Focus on Diabetic Care Issues
Diabetics who show high blood levels of HbA1C above seven do not demonstrate good long-term control of blood sugar. Therefore, they may be more susceptible to oral health problems than non-diabetics. An overview of diabetes management summarizes treatment approaches for a disease that affects 18 million people in the United States. Diabetes is expected to double by 2010, due to aging and increasing obesity in the population. (Golla, K. et al. Diabetes Mellitus: An updated overview of medical management and dental implications. General Dentistry. Nov/Dec 2004: 529-535.)
Key facts women dental professionals should consider when providing oral care for diabetics:
Each dental office should have a glucose testing meter and fast acting glucose readily available for their diabetic patients.
Women dentists should be able to manage the immediate and long-term needs of their diabetic patients. They should take a thorough medical history, have the name of the treating physician, and keep a phone number of that physician in the patient file.
Oral health complications of diabetics can include a number of abnormal findings. These include dry mouth, oral infections or lesions, increased risk for decay and periodontal disease, and delayed wound healing. Water intake, chewing sugarless gum, and customized care regimens can assist with dry mouth.
For poor wound healing of diabetics, antibiotics may speed healing. Consultation with a physician may be needed for major surgical procedures for a team approach to care.
Morning dental appointments may be preferable for diabetic patients because blood glucose levels tend to be lower at this time. Dental procedures should be short, with low stress and pain control optimal.
Diabetic patients should eat and take medications as directed before a scheduled appointment. Patients should be encouraged to eat normally, follow a normal daily routine, and stay relaxed to prevent a hypoglycemic reaction following a dental procedure.
If blood sugar is not under control or HbA1C is high, women dentists may wish to consult with the patient’s physician and coordinate care with the physician for any surgical procedures and timing of elective dental care.
Stroke & Oral Health
Stroke is the third leading cause of death in the United States today and the leading cause of serious disability. A case report notes that a dentist detected calcifications of a carotid artery in a routine panoramic x-ray. He referred the patient to his primary care physician for further testing and ultimately a Carotid Duplex Ultrasound. The test revealed 80 percent stenosis of the carotid artery. Risk factors for stroke include high blood pressure, heart disease, tobacco use, diabetes mellitus and cholesterol. (Almog, Dov. et al. The role of panoramic radiographs in the medical surveillance of a patient at risk for stroke: a case report. General Dentistry. Nov/Dec 2004: 514-516. ) Women dentists are encouraged to submit additional case reports of a similar nature.
C-reactive Protein Important in Reducing Heart Risk
Two articles in the New England Journal of Medicine confirm the importance of lowering C-reactive protein, as well as reducing low-density lipoprotein (LDL) with statin treatment. Ridker’s team analyzed 3,745 patients and compared two cholesterol-lowering drugs, Lipitor and Pravachol. Ideally, C-reactive protein levels below two milligrams per liter of blood can reduce the risk of recurrent heart attacks or of dying from heart attack or stroke by another 50 percent. Nissan’s team analyzed the blood of 502 coronary patients at baseline for 18 months. The group took the two cholesterol-lowering drugs. It was learned that aggressive statins use resulted in less atherogenic lipoproteins and C-reactive protein levels. (Ridker, P et al. C-Reactive Protein Levels and Outcomes After Statin Therapy. NEJM. January 6, 2005. 352:20-28. Nissan, S. Statin Therapy, LDL Cholesterol, C-Reactive Protein and Coronary Heart Disease. NEJM. January 6, 2005. 352: 29-38.)
New Pain Medication Developments
Last year, the FDA withdrew Vioxx and Celebrex and released data that demonstrates that these drugs are no more effective than traditional NSAIDs (non-steroidal anti-inflammatory agents) and aspirin. This makes prescribing pain medication for chronic oral pain or after major dental care more straightforward. A new class of drugs may be important for oral trauma or major dental surgery. This class is known as N-type calcium channel blockers, with the generic name of ziconotide or Prialt. The drug is expected to become available in January through the Elan Corporation.
Moms May Be Key to Toddler Oral Health
A recent pilot study of 18 families investigated the tooth brushing behavior of parents and toddlers. Using videotapes of all brushing sessions among a select group of families, investigators found that 89 percent of the families had at least two sessions per day, which were usually supervised by mothers. The average age of toddlers was 2.5 years. While the length of sessions averaged 142 seconds, the brush was in the child’s mouth only about half that time. These families had high dental IQs because they were already enrolled in an ongoing prevention-intervention study in the UK. Investigators found that on average, 10 seconds was spent brushing the anterior teeth, 13 seconds on posterior teeth, and 29 seconds on non-brushing behavior, such as biting the brush or sucking water. Despite the fact that such a short amount of time was spent brushing, parental feedback indicated that they were generally confident that the session had been effective. The authors concluded that home-based brushing with fluoride may be insufficient to be effective in decay prevention among toddlers. Larger studies are needed to address the role of mothers and proper training in brushing of infants and toddlers. (M.S. Zeedyk, C. Longbottom, N.B. Pitts, “Tooth-Brushing Practices of Parents and Toddlers: A Study of Home-Based Videotaped Sessions. Caries Research, 39: #1:27-33. (DOI: 10.1159/000081653)
Military Reservists Don�t Have Dental Care Along With Other Americans
A recent New York Times article noted that some military recruits are not deployable due to poor oral health. A recent Government Accounting Office analysis of seven U.S. Army units slated for Iraq noted that a quarter of reservists had oral problems that could cause an emergency in the next year. They may not fare better than the general population, with only 39 percent of employed persons having dental insurance. Since only about half of the U.S. adult population has any form of dental insurance, addressing the double standard of care is a high priority of the American Dental Association this year, according to president Richard Haught. (http://www.iht.com/articles/2004/12/28/news/teeth.html)
New Book on Latest Caries Research
A new book that describes advances in caries research, titled “Cariology in the 21st Century,” is available free. Noting the change in dentistry from surgical intervention to the physician type model of dental practice, the book outlines research on early caries, diagnosis of caries, and primary prevention for clinical practice. Edited by B. Nyvad, J. van Cate and C. Robinson of the European Organization for Caries Research (ORCA), the book presents the emerging paradigm of prevention and treatment in the management of dental caries as an infectious, multifactoral, controllable disease throughout the lives of individuals. Go to: http://content.karger.com/ProdukteDB/produkte.asp?Aktion=JournalHome&ProduktNr=224219.
Evidence-Based Dentistry for Burning Mouth Not Available
In November 2004, the Cochrane Collaboration released an update of an evidence-based review (EBD) of Interventions for the treatment of burning mouth syndrome (BMS). Reported prevalence rates of BMS in selected populations range from .7 percent to 15 percent. Six trials were reviewed - two of antidepressants, and one each of behavioral therapy, analgesics, hormone replacement therapy, and vitamin therapy. Only trials with cognitive behavior therapy and vitamins were found to be somewhat effective in reducing symptoms of BMS. The authors state that there is little research evidence for providing guidance for treatment of patients with BMS. Further trials of high methodological quality should be undertaken to establish effective forms of treatment for patients with BMS. (Zakrzewska JM, Glenny AM, Forssell H. Interventions for the treatment of burning mouth syndrome (Cochrane Review). In: The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiley & Sons, Ltd.)
