Diabetes and Oral Health – A Two-Way Relationship of Clinical Importance
Diabetes and Oral Health – A Two-Way Relationship of Clinical Importance
Introduction
Diabetes
mellitus (DM) is a multisystemic metabolic disorder characterized by abnormal
carbohydrate, protein and lipid metabolism. The cardinal biochemical feature of
this disease is hyperglycemia, resulting from either a defect in insulin
secretion from the pancreas, a change in insulin action, or both. Chronic
hyperglycemia results in widespread multisystem damage, collectively referred
to as, ‘Diabetic complications,’ which include retinopathy, neuropathy, nephropathy,
macrovasular disease and delayed wound healing. Diabetes is a looming health
issue, constituting a huge global public health burden that is predicted to
afflict 300 million people globally by 2025 and at least 366 million people by
2030.
Diabetes
mellitus alters the cellular microenvironment in multiple organ systems,
including the eyes, nerves, kidneys, and blood vessels. Oral cavity is not an
exception. Diabetes has profound effects on oral tissues, particularly in
individuals with poor glycemic control.
The American Diabetes Association has proposed
a classification scheme based on disease etiology, which includes two major
forms — Type 1 and Type 2 diabetes. Type 1 disease includes type A
(immunemediated) and type B (idiopathic) DM. Type 2 includes the most common
form, which combines insulin resistance and the insulin secretory defect. Other
specific forms are diabetes secondary to autoimmune endocrinopathies, infection
(congenital rubella, cytomegalovirus, coxsackie virus), genetic disease, and DM
induced by drugs or pregnancy.
Pathophysiology
of Diabetes Mellitus
Type
1 diabetes is caused by insulin deficiency, due to autoimmune destruction of
pancreatic β-cells mediated by T cells and humoral mediators (Tumor necrosis
factor, Interleukin-1, Nitric oxide). The pathophysiology of Type 2 diabetes is
characterized by β-cell dysfunction, with relative insulin deficiency and
peripheral insulin resistance.
Prevalence of Diabetes Mellitus
According to W.H.O.
about 422 million people worldwide have diabetes, the majority living in
low-and middle-income countries and 1.6 million deaths are directly attributed
to diabetes each year. Both the number of cases and the prevalence of diabetes
have been steadily increasing over the past few decades. India is home to
the second-largest number of adults with diabetes worldwide throwing several
socio-economic and financial challenges. In 2019, the countries with the
largest numbers of adults with diabetes in the age bracket 20–79 syears
were China, India and the United States and are anticipated to remain so in
2030. In India, the number of people with diabetes is expected to rise from 77
million in 2019 to 101 million in 2030 to 134 million in 2045. India also ranks
second in the number of people with undiagnosed diabetes: China (65.2 million);
India (43.9 million) and the United States (11.8 million).
With the rising trajectory of diabetes in India, there is a need for more effective health policy interventions. The National Health Policy 2017 aims to increase screening and treatment of 80 percent of people with diabetes and reduce premature deaths from diabetes by 25 percent by 2025. This, however, entails a relook at the existing strategies and devising new measures for arresting the growth. .
Results from a study conducted by the Indian Council of Medical research reported that less population is affected in states of Northern India (Chandigarh 0.12 million, Jharkhand 0.96 million) as compared to Maharashtra (9.2 million) and Tamil Nadu (4.8 million). The National Urban Survey conducted across the metropolitan cities of India revealed the prevalence of diabetes is 11.7% in Kolkata, 6.1% in Kashmir Valley, 11.6% in New Delhi and 9.3% in Mumbai compared with 13.5% in Chennai, 16.6% in Hyderabad and 12.4% Bangalore.
