Enabling effective care in diabetes and periodontitis
News Promotional FeaturesPosted by: Dental Design 8th September 2023
The interlinked relationship between a patient’s diabetes and oral health status has been recognised for some time. The interaction between these conditions is important to consider whenever assessing, treating or referring a patient for specialist care, as it has a significant impact on both general and oral-specific health outcomes.
Patients need to understand their own responsibility in managing periodontal issues. Without an open and effective conversation about the necessary at-home care, their issues could spiral further to a point that has devastating effects on their health and confidence.
The difference diabetes makes
Periodontal diseases are intimately affected by a series of systemic risk factors, each relating to a patient’s overall health and wellbeing. Smoking, stress and medication use are three of the most well-known, alongside poorly controlled diabetes.[i] Diabetes should be considered a modifiable factor for periodontal diseases. Whilst it cannot be cured, it can be managed, and in doing so, susceptibility for and severity of periodontal issues reduces.[ii]
The risk for periodontitis development is two to three times higher in those with diabetes than individuals without it.[iii] On the other hand, periodontitis is linked with higher glycated haemoglobin (HbA1C), which if pushed too far increases the risk of developing diabetes for a patient who didn’t initially have the condition.[iv] This bidirectional relationship fuels the need for attentive care in those at a higher risk of developing, or who are already living with, either condition.
Diabetic patients need to be aware of how this link can affect their own need for periodontal treatment and sustained care. A conversation with their clinician could be the most effective way to both understand and become motivated to build upon positive behaviours outside of the practice. These include consistent brushing, interdental cleaning, and potentially improving glycaemic control.[v]
Effective communication
The first aim of a discussion should be to raise a patient’s awareness of the proven bidirectional relationship. Across various studies, patient knowledge of the connection between diabetes and periodontal health is poor.[vi],[vii] Just beginning the conversation could already be an improvement.
When armed with an increased knowledge of the risks surrounding their oral health, patients can actively make decisions towards taking control of it. Alongside your patient, decide upon attainable goals for their at-home care routine outside of the practice.[viii] Refrain from bombarding objectives with dental jargon, make the required actions clear for the patient, and empower them with ways to track their progress. Visual aids such as disclosing tablets could enable effective self-monitoring, sustaining the motivation to improve an oral care routine by providing visible results.[ix]
In the extreme cases where patients are recommended periodontic focused therapy, or even surgery, they will want to understand its benefits in full. Reducing the risk of bleeding, loosening or loss of teeth, and overall pain could be incentive enough for improved at-home oral hygiene routines. However, diabetic patients could be convinced to act when they understand the reciprocated effect that dental health has on their overall health. For those already experiencing periodontal issues, successful periodontal treatment has been found to improve glycaemic control, with a 0.4% reduction in HbA1C in some cases.[x] A one-time treatment could be as effective as a medication prescribed by a GP; upon hearing this, patients may consider dedicated periodontal care a favourable solution.[xi]
Improving diabetic considerations
Asking the right questions of your patients is important to gain a complete understanding of their condition and to provide an accurate diagnosis or prognosis. Instead of simply asking how well they are handling their diabetes – often prompting a casual “all good” – enquire about their HbA1C level. Their answer could enhance your understanding of the patient, and the most appropriate way to plan and undertake any necessary care. Figures less than 6.5% or 48mmol/mol signal the best chance for effective periodontal treatment for a diabetic patient,[xii]any higher could limit the benefits.
Your assessment establishes a foundation for future treatment plans; this could range from simply monitoring oral hygiene routines, to undertaking treatments in-house or referring out of practice, in the most extreme cases. Accurate and thorough notes enhance the entire care process, and the ease of sharing this information between the relevant professionals. They also protect dental professionals against litigation, especially important within periodontology, the most common area of legal action in dentistry.[xiii]
Excellent note taking and record-keeping ensures all patients receive attentive care that accounts for their overall health. With Kiroku, the digital note taking platform, your note taking is made simpler and quicker with the help of the industry’s leading dental artificial intelligence authority. Dynamic templates are designed to gather and organise notes 60% faster, so you can concentrate on providing informed, personalised care. A variety of templates can be uniquely tailored to you and your patients, optimised to efficiently collect information throughout the entire treatment process.
Diabetic patients need a full understanding of how their periodontal health can afflict and benefit them, and how the bidirectional relationship is affected by well-controlled glycaemic levels. Empowering their care and responsibilities means patients and practitioners can come together to affect their entire well-being in life.
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[i] British Society of Periodontology. (2016). The good practitioner’s guide to periodontology. British Society of Periodontology.
[ii] Wadia, R. (2023). Perio in Practice, Sponsored by Kiroku. Dental Update Webinars. (Online). Available at: https://view6.workcast.net/ControlUsher.aspx?cpak=5177947922776540&pak=1456186858456645 (Accessed June 2023)
[iii] Preshaw, P. M., & Bissett, S. M. (2019). Periodontitis and diabetes. British dental journal, 227(7), 577-584.
[iv] Preshaw, P. M., & Bissett, S. M. (2019). Periodontitis and diabetes. British dental journal, 227(7), 577-584.
[v] Oguntimein, O., Butler, J., Desmond, S., Green, K. M., He, X., & Horowitz, A. M. (2020). Patients’ understanding of the relationship between their diabetes and periodontal disease. The Journal of the American Board of Family Medicine, 33(6), 1004-1010.
[vi] Siddiqi, A., Zafar, S., Sharma, A., & Quaranta, A. (2019). Diabetic patients’ knowledge of the bidirectional link: are dental health care professionals effectively conveying the message?. Australian dental journal, 64(4), 312-326.
[vii] Maia, M. B., Souza, J. G., Bertolini, M., Costa, R. C., Costa, G. S., Torres, S. D. A., … & Martins, A. M. (2023). Knowledge of bidirectional relationship between diabetes and periodontal disease among diabetes patients: A systematic review. International Journal of Dental Hygiene, 21(1), 28-40.
[viii] Gillam, D. G., & Yusuf, H. (2019). Brief motivational interviewing in dental practice. Dentistry Journal, 7(2), 51.
[ix] Wadia, R. (2019). A brief perio update. BDJ Team, 6, 18-19.
[x] Simpson, T. C., Needleman, I., Wild, S. H., Moles, D. R., & Mills, E. J. (2010). Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database of Systematic Reviews, (5).
[xi] Wadia, R. (2023). Perio in Practice, Sponsored by Kiroku. Dental Update Webinars. (Online). Available at: https://view6.workcast.net/ControlUsher.aspx?cpak=5177947922776540&pak=1456186858456645 (Accessed June 2023)
[xii] Wadia, R. (2023). Perio in Practice, Sponsored by Kiroku. Dental Update Webinars. (Online). Available at: https://view6.workcast.net/ControlUsher.aspx?cpak=5177947922776540&pak=1456186858456645 (Accessed June 2023)
[xiii] Wadia, R. (2019). Essentials of Periodontal Care in Practice. Primary Dental Journal, 8(4), 4-5.
