diabetes and oral health february...

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DisclosuresDiabetes and Oral Health Care

February 20, 2019

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HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION

Diabetes and Oral Health Care

Lauren Neufeld RDH, BSDH, UDOHMichelle Martin RDH, MPH, UDOH

December 27, 2018


The Utah Department of Health’s mission is to protect the public’s health through

preventing avoidable illness, injury, disability, and premature death; assuring access to affordable, quality health care;

and promoting healthy lifestyles.

MISSION & VISION

Our vision is for Utah to be a place where all people can enjoy the best health

possible, where all can live and thrive in healthy and safe communities.


STRATEGIC PRIORITIES

Healthiest People – The people of Utah will be among the healthiest in the country.

Optimize Medicaid – Utah Medicaid will be a respected innovator in employing health care delivery and payment reforms that improve the health of Medicaid members and keep expenditure growth at a sustainable level.

A Great Organization – The UDOH will be recognized as a leader in government and public health for its excellent performance. The organization will continue to grow its ability to attract, retain, and value the best professionals and public servants.


Lauren Neufeld, RDH, BSDH is the Oral Health Educator for the Oral Health Program at the Utah Department of Health. Lauren is a native of Utah, graduating with her bachelors in dental hygiene science from the Utah College of Dental Hygiene. She has practiced clinical dental hygiene since graduating in 2012, before joining the Utah Department of Health. She spent much of that time in Public Health settings working with vulnerable children, adolescents and families. Lauren launched the adolescent oral health campaign for the Utah Department of Health in 2016. She enjoys traveling the state and teaching youth about oral health and raising awareness of the link between oral and systemic health.




Objectives

To clinically recognize periodontal disease and know when to refer a patient for dental care.

To understand the effects Diabetes has on the Periodontium and to understand the effects Periodontal Disease has on the Diabetic State.

To be able to confidently teach patients about the bi‐directional relationship of periodontal disease and diabetes and advise them on healthy habits they can adopt for optimal health.



Dr. David Satcher, Surgeon General Report 2000

You are not healthy without a healthy mouth…


We can not be completely healthy without oral health being addressed too.

Association between chronic oral infections & Diabetes Heart Disease Lung Disease Stroke Low‐Birth‐Weight Premature Births


Oral Health is Part of General Health


Statistics Say …


1/3 of people with diabetes have severe periodontal disease (5mm or more of clinical attachment loss)

18 % of cases of complete tooth loss in the US are attributable to diabetes.

Among young adults, those with diabetes have about twice the risk of developing periodontitis as those without diabetes. (NDEP)



Most Common Oral Health Problems Associated with Diabetes

Tooth decay

Periodontal (gum) disease

Salivary gland dysfunction

Fungal infections

Infection and delayed healing

Taste impairment

Diabetes and Oral Health Care Diabetes and Oral Health Care




Inflammation and infection destroys the tissues that support the teeth.

This includes the gums, the periodontal ligaments, and the tooth sockets (alveolar bone).



Periodontal Disease 101

In a nutshell, it includes gingivitis and periodontitis….both serious infections if left untreated, can lead to tooth loss.

There are more bacteria in your mouth right now than there are people on Earth.



Gingivitis

Gingivitis is reversible

If left untreated, it can progress to periodontitis which is irreversible

Plaque contributes to inflammation



Periodontitis

Red or swollen gums that bleed during brushing and flossing and are tender to the touch

Pus between the teeth and gums A consistent foul odor from the mouth Most of time NO pain –

Primary cause of tooth loss in adults



Gums that have pulled away from the teeth, exposing the roots

Irreversible Bone Loss

What to look for?



Nearly 1/3 of people with diabetes have severe periodontal disease

(CDC)

Diabetics are 3 to 4 times more likely to develop periodontal disease

(JDH)

Develop infections easier

Abnormal wound healing

Effects of Diabetes on the Periodontium



PD disrupts glycemic control in diabetics

associated with pre‐diabetic conditions (impaired fasting glucose and impaired glucose tolerance)

causes insulin resistance (via cytokines) impairs glycemic control (increased serum glucose and HbA1c levels)

Periodontal infections contribute to elevated systemic C‐reactive protein (CRP) level

Effects of Periodontal Disease on the Diabetic State and Potential Initiator



*Newresearchhasfoundthatpeoplewithdiabetesandgumdiseasewhoreceiveroutinedentalcareexperiencefewermedicalcomplicationsandhospitalizations,andreducedhealthcarespending.

