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The Not So Sweet Truth about Diabetes

Today Diabetes affects 29+ million adults in the US and the US Centers for Disease Control and Prevention has estimated that by 2050 we that number will grow to 105 million—one in three adults!  Our country faces the paralyzing cost of treatment as well as the loss of productivity that goes hand-in-hand with chronic illness. Diabetes is the single biggest thief of eyesight, kidney function and limbs.

So how does this impact us as dentists and hygienists? 

First, we can help take identify patients with unknown type 2 diabetes.  It might surprise you to know that 20 million US adults have diabetes and don’t know it!  With early identification and a treatment referral we can preempt the loss normal body function such as vision, our ability to fend off bacterial infection, penile rigidity, periodontal disease and the list goes on.

Second, we can help identify insulin resistance and pre-diabetes.  86 million of us have pre-diabetes and don’t know it. With health coaching in the dental office we can help our patients turn things around even before they need a medical remedy. Keep in mind that unless the patient has a medical team that focuses on prevention and behavior modification, the medical team is usually indifferent about a diagnosis of pre-diabetes.  It is not until the patient needs medication for type 2 diabetes that the physician engages the patient about the disease.

Third, by identifying and preempting further disease, your dental office can become a practice of distinction in your community, attracting health-valuing patients.  By communicating your results with medical teams your practice can also bridge the gap between medicine and dentistry, and increase referrals from the medical community.

Fourth, and perhaps most important, knowing a patient’s glycemic status is quickly becoming our professional obligation.  Here’s why: Diabetes Mellitus has a bi-directional relationship to periodontal disease. That is, each of these diseases makes the other worse.

If your patient lacks glycemic control, which includes the unknown diabetic patient, his/her periodontal disease will likely be more pronounced, result in more rapid bone destruction and be more systemically threatening. In addition, patients with poor glycemic control will likely fail to respond to traditional periodontal therapy.

In the other direction, the presence of periodontal infection (like any other infection in the body of an unstable diabetic) will interrupt his/her ability to achieve glycemic control.

Our Pending Responsibility

By 2050, when one in three of us are projected to be diabetic.  Periodontal disease likewise increase in severity and prevalence, to well above the 70+% cross section of US adults who are now affected.

If we accept the idea that we can not safely or effectively treat periodontal disease in an uncontrolled diabetic, then perhaps it is already our responsibility to know the glycemic status of each and every patient with periodontal disease. And if patient has a disease history of diabetes and has periodontal disease, isn’t it our responsibility to monitor the patient’s A1C while continuing to manage the patient’s periodontal disease/stability?  

It seems so.  The good news is, we now have the technology available to achieve fast and accurate A1C testing, from a finger stickblood test, right in the dental office. And

Consider the financial benefit as well. A recent United Concordia study revealed that if 60% of our diabetic patients better managed their gum disease the US medical cost savings would be $39 billion per year—or $1845 per patient.

It’s time for us to bridge the gap!  By working with the patient’s medical team, hand-in-hand, we can better control both diabetes and periodontal disease.

AAOSH Nashville, TN

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