Dental care and diabetes

Posted in Periodontal Therapy on .

Recent research shows that the same treatment can be used for people with diabetes with periodontitis compared to people who don’t have diabetes and that healing will be similar in the short term.

As with all patients, initial dental therapy for patients with diabetes must be directed towards control of acute oral infections. Communication between the dentist and patient’s physician is recommended to enable good blood glucose control to be established. Advanced periodontal disease may increase insulin resistance causing blood glucose levels to rise, therefore it is important that the link between dental and medical personnel be maintained.

While it is known that the presence of periodontal disease may aggravate glycaemic control, there is emerging evidence that periodontal disease may also increase the risk for other vascular diabetic complications such as strokes and heart attacks.

If you have good control of your diabetes and no underlying complications you should be able to follow a normal dental hygiene program to help minimise plaque and calcified plaque (calculus or tartar). This includes careful sel-fcare and regular professional care (3-6 monthly) involving oral hygiene education and motivation and the removal of all plaque and calculus from the tooth roots using handheld curettes and ultrasonic instruments. For those who do not respond well to this initial therapy, there is evidence that certain antibiotic treatments (e.g. Doxycycline) may offer a significant improvement when used in conjunction with conventional therapy. However antibiotic usage on its own is of no benefit and can be counterproductive. In special circumstances more aggressive therapy such as surgery may be employed although this is usually contraindicated in people with diabetes due to their poor wound healing.

Patients with established periodontitis need defined periodontal therapy and not just the occasional ’quick scale’ from the dentist. In cases where control of periodontitis is not being achieved, referral to a specialist Periodontist should be considered. In the vast majority of cases, periodontitis can be successfully treated in people with diabetes by painless and relatively inexpensive modern dental procedures. People with diabetes who are enrolled in a careful plaque control program (usually 3-monthly) following treatment, exhibit a low frequency of recurrent periodontitis which is similar to those who do not have diabetes.

Early recognition of diabetes, good glycaemic control, efficient oral hygiene practices and careful sympathetic dental management will allow people with diabetes to keep their teeth for a lifetime.

Reference: ‘Diabetes and Periodontal Disease’, Journal of Periodontology 2000; 71:664-678