Jessamin Cipollina, MA
February 21, 2022
Diabetes is the 7th leading cause of death in the US, with 1.4 million Americans diagnosed every year. Of the 34 million adults in the US currently living with type 2 diabetes (T2D), 8.5 million are unaware of their condition. Another 88 million adults are prediabetic, and 22% will develop T2D within 5 years if left untreated. Rates of diabetes are highest among American Indians/Alaskan Natives, non-Hispanic blacks and Hispanics, as well as among those from low-income backgrounds. Many people are aware of the risk factors for diabetes – high blood pressure, being overweight, poor diet and family history of diabetes – but few think about the connection between diabetes and oral health.
Diabetes and oral conditions, like periodontal disease, are both inflammation-based, immune-related disorders that share a bi-directional relationship. Poor blood sugar control increases the risk for gum problems, while periodontal disease may cause blood sugar to rise. The body’s natural inflammatory response to bacteria and plaque in the mouth atttacks the gum tissue and supporting tooth structures, increasing risk for periodontal disease and other severe oral health problems like tooth loss.
But, many people with diabetes do not know that they are at high risk for these oral health problems. People who are at risk for diabetes or who are diabetic may experience more difficulty in keeping their mouth healthy and preventing serious oral health problems. Additionally, people who are unaware of their diabetes or who have poorly controlled diabetes are at three times the risk of developing periodontal disease, leading to severe oral infection.
In addition to oral health problems, there are other well-known complications of diabetes, including nerve damage, blindness, kidney failure, and heart disease. Preventive oral health interventions are essential to decreasing risk for these debilitating complications that greatly reduce quality of life and overall health and well-being of those with diabetes.
A key component of diabetes care is oral care. Regular dental visits, along with good oral hygiene, are particularly important in preventing and treating periodontal disease and preventing severe oral problems common in people with diabetes such as tooth decay and tooth loss. Research findings reveal that diabetic patients with treated periodontal disease maintain better glycemic control. Good oral care, like toothbrushing twice per day and flossing once per day, and regular dental cleanings are essential to reducing risk for diabetes-related complications.
Unfortunately, many individuals with diabetes often experience barriers in accessing regular dental care. Medicaid and other low-cost insurance plans do not cover dental care, leaving patients to pay for costly out-of-pocket dental care. Those that cannot afford it, often forgo dental check-ups, so that oral problems remain untreated and can become more severe over time.
Primary care nurses, nurse practitioners, midwives, physicians, physician assistants, pharmacists, and other health care professionals are well-positioned to promote oral health literacy that helps patients who are pre-diabetic or diabetic integrate consistent oral hygiene habits as a part of their daily self-care routine. Providers need to ask about oral health issues as part of the health history and look for symptoms and signs of oral disease by using the HEENOT approach that includes an intra- and extra-oral exam. Common oral complaints that may be reported to clinicians include bleeding and/or pain during brushing and flossing, tooth sensitivity, bad breath or a bad taste in the mouth that won’t go away, loose teeth, and pain when chewing. In the oral exam, providers may see red or swollen gums and gum recession, and the patient may have a history of periodontal abscesses. Any oral health issues need to be documented in the electronic health record (EHR), and providers need to make a dental referral if the patient does not already have a dental home.
Collaboration among primary and dental care team members is essential in caring for patients with diabetes. Motivational interviewing can be used to promote healthy lifestyle changes, such as establishing a nutritional diet and exercise plan, and engaging patients in managing their oral and overall health. Vaccine education and administration (e.g. COVID, flu, pneumonia, shingles) is imperative to protecting overall health and prevent these serious illnesses in patients with diabetes. Primary and dental care professionals can communicate with one another in providing their patients with person-centered care.
The connections between diabetes and oral health are not new and have been established for many years! There is a wealth of evidence-based research and resources for health professionals and patients about the oral-systemic health of those living with diabetes. Faculty and educators need to incorporate oral health into their curricula with nursing and other health professions students to promote oral health integration in clinical practice. Whether in the dental chair, a primary care office, or an acute care setting, remember the connections between oral health and diabetes. We challenge all clinicians, dental and medical, who care for patients with diabetes to engage them in taking charge of their diabetic oral and overall health!
References:
- American Diabetes Association. Statistics About Diabetes. Accessed February 21, 2021.
- Centers for Disease Control and Prevention. Prevalence of Prediabetes Among Adults. Updated September 30, 2022.
- Centers for Disease Control and Prevention. Take Charge of Your Diabetes: Healthy Teeth. Updated January 20, 2021.
- Centers for Disease Control and Prevention. Type 2 Diabetes. Updated December 16, 2021.
- Darling-Fisher C, Borgnakke W, Haber J. Oral health and diabetes. American Nurse Today, 2017;12(8):22–25.
- Darling-Fisher C, Kanjirath PP, Peters MC, Borgnakke W. Oral health: An untapped resource in managing glycemic control in diabetes and promoting overall health. The Journal for Nurse Practitioners, 2015;11(9):889-896. doi: 10.1016/j.nurpra.2015.08.001.
- Faculty Tool Kits. Oral Health Nursing Education and Practice (OHNEP).
- Haber J, Hartnett E, Hallas D, et al. Putting the mouth back in the head: HEENT to HEENOT. American Journal of Public Health, 2015;105(3):437-441. doi: 10.2105/AJPH.2014.302495
- Oral Health and Diabetes Patient Care. Oral Health Literacy. Oral Health Nursing Education and Practice (OHNEP).