Diabetes and Oral Health - A Two Way Relationship
Diabetes mellitus/hyperglycemia adversely
affects oral health
2.1. Periodontal diseases
Hyperglycemia adversely affects all soft and hard tissues of the periodontium. So compared to their normoglycemic counterparts, people with diabetes mellitus, especially poorly controlled, have more gingivitis, both adolescents and adults, especially seniors ages 65 years and older; greater prevalence and severity as well as progression of periodontitis and have lost many more teeth, the ultimate result of unmanaged periodontitis.
Periodontitis refers to inflammation of the tissues that surround and support the teeth. It is the most common chronic oral infection and often the major cause of tooth loss. Diabetes, particularly type 2 diabetes, is considered a risk factor for periodontitis. Periodontitis has been reported as the sixth complication of diabetes. The proposed mechanisms that explain the biological association between these diseases include, (1)microvascular alterations, (2) changes in components of gingival crevicular fluid, (3) changes in collagen metabolism, (4) altered host response, (5) altered subgingival flora, (6) genetic predisposition and (7) non-enzymatic glycation. Not only does diabetes affect the periodontium, but evidence also suggests that periodontal infection may adversely affect the glycemic control of diabetes. Periodontal therapy has shown reasonable improvement in glycemic control in diabetic patients with periodontitis.
2.1.1. Peri-implant diseases
Peri-implant
mucositis is akin to gingivitis and is a reversible inflammation in only the
soft tissue, whereas peri-implantitis is similar to periodontitis with
permanent breakdown of soft and hard tissues around the implant. The latter
will most likely lead to eventual loss of the implant. People with diabetes had
about 50–90% greater risk for periimplantitis than their peers without diabetes
(risk ratio (RR) = 1.46; 95% CI: 1.21–1.77 and OR = 1.89; 95% CI: 1.31–2.46; z =
5.98; p < 0.001). Diabetes may be a risk factor for peri-implantitis,
independent of smoking. Such potential risk should be included – along with the
general description of the unconditional need for life-long meticulous implant
care – in any treatment plan and discussion with patients with diabetes.
The evidence for links between hyperglycemia and caries is inconclusive in children with type 1 diabetes, as well as people of all ages with hyperglycemia. Some researchers find diabetes or elevated glucose levels in saliva, or in serum to be associated with more caries, while others find no difference. Children with type 1 diabetes in good metabolic control might even be considered at low caries risk, while those with poor metabolic control show a more acidic oral environment prone to a high risk of caries.
Based on examination of 8173 Kuwaiti adolescents (mean age: 10.0 years), Goodson and colleagues also suggest dysbiosis in the oral microbiome – with lower diversity and abundance due to acidification of the oral environment in obesity and type 2 diabetes – may predict high salivary glucose levels, which in combination with the acidity predisposes to both caries and enamel erosion. When the carious lesion is so deep that it involves the pulpal tissues, endodontic treatment with obliteration of the root canal is needed. If not provided, the tooth eventually might need extraction.
2.2.1. Periapical lesions
Even though people with diabetes do not necessarily have more caries, except possibly if diabetes is poorly controlled they experience greater risk of periapical lesions in the jaw bone that seem to be present more often and to be larger in size and take longer to heal compared to normo-glycemic people, especially when poorly controlled. However, people with diabetes have more such periapical lesions, both after endodontic treatment and after untreated pulpal death, possibly due to their diminished immune response. Such periapical lesions are only visible on radiographs and only after sufficient amounts of bone tissue is demineralized. The only clinical manifestation of such infection around the root tip is the case in which pus exudes through the oral mucosa, or rarely, via an abscess in the neck.
Periapical lesions, also known as periapical periodontitis, are regarded a likely complication of diabetes, although the scientific literature is still scarce. A critical 2017 review identified nine studies that together provided a trend towards an association between diabetes and periapical periodontitis.
2.3. Early tooth eruption
Children
aged 10–14 years with diabetes experience accelerated tooth eruption compared
to normo-glycemic children, especially among girls, potentially leading to
malocclusion, impaired oral hygiene, periodontal disease, and caries due to the
prolonged exposure in the oral cavity. As well, caregivers may not notice the
first permanent molars that erupt behind the primary (‘‘baby”) teeth, thus
preventing any careful oral hygiene measures or provision of dental sealants of
these teeth.