*United Concordia Dental study Diabetes is the 6th leading cause of

adults going to the Emergency Department (dental pain is #1)

Other Health Outcomes



Suggestion…

A comprehensive periodontal evaluation for those with Diabetes once a year is essential!



Periodontitis – Induced Hyperglycemia is Reversible

Treatment of PD improves glycemic control in diabetics

1% reduction in A1c levels

50mg/dL reduction in serum glucose

reduces insulin requirements

improvements more pronounced in patients with

severe PD



Recent Oral Care Guidelines and Screening Tools

Primary care provider Med Hx of last oral examination Stress importance of oral hygiene Educate about diabetes/PD links and effect of PD on glycemic

control Perform oral examination with referral to dentist if PD symptoms

present Advise self-monitoring of oral health and importance of dental visit

if symptoms are noted Promote healthy lifestyle (diet, exercise) and “ABC” goals (A1c,

blood pressure, cholesterol levels)



Recent Oral Care Guidelines and Screening Tools

Dental provider Open communication with physician Acomprehensiveperiodontalevaluationonceayear Stress prevention, early detection, and treatment of PD Emphasize oral hygiene and provide instruction with regular

reinforcement Advise physician of PD diagnosis and care plan Monitor response to therapy 4-6 weeks post-treatment and

consult physician for reevaluation of A1c level Patient on recall 2-4 times per year depending on severity of the

case



Remind the dentist that they have diabetes

Eat before surgery Take the usual medications Plan for eating needs after

surgery Wait until blood sugar is under

control

Oral Surgery Complications



Summary of Bi-Directional Relationship

Infections affect glucose levels in the blood. Diabetes makes periodontal disease worse. Treatment of periodontal disease can influence diabetes. Diabetes reduces the body’s resistance to periodontal

infections.

Decreases insulin needs Improves glycemic control Decreases complications



Other Oral Manifestations

Dental caries

Taste dysfunction

Increased Salivary Viscosity

Asymptomatic Parotid Gland Swelling



Xerostomia/ Dry Mouth

Diabetes can affect the salivary glands so they don’t produce enough saliva

effects chewing, tasting and swallowing

Higherriskfordentaldecay!



Xerostomia and Burning Mouth Syndrome Treatment Alterthedrugregimen: Consult with physician to change xerostomia-causing drugs.

SalivarySubstitutes Biotinrinses,lozengesorgels

SymptomaticTreatments: Water Sugar-free candies, mints, and gum Eliminate alcohol mouthwash, tobacco, acidic liquids Different toothpaste

Cholinergicagonists:(Stimulatesalivaryglands) Talk to Physician or Dentist about getting these RX



Candidiasis - Thrush

Sore white or red areas in the mouth

Not enough saliva and too much sugar in the saliva allow the fungus to cause candidiasis or thrush



Treatment For Candidiasis

Topical Rinses Topical Creams Systemic Drugs Medicated Lozenges



Fluoride Toothpaste and Rinses Help prevent dental decay with over the

counter fluoride rinses and RX for more severe dry mouth



Recommended – Meticulous Home Dental Care

Brush at least 2 times a day to remove plaque, using a soft brush Brush the top of the tongue

Clean between the teeth with floss or interdental cleaner daily

Power brushes and floss aids



Recommended Professional Dental Care

Regular dental examinations at least 2 times each year

Periodontal evaluation and treatment (SRP), 2 to 4 times each year



Manage ABC’s

A1c ~ less than 7%

Blood pressure ~ 120/80 mmHg

Cholesterol ~ LDL “bad” cholesterol builds up & clogs blood vessels.

Know numbers!

Don’t Smoke!



Prevention, early detection and meticulous home care is key!

THANK YOU!


Contact Information

Lauren Neufeld, RDH, BSDH [email protected],(385) 321‐4099

diabetes and oral health february...

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