2. Oral Manifestations of Diabetes Betsy Hardin, RDH, MS NC Oral Health Section February 3, 2012

3. Teeth Aren’t Important….. Are they???? No one ever dies from bad teeth…

4. A sad story…..  Early 2007, 12 year old Maryland resident, Deamontes Driver died from a tooth infection  The infection went to his brain  Two brain surgeries were unsuccessful  An extraction would have cost only $80

5. The 6 Complications of Diabetes Retinopathy Nephropathy Neuropathy Cardiovascular Disease Stroke Periodontal Disease

6. Importance of Teeth  Chewing  Talking  Smiling  Shape the face  Aid Digestion

7. Periodontal Disease Chronic inflammation of the bone and tissue that surround the teeth.

8. Could Dentists Aid in Diagnosing Diabetes? screen for risk factors – i.e. overweight; high risk ethnic group, high cholesterol, high BP, family member with diabetes, given birth to a 9 lb. baby or having had gestational diabetes Use blood from infected gum area for a glucometer test strip Number of missing teeth and percentage of deep pockets in the gums

9. Periodontal Risk Factors  Poor oral hygiene  Inflammation  Long history of diabetes  Other diabetic complications  Poorly controlled diabetes  Parents  Pregnancy  Obesity  Ethnicity  Stress  Age

10. The Importance of Good BS Control Prevent oral fungal infections Prevent ongoing inflammation in the mouth Prevent further destruction of bone Prevent congenital dental defects in infants

11. The Kiss of Disease

12. Poor Oral Hygiene Leads to the formation of plaque which is the same plaque that has been found inside the walls of blocked arteries.

13. Is this ? Caused by this?

14. Infection from Uncontrolled Diabetes

15. Prevalence of Periodontal Disease 50% of ALL adults develop periodontal disease. 70% of the people who have diabetes will develop periodontal disease. 10% of adults have lost ALL their teeth, 25% of adults over 65 have lost their teeth. One-third of people who have diabetes will have SEVERE periodontal disease.

16. Symptoms of Periodontal Disease Red, sore, swollen gums Teeth that s e p a r a t e Persistent BAD breath Loose or sensitive teeth Yellow/white biofilm between teeth Pus around the gums Ill fitting dentures Gums pulling away from the teeth

17. Mouth with Normal Bone

18. The Importance of Vitamin D Low serum levels of Vitamin D may result in insulin resistance Insufficient Vitamin D leads to osteopenia and/or osteoporosis A lack of Vitamin D can lead to Periodontal Disease and tooth loss Diabetes patients should have a blood test to check Vitamin D levels

19. Oral Osteoporosis

20. Ravages of Dry Mouth

21. Treating Dry Mouth Chewing gum Water Toothpaste Mouthrinse Oral lubricants

22. Prevalence of Periodontal Disease Young adults who have an A1c above 9 are 3x more likely to develop periodontal disease than someone without diabetes Smokers who have poorly controlled diabetes are 4.6x more likely to develop periodontal disease

23. Periodontitis Chronic inflammation of the periodontal ligament, which surrounds the root of the tooth, may lead to anemia in people with diabetes. Non-surgical periodontal treatment can help improve the anemia.

24. Periodontal Disease Prevention Thoroughly clean the mouth 2/day w/brush and floss Visit the dentist at least 2/yr or as often as recommended by your dentist People with diabetes should take their glucose meter with them to the DDS Eat a healthy diet with fruits and vegetables Quit smoking Control stress

25. Dental Appointments “Patients with diabetes should see their dentist every 3 months because their bodies cannot manage the challenge of the bacterial onslaught of periodontal disease as well as someone who is healthy. With the economy being so bad, everybody’s worried about if they can postpone that dental appointment or that dental hygiene appointment, or if they have the resources to get the kind of care they need.” Maria Emanuel Ryan, DDS, PhD.

26. Treating Gum Disease Lowers Medical Costs A report from the University of Michigan suggests that patients who have diabetes and who receive one or two periodontal procedures per year experience a 10 – 12% drop in their medical costs annually. Patients who don’t receive routine dental care and require immediate treatment for periodontitis, cost insurance companies more than $2,484/year. University of Michigan School of Dentistry Dec. 2008

27. Easy Solution to Dental Problems

28. REMEMBER…….. 90% of Dental Care is Self-Care What is the single most important thing a person with diabetes can do to PREVENT periodontal disease and other oral problems?

29. ANSWER Maintain blood sugar as near normal as possible What is NORMAL? For children under age 6 (100 - 180) For children 6 – 12 (90 - 180) For teens 13-19(90 - 130) For adults(70 - 130) For senior adults slightly higher

30. No ONE Answer Good oral health is a combination of many things Good oral hygiene Regular dental visits Good diet Good overall health Most of all GOOD Blood Sugar Control A1c <7.0

31. A RARE Opportunity Diabetes educators need to become RARE health care professionals, Recognize periodontal disease as a chronic inflammatory disease with systemic ramifications Assume your patient with diabetes is at risk for periodontal disease Refer for periodontal screening Educate your patients on the importance of oral health and regular dental visits to improve patients’ health and well-being

32. Something to Think About “There is a heavy burden on health-care professionals today regarding the recognition, treatment, and proactive management of a disease that has reached epidemic proportions worldwide.” As medical and dental professionals, let’s work together to help control this epidemic; our patients are depending on us! RDH Magazine for Dental Hygiene Professionals, November, 2011