New Perspectives In Oral Care For Those With Type 1 And Type 2 Diabetes

New Perspectives In Oral Care For Those With
Type 1 And Type 2 Diabetes
Charles W Martin, DDS

Perhaps the most misunderstood area of treatment for the diabetic patient is oral care. This may due to the fact that oral health and systemic health have historically been viewed as separate systems, and they were treated as such. That may be about to change as some unexpected advocates for integrate oral and systemic care are coming forward.

Perhaps the most misunderstood area of treatment for the diabetic patient is oral care. Not because oral diseases are more complex than vascular or retinal complications, but simply because history has worked against its early diagnosis and integration with overall diabetic care programs.

Numerous studies performed in the last sixty years have identified clear connections between the oral health and systemic health of the diabetic patient.

However, as most diabetic care physicians and dentists can attest, medical and oral care have virtually always been viewed as completely separate systems.

This separation began long before doctors became doctors and dentists became dentists. Beginning in medical school and dental school, the oral cavity was disconnected from rest of the organism. And diagnosis and treatment were divided between medical and dental disciplines.

Changing Perceptions
That may be about to change, however. While researchers continue to uncover connections between oral health and systemic health – physicians, dentists and even health insurance carriers are beginning to change the way they think and act.

At a time when healthcare costs continue to rise, the Journal of the American Medical Association recently reported that Blue Cross Blue Shield of Michigan is incorporating some dental services into some of its medical plans [T Hampton. Studies Prove Oral Health – Diabetes Link, Jama. Dec 3, 2008. Vol. 300, (21): 2471-2473.].

Why? Because they see a connection between preventive oral care and improved overall health of diabetic patients.

Blue Cross Blue Shield is also working with George Taylor, DrPH, DMD (associate professor for the University of Michigan School of Dentistry and Public Health) on a study to quantify to what degree good oral health and preventive care may save overall medical costs for patients with diabetes type 1 and diabetes type 2.

Dr. Bernardine King, a cardiologist with the Gainesville Heart Group, recently said in an interview with the Gainesville Times, "When we treat the heart, we look at the whole patient (including the teeth).”

King may have been referring to three key points of which cardiologists are keenly aware.

1. The risk factors associated with periodontitis. Periodontitis may cause bacteria to enter the bloodstream. These bacterium may settle in defective vascular pathways. Hence, cardiologists advise those patients with cardiovascular defects to take antimicrobials before receiving dental treatment of any kind.
2. Research shows that patients who have severe gum disease, or periodontitis, are much more likely to accumulate plaque in their arteries.
3. A growing body of research into the role inflammation and periodontal disease in diabetes, heart disease and insulin sensitivity. Beck et al, 1996 and Loos 2005 found that periodontal disease induces production of pro-inflammatory cytokines such as TNF- , IL-1, and IL-6.1 Saito et al., 2001; Nishimura et al., 2003 determined that secretion of tumor necrosis factor-alpha (TNF- ) by adipose (fatty) tissue triggered by lipopolysaccharide from periodontal gram-negative bacteria may promote hepatic dyslipidemia and decrease insulin sensitivity.2 Grossi and Genco, 1998; Genco et al, 2005 cited evidence that  type 2 diabetes and decreased insulin sensitivity have been associated with the production of advanced glycation end-products (AGE), which trigger inflammatory cytokine production, thus predisposing for inflammatory diseases such as periodontitis and atherosclerosis.3  

Learn more about the connection between systemic health and oral health for those with diabetes mellitus.

Charles W Martin, DDS is the author of the book: Don’t Sugarcoat it: The Story of Diabetes and Dentistry and founder of DentistryForDiabetics, a nationwide group of dentists committed to helping those with diabetes. His next book, Are Your Teeth Killing You? describing the relationships between oral health and systemic health will be published this year. He practices in Richmond, VA

1. T. Saito, Y. Shimazaki, T. Koga, M. Tsuzuki, and A. Ohshima. Relationship between upper body obesity and periodontitis. J. Dent. Res. 2001 80: 1631-1636. 
2. RJ Genco, SG Grossi, A Ho, F Nishimura, Y Murayama. A Proposed Model Linking Inflammation to Obesity, Diabetes, and Periodontal Infections. Journal of Periodontology, 2005 - Am Acad Periodontology. 2005 Nov;76(11 Suppl): 2075-84.
3. Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: a two-way relationship. Ann Periodontol 1998;3(1): 51–61.