Diabetes and oral health: What care providers need to know

Diabetes is a complex disease that can cause many complications throughout the body: kidney failure, limb amputations, blindness, stroke, even pneumococcal disease.
 
But oral and dental health tends to fly under the radar when compared to other diabetes-related complications.
 
‘Despite good quality care provided by many GPs, we need to raise the awareness of dental health, as dental diseases may, to a point, have been thought of as being the role of our dental colleagues,’ Dr Gary Deed, GP and Chair of the RACGP Diabetes Specific Interests network, told newsGP.
 
Prakash Poudel, a PhD candidate at the Centre for Oral Health Outcomes, Research Translation and Evaluation at Western Sydney University, is currently investigating the role of non-dental diabetes care providers in oral health promotion, as well as their knowledge of oral health care.
 
‘We conducted some qualitative focus groups with diabetes educators across south-western Sydney and the results suggest that oral health is often neglected in diabetes care,’ Mr Poudel told newsGP.
 
‘We are also currently undertaking telephone interviews with GPs and preliminary findings show limited oral health education and referrals being provided to patients with diabetes.’
 
While patients with diabetes receive less information about and attention to their oral health, they actually have increased risk in this area.
 
‘Some medications for diabetes may result in xerostomia, or dry mouth, which can increase the accumulation of plaque and the risk of oral health problems, especially periodontal disease,’ Mr Poudel said.
 
Periodontal disease can lead to further problems with oral health and has been found to be more likely to occur in patients with diabetes.
 
‘People with type 2 diabetes have a doubling of the risk of periodontal disease compared to those without diabetes,’ Dr Deed said. ‘Periodontal disease is also linked with higher rates of dental caries and is a major cause of tooth loss in people with type 2 diabetes.’
 
A further issue is that combining diabetes with a lack of oral and dental health care can result in something of a feedback loop.
 
‘Periodontal diseases negatively affect blood glucose control, which means patient with diabetes who also have periodontal disease may find it harder to control their diabetes,’ Mr Poudel said.
 
‘Furthermore, evidence suggests that treatment of gum disease could be beneficial to reduce the blood glucose level.’
 
In addition to assessing gaps in diabetes care and knowledge among non-dental health care professionals, Poudel and his team are keen to investigate the reasons behind these gaps so they can help provide solutions.
 
‘The primary barriers to promoting oral health are limited knowledge and training about oral health among diabetes care providers, and a lack of guidelines and resources to support them in this area,’ Mr Poudel said.
 
‘Other barriers reported include lack of referral pathway for patients to access oral health care and time constraints.
 
‘We are currently developing a patient brochure with NSW Health to assist care providers raise awareness among diabetes patients about oral health problems. We are also in the process of developing a simple oral assessment tool that would assist diabetes care providers to detect patients at risk of poor oral health who require dental referrals.
 
‘There is also a need to establish appropriate and affordable referral pathways for patients with diabetes who require dental treatment.’
 
In the meantime, Dr Deed suggests GPs incorporate dental health examination as a regular aspect of consultations with patients who have diabetes.
 
‘Ask about dental health and gum disease as part of a systematic quality approach to assessment and management of diabetes in each person, and also examine the oral cavity and dental structures carefully, especially in those with elevated HbA1c levels,’ he said. ‘This could be incorporated in an annual review assessment.
 
‘Also, actively encourage healthy dental routines to all patients and refer patients for specialist dental care in a timely fashion.’

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