2.4. Dry mouth
People with diabetes often suffer from hyposalivation, a decreased salivary output, that may be due to diabetic neuropathy, changes in the salivary glands generated by prolonged hyperglycemia, polyuria, or radiation to the head and neck region without proper protection to the contra-lateral side. Both unstimulated and stimulated salivary flow rates were also significantly lower in children aged 10–15 years with type 1 diabetes compared to healthy children. Moreover, all major medication drug groups have the potential to lead to dry mouth. Hyposalivation can cause salivary changes, such as increased concentration of glucose and mucin and changes in viscosity and decreased production of antimicrobial substances and hence contribute to oral diseases, such as taste disturbance; halitosis (foul breath); coated tongue; fissured tongue; periodontal diseases; peri-implantitis; caries; delayed wound healing; predisposition for oral mucosal lesions, such as candidiasis and lichen planus and problems keeping removable (upper) dentures in place.
With decreased saliva levels, its cleansing, lubricating, digestive, and antimicrobial properties are diminished and hence speaking, biting, chewing, and swallowing are impeded and the risk of infection increased. It should be noted that xerostomia is not directly related to hyposalivation, so that patients with decreased salivary output may not feel or complain of dry mouth and people experiencing xerostomia may not have objectively measured hyposalivation. Therefore, the provider needs to inquire about dry mouth.
2.5. Tooth loss
Consistently in the body of scientific literature, people with diabetes are reported to have lost more teeth – usually about double as many – than their peers without diabetes in cross sectional studies. Greater tooth loss in participants with diabetes is also reported in prospective studies. For instance, people with diabetes (HbA1c 6.5%) had a significant 3-fold (odds ratio (OR): 3.1; 95%CI: 1.03–10.89) greater risk of losing teeth over a 5-year study in Brazil. Similarly, postmenopausal women in New York State with a history of diabetes had 2.5 greater risk for tooth loss over a mean of 5.1 years follow-up (OR = 2.45; 95% CI: 1.26–4.77).
2.6. Candidiasis
Oral
candidiasis, also named thrush, is found more often in people with diabetes,
especially poorly controlled, compared to people without diabetes. Oral candida is an infection of the yeast
fungus C. Albicans. As a result of side effect of taking medications such as
antibiotics, antihistamines or chemotherapy drugs. Other disorders are
associated with the development of xerostomia which includes diabetes, drug
abuse, malnutrition, immune deficiencies and old age. In almost half of the
population, Candida is present in the oral cavity and has been shown more
prevalent in people with diabetes as well. Studies have shown a higher
prevalence of candida in diabetic versus non diabetic individuals. In a study
of children aged 3–18 years in Poland, only those with type 1 diabetes or
nephrotic syndrome developed Candidiasis, despite Candida species were found
also in the systemically healthy control group.
Oral Candidiasis in Upper Palate
2.7. Delayed wound healing
Poor
glycemic control in type 2 diabetes is often cited as a risk factor for delayed
wound healing. However, some studies report not finding such delay, for
instance upon tooth extraction. Importantly, the wound healing upon extraction
of uninfected, erupted teeth was not disturbed by infections, hence antibiotics
should not be prescribed only due to having type 2 diabetes nor due to the
level of glycemic control.
2.8. Iron precipitation in dental
tissue
A
novel effect of hyperglycemia is deposit of iron elements in the dentin inside
the tooth that is covered by the enamel on the crown, but not on the root. Such
deposits can cause stain seen through the enamel and cause aesthetic issues.
Such deposits might in the future be used for early indication of undiagnosed
dysglycemia by dentists.
