Oral care for patients with diabetes

Date: October 2020

Author: Louise Sinclair

According to the Centers for Disease Control and Prevention (CDC), 26.9 million people in the United States are currently living with diabetes that has been diagnosed, and a further 7.3 million people are thought to have undiagnosed diabetes. Together, this represents 10.5% of the US population. In addition, a staggering 88 million are believed to have prediabetes.

With such a high prevalence, dentists are likely to encounter patients with diabetes or prediabetes frequently. As there is a two-way relationship between diabetes and periodontitis, we must take extra care to educate these patients on the importance of oral health and oral hygiene. In doing so, we can help our patients by educating them and helping them improve their oral and systemic health outcomes, and potentially reduce the burden of not one but two major public health issues.

Diabetes and oral health

Dentists have long been aware that diabetes increases the risk of periodontal disease. According to the Diabetologia journal, patients with diabetes have a threefold risk for periodontitis compared to individuals without diabetes. In fact, periodontitis is sometimes referred to as “the sixth complication of diabetes.”

More recently, we discovered that this connection goes both ways. Periodontitis negatively affects glycemic control, elevating blood glucose and worsening oral and systemic complications in diabetic patients.

In addition to gingivitis and periodontitis, diabetes is associated with other oral health conditions. The American Dental Association (ADA) advises looking for and enquiring about the following during an examination as these are signs and symptoms of poorly-controlled diabetes:

  • Bleeding
  • Xerostomia
  • Change in taste
  • Burning sensation
  • Oral infections such as candidiasis
  • Slow healing of lesions
  • Enlargement of the parotid salivary glands

This means that you may be finding signs and symptoms which could be associated with diabetes in patients who have diabetes but are unaware of it. A blood glucose assessment could also be performed in the dental office. Patients suspected of having diabetes should be referred for medical evaluation and if indicated can then receive medical care for this condition.

Educating patients about the oral-systemic connection

Our patients are often unaware of the two-way relationship between oral health and diabetes, let alone the potential ramifications. The first step, then, is simply to educate the patient.

Use non-technical language to explain the connection, e.g., “gum disease” rather than “periodontitis.” It may help to use educational tools like videos, infographics, or slideshows like this one from Mouth Healthy, which explains the oral complications of diabetes in an accessible and engaging way. You can also give them takeaway literature, such as these Diabetes and Your Oral Health brochures available from the ADA.

Improving oral self-care

We only have limited chair time with our patients, so the biggest wins will be gained by helping them improve their at-home behaviors. Emphasize that good oral health will make a difference, and be sure that your patient is well-equipped to perform thorough oral hygiene at home on an ongoing basis.

Ask your patient to talk you through their oral care routine (or even better, to demonstrate it) and highlight areas for improvement. Remember that patients will sometimes gloss over bad habits, so make sure to approach the topic in a sensitive, compassionate and non-judgemental manner.

You can also recommend helpful oral care products. Using an antibacterial toothpaste twice daily, followed by an antibacterial rinse is a simple and effective way to help reduce plaque and gingivitis as well as other oral health conditions. We can also explain to patients that gingivitis is the early phase of gum disease and that it can be reversed before there is the possibility of it progressing to the more advanced form of gum disease, periodontitis when bone loss around the teeth occurs.

People with diabetes might experience persistent soft-tissue lesions that are slow to heal. You might also show your patient how to check for these at home, and advise them on when to seek your help.

Finally, we should all be conscious of the fact that managing diabetes is notoriously difficult and requires a lot of learning for the patient. Rather than presenting oral healthcare as yet another job required of them, present it as a way to help reduce the potential burden of diabetes and to take control of their long-term outcomes. When patients feel empowered, they are likely to be much more motivated to invest time and energy into their oral and overall health.