The dental professional will encounter various oral health problems during the course of treating his or her patients with diabetes. Depending on a variety of factors, the type and scope of dental problems that may occur will vary widely. So for today's blog I will list the most common problems, but I want to hear from you or your friends with diabetes: what are your most pressing dental issues or concerns?
The major dental issues facing patients with diabetes are:
-Periodontal (Gum) Disease
-Xerostomia/Dry mouth
-Caries
-Infections
Minor dental issues include:
-Dysguessia (altered taste)
-Burning mouth syndrome
-Facial pain/Neuralgia/TMD dysfunction
-Swallowing problems (autonomic neuropathy)
-Halitosis (bad breath)
The majority of dental research in diabetes patients has revolved around the incidence and influence of periodontal disease on glycemic control. For the most part, there is a direct relationship between periodontal disease and glycemic control. However, due to the shear number of research projects that have been conducted on this topic, one might assume that this affects a majority of diabetes patients.
In my practice, however, I have found that the majority of my patients with diabetes (~250 in my practice) complain of dry mouth or an altered saliva flow. I also have several patients with poor glycemic control but no gum disease due to their great dental care at home. And I have a few with great glycemic control and periodontal disease.
Generally, the dry mouth is related to the side effects of blood pressure drugs or other heart medications given in conjunction with diabetes medications. The problem afflicts many patients with a variety of systemic illnesses. It has been documented that there are more than 500 OTC and prescription drugs that list dry mouth as a side effect. In addition, dry mouth could also be an indication of an autonomic neuropathy due to the diabetes since these nerves control salivary flow. The research papers on this issue are few.
Despite attempts and offers to speak at professional dental conferences, there seems to be little interest in a diabetes lecture. For a few of my dental colleagues who lecture on this topic, their phones are not ringing. Many states have an ongoing continuing education requirement for dental licensure. The majority of the topics have focused on cosmetic and implant dentistry, practice management, dental operative procedures, infection control, etc. -- not diabetes care.
Although I do practice cosmetic and implant dentistry, I also feel a balance must be achieved to be better informed about the chronic illnesses plaguing society today and ultimately my patients. Using that knowledge influences my treatment planning for my patients and improves treatment outcomes. Despite the dramatic increase in chronic disease in the United States and the World, dental continuing education on these issues is disproportionately lacking.
