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Dental professionals vital part of diabetes treatment team

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Annual Meeting of the CDA/CSEM

TORONTO — Dental practitioners should be active in the treatment of diabetes because of the detrimental effects of gum disease on glycemic control, according to Doug Brothwell, DMD, MSc, who gave a presentation here on the link between smoking, periodontitis and diabetes.

"Dentists and dental hygienists are not usually part of the [diabetes treatment] team, but they need to be," said Brothwell, who is associate dean of the Faculty of Dentistry at the University of Manitoba in Winnipeg, Manitoba, Canada.

In addition, he said health practitioners should screen patients with diabetes for periodontal disease by using the acronym BUG (Bleeding gums, Unsteady teeth and Gum recession).

Those with diabetes tend to get more gum disease, causing a source of inflammation where chemicals are released into the bloodstream, according to Brothwell. Those chemicals create insulin resistance by inhibiting cells' ability to use insulin to uptake sugar.

Published research shows that patients with diabetes are two to three times more likely to develop periodontitis compared with nondiabetic patients and are 15 times more likely to lose their teeth, he said.

Research from the National Health and Nutrition Examination Survey III showed that more than half of cases of periodontitis in the United States were attributable to current or former smoking. According to Brothwell, smoking cessation is a way for patients with diabetes to avoid periodontitis.

He said treating periodontitis in patients with diabetes reduces elevated glucose levels. A meta-analysis published in Diabetes & Metabolism in 2008 demonstrated that periodontal therapy resulted in a mean HbA1c reduction of 0.46, about 13%.

Left untreated, however, periodontitis can cause tooth loss, which increases the likelihood that patients will avoid eating raw and fresh fruits and vegetables, and instead turn to unhealthy, high-carbohydrate foods, which is detrimental to blood sugar control, Brothwell said.

For more information:

• Brothwell D. #3. Presented at: Annual Meeting of the Canadian Diabetes Association/Canadian Society of Endocrinology and Metabolism; Oct. 26-29, 2011; Toronto.
• Darré L. Diabetes Metab. 2008;34:497-506.

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