Diabetes and Dental Health

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1 Diabetes and Dental Health Debra Brown Bachelor of Dental Science (Honours) Member of the Royal Australasian College of Dental Surgeons (MRACDS) Board Member of North Queensland Primary Health Network

2 Complications of Diabetes much attention is given to heart, kidney, eye, skin/ feet complications and neuropathy associated with diabetes oral complications are overlooked - 6th significant complication of diabetes

3 The Big Five Six

4 Oral complications of Diabetes: 1) Xerostomia (dry mouth) - increases risk 2) & 3) 2) Increased decay/ cavities 3) Candidiasis (thrush) 4) Periodontal disease (gum disease) 5) Impaired wound healing

5 2) Increased dental decay Diabetes causes affects on saliva flow and composition. Saliva has a protective mechanism for teeth and oral structures. Diet - increased carbohydrate intake -> increased decay - esp. type II

6 4) Diabetes and Periodontal disease (gum disease) most significant oral complication two way relationship: diabetes control periodontal disease

7 What is Periodontal Disease? also know as gum disease - misleading* chronic infection of bone and gum surrounding the teeth

8 What is periodontal disease? caused by bacteria (virulent) resulting in gradual destruction of the bone and gum surrounding the teeth, eventually the teeth become loose and fall out or removed

9 Periodontal disease symptoms: red or swollen gums that bleed during brushing and flossing gums that have pulled away from the teeth, exposing the roots bad breath pus between teeth and gums mobile teeth

10 Incidence of periodontal disease in general population common disease, chronic and painless.: people rarely seek treatment isn t a localised condition, bacteria enter blood stream it is known to be involved in the development of at least 16 systemic health complications such as coronary heart disease, cerebrovascular disease, cancer, alzheimer's, rheumatoid arthritis

11 Periodontal disease in Diabetics 64% of adults with D have perio D are 3-4 x more likely to develop perio Periodontal disease is a host mediated immune inflammatory response.: perio can be involved in exacerbating disease perio severity, disease progression is increased in people with D Diabetes periodontal disease severity and progression.: Diabetes and periodontal disease have a two way relationship

12 The problem with Periodontal disease in Diabetics Chronic perio patient the ulcerated surface area is large ~ approx size of your hand.: large potential source of infection/ problems

13 .: large portal of entry for bacteria (involved in perio) and various host mediated inflammatory mediators, to the body -> bacterial infiltration and interference with insulin receptors (problems with glycaemic control.: diabetic complications).: not a localised disease but a potential source of systemic infection and low grade chronic systemic inflammation this is a concern when the goal in management of diabetes is elimination of sources of infection and establishing normal blood sugar levels not going to be possible if there is periodontal disease present

14 The problem with periodontal disease in Diabetics.: periodontal disease glycemic control & diabetes disease progression

15 Treatment of Periodontal disease (by dentists): Improves glycaemic control in diabetes 1% reduction in HbA1c levels 50mg/dL reduction in serum glucose reduces insulin requirements improvements more pronounced in patients with severe periodontal disease.: decreases risk of diabetic complications patients are given anti-diabetic drugs to aid metabolic control, these aren t without adverse side effects and cost to consumer and government - theoretically periodontal treatment substitute for drugs potential to save ~$2000/ year on medical treatment

16 Dental Management of Periodontal Disease antibiotics are NOT effective! insidious disease - painless, not visible involves mechanical removal of plaque and calculus deposits on teeth and education of patients to improve at home oral care practices regular dentist review

17 Take home message Good dental health is important in management of diabetes If people are having troubles controlling their diabetes it may be worth looking at their dental health as a potential cause of problems. Thank you!