2.9. Burning mouth syndrome
Burning
mouth syndrome is a chronic, oral pain associated with burning sensations of
the tongue, lips and mucosal regions of the mouth. The pathophysiology is
idiopathic but can be associated with uncontrolled diabetes, hormone therapy,
psychological disorder, neuropathy, xerostomia, and candidiasis. Moore PA 2007
conducted a study in Pittsburgh to know burning mouth syndrome and peripheral
neuropathy among type 1 diabetes mellitus patients reported that BMS or related
discomforts occurred slightly more frequently among type 1 diabetes mellitus
than in the control group.
2.10. Oral lichen planus
Oral
lichen planus is a chronic inflammatory disease that causes bilateral white
striations, papules or plaques on the buccal mucosa, tongue, and gingiva.
Erythema, erosions, and blisters may or may not be present. The pathogenesis is
unknown for the disorder. Evidence suggested that lichen planus is a T cell –
mediated autoimmune disease in which cytotoxic CD8+ T-cells trigger apoptosis
of the oral epithelial cells. Microscopically, a lymphocytic infiltrate is
composed of T-cells and many of the T cells in the epithelium are activated
CD8+ lymphocytes. Lichen planus may predispose individuals to cancer and oral
C. Albicans superinfection. Fewer than 5% of these patients will develop oral
squamous cell carcinoma (SCC) (Atrophic, Erosive and plaque lesions) may
develop a greater risk of malignant change, although SCC may arise in the
unaffected oral mucosa. A study among 40 lichen planus patients reported that
11 patients had latent diabetes, compared with none in the control group.
2.11. Oral cancer
Just
like cancers at several body sites, oral cancer and precancerous lesions are
more prevalent among people with type 2 diabetes, with an overall 15% (and 85%
for case studies only) excessive risk compared to people without diabetes as
reported by a 2015 systematic review. Among people with periodontitis, those
also suffering from diabetes had 2.5 times (adjusted OR (aOR) = 2.52; 95% CI:
1.22–5.18) greater risk for oral squamous cell carcinoma than those with only
periodontitis. Furthermore, women may be at greater risk than men, having a 13%
excess risk as reported by a 2018 systematic review. A significant association
between diabetes and pre-malignant oral lesions was found only in women, but
not in men, in a large study in India. Compared to women without diabetes and
upon adjusting for potential confounders, those with diabetes had double the
risk for oral leukoplakia (OR = 2.0; 95% CI: 1.4–2.9) and more than three times
the risk for erythroplakia (OR = 3.2; 95% CI = 1.3–7.9).
2.12. Diabetes complications
2.12.1. Diabetic neuropathy
Diabetic
neuropathy can lead to burning mouth syndrome (glossodynia), taste impairment
(dysgeusia), and hyposalivation that causes mouth (a risk factor for both
periodontal diseases and caries) – and possibly a feeling of mouth dryness
(xerostomia). Diabetic neuropathy is also associated with periodontitis in type
2 diabetes, in a dose-response manner.
2.12.2. Diabetic retinopathy
The
severity of diabetic retinopathy and the severity of periodontitis are
associated, as are retinal and gingival hemorrhaging , in a dose-response
manner with levels of HbA1c.
2.12.3. Diabetic nephropathy
Periodontitis
is also associated with diabetic nephropathy. A study among 207 patients with
type 2 diabetes in India reported periodontitis to be associated with glycemic
control and diabetic nephropathy.
2.13. Osteonecrosis of the Jaw (ONJ)
DM is an established risk factor for ONJ in general and medication-related ONJ (MRONJ). Microvascular complications (angiopathy, ischemia, endothelial cell dysfunction) impair blood circulation and hence bone nutrition and quality with reduced remodeling. DM also causes increased apoptosis of osteoblasts and osteocytes and changes in immune cell function, promoting inflammation.
