Diabetes affects as many as 463 million people worldwide, causing serious and potentially disabling complications like heart disease, kidney damage, nerve damage, vision loss and limb loss. It also ranks as the world’s 9th leading cause of death, making diabetes an urgent global public health priority.
The bi-directional relationship between diabetes and periodontal disease is becoming ever clearer. As we approach World Diabetes Day on November 14th 2021, we take this opportunity to discuss why and how dentists should be taking extra care to educate their patients with diabetes on the connection between their oral and systemic health.
Diabetes and periodontal disease
People with diabetes have consistently been shown to suffer from periodontal disease at higher rates than the general population. The severity of periodontal disease is also greater in people with diabetes than in those without, especially when diabetes is poorly controlled. This connection is so well-established that periodontitis has been referred to as “the sixth complication of diabetes”.
This relationship goes both ways, with periodontal disease also known to increase the risk of developing type 2 diabetes. Further, not only can periodontal disease make glycemic control more difficult to establish and maintain, it also increases the risk of macro-vascular complications of diabetes, such as cardiovascular disease, stroke and kidney damage.
World Diabetes Day 2021-23
With this connection in mind, the need for dental professionals to proactively educate their patients about the connection between diabetes and periodontal health has never been clearer. World Diabetes Day represents an ideal opportunity to double down on these efforts.
World Diabetes Day began in 1991 as a collaborative effort between the International Diabetes Federation (IDF) and the World Health Organization (WHO), later gaining recognition as an official United Nations Day in 2007. Goals are to improve global access to diabetes prevention, education and care, and to reduce the prevalence and burden of the disease.
Given the relationship between diabetes and periodontal disease, you are uniquely equipped to help your patients with diabetes improve their systemic and oral health outcomes. You can do so in a number of ways.
What you can do for your patients with diabetes
Education is fundamental to the prevention and management of both diabetes and periodontal disease. However, in one survey, 55% of patients were completely unaware of the connection between the two.
Start by explaining the relationship, making sure to use non-technical language. This can be supported with educational tools like videos or slideshows, with patient-friendly information resources like Mouth Healthy, and take-home resources such as these American Dental Association (ADA) Diabetes and Your Oral Health brochures.
Once patients understand the importance of periodontal health, make sure that they know exactly what they need to do to maintain it, with the emphasis on controlling biofilm.
Don’t assume that your patient already knows the basics; coach them on brushing twice a day with a fluoride toothpaste and using interdental cleaning tools, and demonstrate proper technique if necessary. If the patient has dental appliances, you might also offer advice on regular cleaning and maintenance of these.
Guidance on diet and behavioral risk factors, like alcohol consumption and smoking, are also important and patients can be referred to appropriate third parties to manage these if needed.
It’s important that your patients with diabetes use products specially formulated to help control biofilm. A toothpaste like Colgate Total fights plaque-causing bacteria on 100% of mouth surfaces and is clinically proven to offer significant reductions in biofilm, calculus and gingivitis. This can be followed up with a mouth rinse like Colgate Total 12hr Pro-Shield Mouthwash, shown to prevent and reduce biofilm and gingivitis. For those with active gingival inflammation, you can prescribe a therapeutic mouthwash like Colgate PerioGard.
Finally, offer your patient support and encouragement as they learn to manage and improve their health. Remember that diabetes management requires the patient to make significant lifestyle changes and monitor a number of serious health risks, all of which can be difficult and emotionally taxing. Empathize, maintain a positive and supportive tone, and frame your recommendations as a way to ease some of that burden, rather than one more thing to worry about!