doctors to learn about common dental problems. Patients with diabetes also need to know how important it is to take care of their teeth.
  • Dental and mouth concerns linked to diabetes include gum disease (gingivitis or periodontitis), cavities, burning or dryness of the mouth, saliva problems, nerve problems, sores or rashes, thrush (an oral yeast infection), and various other infections.
  • It’s a two-way street: people with diabetes are more likely to get gum disease, and having gum disease makes it harder to control diabetes.
  • Because people often have dental check-ups more frequently than they see their doctor, dentists are in a good position to find patients who have or are at risk for diabetes. In one study of more than 500 patients, dentists were able to spot 97 percent of those with diabetes by doing a regular dental exam and giving patients an in-office A1C test (a blood test that shows blood glucose control in the past 2–3 months).
  • Routine dental visits could also be a good time to check blood glucose levels for patients with diabetes. And because dentists already help patients adopt good lifestyle habits such as eating healthy foods, stopping smoking, and taking better care of their teeth, they could also help patients make other changes to improve their overall health and manage their diabetes.
  • Orthodontists, who care for young patients who need braces, could also help because type 2 diabetes is on the rise in adolescents.
  • Training is important for dentists to be able to help doctors care for problems such as diabetes. More dental schools are adding such training to their education programs. Doctors can also be trained to check their patients’ mouth and teeth and to ask patients about their dental health.
  • People with diabetes have special dental needs. It is important to let your dentist know if you have diabetes and if your diabetes care plan or medicines change.

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