2.14. The oral microbiome in health, prediabetes, and manifest diabetes
The
oral microbiome refers to the community of microbes that populate the oral
cavity, also referred to as the oral microbiota. However, its composition
varies between various sites in the mouth, such as on the teeth, in the pockets
between the teeth and the gingiva, the dorsum of the tongue, the cheeks, etc..
Furthermore, at the microbiome level, the composition and abundance of
commensal (usually inhabiting) bacteria in the dental plaque in the pockets
between the gums and the teeth varies with level of hyperglycemia. It is even
possible to discern differences between prediabetes and normoglycemia in
diabetes-free adults and between diabetes, obese without diabetes, and normal
weight adults, ‘‘suggesting that the oral microbiome may play an important role
in diabetes etiology” – although it is also possible that the varying glucose
concentrations affect the types and abundance of microbes.
A
study conducted in Mauritius found oral dysbacteriosis in people with type 2
diabetes whose saliva flow rate and buffer capacity were decreased compared to
their healthy peers. That is, those with hyperglycemia of long duration
harbored a higher abundance of the cariogenic bacterium Streptococcus mutans and
intriguingly, the participants with cardiac disease had even twice the
abundance of Streptococcus mutans. The authors suggest such dysbiosis in the
salivary microbiome may play a role in heart disease in these people with diabetes.
2.15. Quality of Life
DM decreases QoL with a further decrease in oral health-related QoL (OHRQoL). Importantly, QoL correlates strongly with OHRQoL, so treating oral diseases increases QoL in Diabetes Mellitus.
3. Oral health adversely affects
diabetes mellitus/ hyperglycemia
3.1. Periodontitis
The
first systematic review of effects of periodontitis on diabetes mellitus
included only studies in which effect directionality could be determined and
concluded in 2013 that the scientific evidence suggests that periodontitis
adversely affects glycemic control and diabetes complications or promotes
development of type 2 diabetes. People with manifest type 2 diabetes,
pre-diabetes, or no known diabetes, who have poorer periodontal health, have poorer
glycemic control than those with better periodontal health. Moreover, people
with diabetes, who have poorer periodontal health, have more diabetes-related
complications than those with better periodontal health.
Another
2018 systematic review concluded that people with professionally diagnosed
periodontitis and clinically assessed diabetes had almost three times greater
prevalence (17.3% versus 6.2%) and more than twice the risk (OR = 2.27 (95% CI:
1.90–2.72) of having diabetes than their periodontitis-free peers .
Analyses
of claims data from the nationwide insurance program in Taiwan demonstrated
that those with periodontitis who needed periodontal surgery (n = 22,299) had
about 29% greater risk of developing type 2 diabetes within 2 years than those
with less severe periodontitis not in need of intrusive treatment (n = 22,302).
Random fasting blood sugar levels are found to
increase with increasing severity of periodontitis. Hitherto unknown
dysglycemia (elevated HbA1c level) was found more often in people with
periodontitis compared to those with a healthy periodontium in a Danish study.
People
with periodontitis and type 2 diabetes have elevated levels of inflammatory
markers in both serum and in the inflammatory exudate in the periodontal
pockets called gingivo-crevicular fluid, compared to having type 2 diabetes
with healthy periodontium.
3.2. Caries
During
the phase of active dental caries of a substantial extent, there should be
sensitivity to hot/cold temperatures, sweet/sour tasting food items and drinks,
as well as pain during mastication. Subsequent problems with eating a healthy
diet should conceivably lead to poorer diet and poorer nutrition and hence
poorer glycemic control. However, there seems to be a void in the scientific
literature to specifically support such hypothesis. Nonetheless, the subsequent
periapical periodontitis decreases insulin sensitivity.
3.3. Tooth loss
The
ultimate result of untreated periodontitis and caries is tooth loss. Missing
teeth – or having teeth that hurt either spontaneously or during biting off or
mastication due to being mobile (loose) – leads to trouble eating (biting,
chewing, and swallowing) and hence decreases the intake of a healthy diet with
fruit and vegetables that often are crisp and hard to bite off and chew. This
subsequently can lead to intake of soft foods, often laden with fat, sugar and
salt – exactly what people with diabetes should try to avoid. For example, the
risk for metabolic syndrome was 54% greater in 75–80-year old Japanese with 0–9
teeth remaining, compared to those with 20–28 teeth.
