Periodontal Management of the Diabetic Patient

      What do Periodontal (gum) Disease and Diabetes Mellitus have in common?  Both are inflammatory diseases.  This means if one disease can hurt an organ – say your heart – so can the other.  This make the two diseases synergistic – the sum of the two problems is often worse than what you might expect from either disease.

      Makefield Dental is geared towards treating gum disease as a systemic disease – one that effects your entire body.  We understand how Periodontal Disease contributes to problems with glucose control for diabetics, so we can help you manage both diseases.  Two recent studies have shown that controling advanced Periodontal Disease can reduce HbA1c levels by an average of 0.6%.  Sometimes, this can be much higher! 

      Here is an overview of how our system can help you if you’re diabetic:                        

Patient History

            Treatment for patients that have gum disease often involves understanding the origins of the disease, so a carefully detailed history is very important. 

!          Genetics – do other close relatives have problems with their gums too?  If so, you may be more susceptible to gum disease than others.

!          Environment – Do you smoke?  70% of patients with moderate to severe gum disease are smokers.  Smoking cessation can improve your gum disease as well as your risk of developing any of the other know risks for diabetics  – eye problems, kidney disease, peripheral nerve damage and infection, heart disease and stroke.

!          Medications – Many common drugs, including antidepressants, antihistamines and blood pressure medications can cause changes in your mouth that favor cavities and gum disease.  Most diabetics take two or three medications for diabetes, and another set of drugs for other problems common to diabetics, such as high blood pressure or high cholesterol.

!          Health – Stress, poor diet, poor sleep habits, short-term illnesses such as a cold or the flu; if you’re diabetic, you’ve heard the list before.  These factors affect your insulin requirements and blood sugar levels.   All of these problems can make any disease worse, including gum disease.           

Communication

            Diabetes is a constantly evolving disease.  Each year, between 2% and 6% of your remaining insulin-producing beta cells disappear.  This means your insulin requirements and medications may be constantly changing.  Damage to organs and other tissues is cumulative.  In gum disease, damage to bone and the surrounding tissues is cumulative too.

            For this reason, it is very important to include your dentist in your Diabetes Management Team.  We can be a valuable resource to your physician and endocrinologist when blood glucose management becomes an issue.  The more your dentist knows about your Diabetes, the more valuable a member of your team he can be.

Treatment

            If your gums are not healthy, we have several levels of care geared to bring them back to health.   Our goal is ZBOP – Zero Bleeding On Probing.  This means that when we check your mouth for bleeding, the classic sign of gum disease, we find none.  We have an extraordinarily wide range of tools that help us to achieve this goal.

            How important is gum treatment?  If you are diabetic, you know that each medication you take reduces your HbA1c levels by about 1%.  Multiple drugs are often necessary to get the HbA1c levels down to the target range of 6%.  Studies have shown that patients with advanced gum disease have lowered their HbA1c levels by an average of 0.6%  – and as much as 3.5% – after they received treatment for their gum disease.  Wouldn’t it be great to be able to drop one of your medications because you were able to get your blood sugar levels under tighter control?? 

Maintenance

            Even Diabetics with healthy gums require a different standard of care. We recognize that gum disease and Diabetes are not independent.   If your gums are healthy (only 25% of the adult population can say this about themselves!), we take an active monitoring position.  We make sure that you are seen regularly, and we monitor you closely for changes.  Problems with glucose control can rapidly affect the health of your gums.

            If you have a history of Periodontal Disease, maintenance is even more important.  Like Diabetes, Periodontal Disease is a chronic, progressive disease.  Once you’ve lost bone, it’s gone forever.  In our office, we take an active approach to periodontal maintenance, treating any flair-ups before they get out of control and insuring that you have the right tools to keep your teeth clean and healthy at home.  Many dental offices consider things “OK” as long as the patient hasn’t lost a lot of bone.  We understand that this is not so – if your gums are bleeding, you have a problem that extends beyond your gums.  If your hand was bleeding, you’d be concerned; if you’ve got blood on your toothbrush or floss, you should be concerned about this too.

For more information, please see our web pages on The Connections Between Periodontal Disease and Diabetes and the Diabetes Mellitus page of the Periodontal Disease Resource Center.