Download Periodontal Management of the Diabetic Patient

Periodontal Management of the Diabetic Patient
What do Periodontal (gum) Disease and Diabetes Mellitus have in common? Both
are inflammatory diseases. This means if one disease can hurt an organ – say your heart
– so can the other. This make the two diseases synergistic – the sum of the two problems
is often worse than what you might expect from either disease.
Makefield Dental is geared towards treating gum disease as a systemic disease – one
that effects your entire body. We understand how Periodontal Disease contributes to
problems with glucose control for diabetics, so we can help you manage both diseases.
Two recent studies have shown that controling advanced Periodontal Disease can reduce
HbA1c levels by an average of 0.6%. Sometimes, this can be much higher!
Here is an overview of how our system can help you if you’re diabetic:
Patient History
Treatment for patients that have gum disease often involves understanding the
origins of the disease, so a carefully detailed history is very important.
!
Genetics – do other close relatives have problems with their gums too? If so,
you may be more susceptible to gum disease than others.
!
Environment – Do you smoke? 70% of patients with moderate to severe
gum disease are smokers. Smoking cessation can improve your gum disease
as well as your risk of developing any of the other know risks for diabetics –
eye problems, kidney disease, peripheral nerve damage and infection, heart
disease and stroke.
!
Medications – Many common drugs, including antidepressants, antihistamines
and blood pressure medications can cause changes in your mouth that favor
cavities and gum disease. Most diabetics take two or three medications for
diabetes, and another set of drugs for other problems common to diabetics,
such as high blood pressure or high cholesterol.
!
Health – Stress, poor diet, poor sleep habits, short-term illnesses such as a
cold or the flu; if you’re diabetic, you’ve heard the list before. These factors
affect your insulin requirements and blood sugar levels. All of these
problems can make any disease worse, including gum disease.
Communication
Diabetes is a constantly evolving disease. Each year, between 2% and 6% of your
remaining insulin-producing beta cells disappear. This means your insulin
requirements and medications may be constantly changing. Damage to organs and
other tissues is cumulative. In gum disease, damage to bone and the surrounding
tissues is cumulative too.
For this reason, it is very important to include your dentist in your Diabetes
Management Team. We can be a valuable resource to your physician and
endocrinologist when blood glucose management becomes an issue. The more your
dentist knows about your Diabetes, the more valuable a member of your team he can
be.
Treatment
If your gums are not healthy, we have several levels of care geared to bring them
back to health. Our goal is ZBOP – Zero Bleeding On Probing. This means that
when we check your mouth for bleeding, the classic sign of gum disease, we find
none. We have an extraordinarily wide range of tools that help us to achieve this
goal.
How important is gum treatment? If you are diabetic, you know that each
medication you take reduces your HbA1c levels by about 1%. Multiple drugs are
often necessary to get the HbA1c levels down to the target range of 6%. Studies have
shown that patients with advanced gum disease have lowered their HbA1c levels by
an average of 0.6% – and as much as 3.5% – after they received treatment for their
gum disease. Wouldn’t it be great to be able to drop one of your medications because
you were able to get your blood sugar levels under tighter control??
Maintenance
Even Diabetics with healthy gums require a different standard of care. We
recognize that gum disease and Diabetes are not independent. If your gums are
healthy (only 25% of the adult population can say this about themselves!), we take an
active monitoring position. We make sure that you are seen regularly, and we
monitor you closely for changes. Problems with glucose control can rapidly affect
the health of your gums.
If you have a history of Periodontal Disease, maintenance is even more
important. Like Diabetes, Periodontal Disease is a chronic, progressive disease.
Once you’ve lost bone, it’s gone forever. In our office, we take an active approach to
periodontal maintenance, treating any flair-ups before they get out of control and
insuring that you have the right tools to keep your teeth clean and healthy at home.
Many dental offices consider things “OK” as long as the patient hasn’t lost a lot of
bone. We understand that this is not so – if your gums are bleeding, you have a
problem that extends beyond your gums. If your hand was bleeding, you’d be
concerned; if you’ve got blood on your toothbrush or floss, you should be concerned
about this too.
For more information, please see our web pages on The Connections Between
Periodontal Disease and Diabetes and the Diabetes Mellitus page of the Periodontal
Disease Resource Center.