Similarly,
tooth loss was strongly associated with impaired glucose metabolism in
middle-aged Finnish women during 46-years follow up. Even modest tooth loss
represents increased risk for diabetes in Finns. The direction of this
association can be questioned, that is, which is the agent and which is the
outcome. Likely, this is a two-way relationship.
It
should be noted that prolonged hyperglycemia is found to lead to glycated
substances in the cementum, which is the thin layer that cover the root of the
tooth and into which the connective tissue fibers that keep the teeth in their
bone socket attach. This likely causes alterations in the cementum that impairs
the normal attachment ability and ultimately can lead to tooth loss.
3.4. Oral diseases other than
periodontitis
Any acute or chronic disease or condition in
the oral cavity that involves infection and its subsequent local as well as
systemic inflammatory responses possesses the ability to increase the blood
glucose level. Hence, frequent oral inspections for any such oral diseases
would be prudent as part of any diabetes management, followed by any pertinent
referral.
4. Periodontal treatment positively
affects diabetes mellitus/hyperglycemia and its complications
4.1. Periodontal treatment: effect
on glycemic control
Non
Surgical Periodontal Treatment (Deep Cleaning) reduces the level of inflammatory
biomarkers in both gingivo-crevicular fluid (inflammation exudate in the
periodontal pocket), saliva, and serum. A systematic review concluded that
periodontal therapy in type 2 diabetes leads to significant decreases in the
inflammatory markers tumor necrosis factor-alpha (TNF-a) and C-reactive protein
(CRP). Another systematic review found a decrease in interleukin-6 (IL-6) when
controlling for obesity.
A
more recent, well designed and well executed randomized clinical trial (n = 134
cases, n = 131 controls) was conducted in the United Kingdom and hence may be
regarded as definitive in answering the question regarding whether
(non-surgical and surgical) periodontal treatment can affect the HbA1c levels
in people with type 2 diabetes. Both study groups had a baseline HbA1c of 8.1%.
D’Aiuto and colleagues reported that after 12 months, the HbA1c level in the
test group receiving intensive periodontal treatment with 3-monthly maintenance
visits decreased by 0.3 percentage point since baseline, which was 0.6
percentage point lower than the control group receiving only tooth polishing in
which HbA1c increased to 8.3% after 12 months. Hence, periodontal treatment may
not only decrease the blood sugar level, but also aid in diabetes control not
deteriorating over 12 months.
4.2. Extraction of periodontally
diseased teeth: effect on glycemic control
Full-mouth
tooth extraction of teeth with terminally advanced periodontitis leads to
decreases in local and systemic inflammatory biomarkers and a significant
decrease in HbA1c levels in type 2 diabetes. For example, in a study conducted
in Jordan, the HbA1c level dropped from 8.6% at baseline to 7.4% three months
post-extraction and was 7.3% after 6 months. The control group that did not
have all teeth extracted had mean HbA1c values of 7.7% at baseline and 7.5% after
3 as well as 6 months.
4.3. Periodontal treatment and
health care costs
Based
on the Global Burden of Disease Study, direct dental treatment costs were
estimated at US$298 billion annually, corresponding to an average of 4.6% of
global health expenditure. Indirect costs (productivity losses due to
absenteeism from work) due to dental diseases worldwide amounted to US$144
billion yearly, suggesting that the global economic impact of dental diseases
amounted to US$442 billion in 2010.
Among
older Japanese persons with diabetes, the monthly medical expenditures were
much greater among those with more extensive periodontitis (16,348 JPY)
compared to those with less periodontitis (6904 JPY). Similarly, in a US
insured population, insureds who received periodontitis treatment incurred
significantly higher medical costs expressed as per member per month than
enrollees who received gingivitis treatment, dental maintenance services, other
dental services, or no dental services.
Periodontal
treatment is estimated to decrease annual heath care costs in people with newly
diagnosed type 2 diabetes in the US, namely by $US 1799 per person for total
health care costs, $US 1577 for medical costs except for pharmacy costs and by
$US 408 for diabetes-related costs.
Based
on people in the US with a dental, but no medical, visit the last 12 months,
chairside screening in the dental office for diabetes, hypertension, and
hypercholesterolemia could save the health care system from $42.4 million to
$102.6 million over 1 year.
Proper
dental care
To help prevent damage to your teeth and gums, take diabetes and
dental care seriously:
· Make a commitment to manage your diabetes. Monitor your
blood sugar level and follow your doctor's instructions for keeping your blood
sugar level within your target range. The better you control your blood sugars,
the less likely you are to develop gingivitis and other dental problems.
· Brush your teeth at least twice a day. Brush in the
morning, at night and ideally, after meals and snacks. Use a soft-bristled
toothbrush and toothpaste that contains fluoride. Avoid vigorous or harsh
scrubbing, which can irritate your gums.
Consider using an
electric toothbrush, especially if you have arthritis or other problems that
make it difficult to brush well. Get a new toothbrush at least every three
months.
· Floss your teeth at least once a day. Flossing helps
remove plaque between your teeth and under your gumline. If you have trouble
getting dental floss through your teeth, use the waxed variety. If it's hard to
manipulate the floss, use a floss holder.
· Schedule regular dental visits. Visit your
dentist at least twice a year for professional cleanings, X-rays and checkups.
· Make sure your dentist knows you have diabetes. Every time you
visit your dentist, remind him or her that you have diabetes. Make sure your
dentist has contact information for your doctor who helps you manage your
diabetes.
· Look for early signs of gum disease. Report any signs
of gum disease — including redness, swelling and bleeding gums — to your
dentist. Also mention any other signs and symptoms, such as dry mouth, loose
teeth or mouth pain.
· Don't smoke. Smoking increases the risk of serious diabetes
complications, including gum disease and ultimately, loss of your teeth. If you
smoke, ask your doctor about options to help you quit.
Managing
diabetes is a lifelong commitment and that includes proper dental care. Your
efforts will be rewarded with a lifetime of healthy teeth and gums.
Conclusion
Diabetes mellitus affects all age people and its
prevalence has been increasing. To provide safe and effective oral medical care
for diabetic patients needs to understand the disease and should be familiar
about its oral manifestations. The goal of therapy is oral health promotion in
diabetic patients and prevention and diagnosis of diabetes in dental patients
who are receiving routine stomatological care and enhancing the quality of life
for patients.
Goal of dental health care is to maintain a healthy
dentition for the purpose of aesthetics, dietary intake, nutrition, and quality
of life. More dental care should be focused on efficient, preventive, and
therapeutic management for public awareness and education efforts. The dentist
plays a major role with allied members of the health team in helping a patient
maintain glycemic control by properly treating oral infections and by
instructing the patient with diabetes to maintain rigorous oral hygiene and a
proper diet. The dental practitioner also plays a role in referring undiagnosed
diabetic patients to a physician for evaluation. Finally, as an integral member
of the team, the dentist can counsel patients with diabetes to stop smoking a
risk factor that may exacerbate some of the vascular complications associated
with diabetes.
Dr. Mayank Chandrakar is a writer also. My first book "Ayurveda Self Healing: How to Achieve Health and Happiness" is available on Kobo and Instamojo. You can buy and read.
For Kobo-
https://www.kobo.com/search?query=Ayurveda+Self+Healing
The second Book "Think Positive Live Positive: How Optimism and Gratitude can change your life" is available on Kobo and Instamojo.
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