Oral health & Diabetes, Steven Steed, DDS -- Utah Telehealth Program


Published on

Wednesday, June 16, 2010


Steven Steed, DDS, is the Dental Director at the Utah Department of Health, and President of the Association of State and Territorial Dental Directors (ASTDD). Dr. Steed has championed efforts in Utah, as well as nationally, in early detection and prevention of dental disease in children. He helped to author the ASTDD “Best Practice Approach to School-based Dental Sealant Programs”, which has become the standard of dental sealant prevention programs nationwide. Dr. Steed works directly with the Utah Dental Association and Utah State Legislature on advancing oral health initiatives. Dr. Steed organized and oversees the Utah Oral Health Coalition, whose mission is to increase community awareness of oral health needs. Dr. Steed is also a member of the Utah Diabetes Advisory Board and seeks to provide awareness on the links between oral health conditions and diabetes. For this program, Dr. Steed will discuss connections between oral health care and diabetes prevention and care.

Program Description: The Utah Diabetes Telehealth Series is a monthly continuing education program for professionals with interest in the field of diabetes and related conditions. The program is free of charge, always held on the 3rd Wednesday from 12-1pm MDT, and participation is available by video conference, webstreaming, or telephone (as a live, distance learning format).

1 Comment
  • Seems odd that a lot of Americans are so caught up with paying insurance companies to get medical care and dental care. Why not just save the money and use it for actually paying for the cheap medical and affordable dental work that you need. . .Are there any other groups other than OPtumhealth.com (medical) or healthsouk.com (dental, dentistry) that provides an opportunity for people to pay their doctor directly?
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Oral health & Diabetes, Steven Steed, DDS -- Utah Telehealth Program

  1. 1. Oral Health Care and Diabetes Utah Department of Health Oral Health Program June 16, 2010
  2. 2. Oral Health is Part of General Health <ul><li>Cannot be completely healthy without oral health </li></ul><ul><li>Association between chronic oral infections & </li></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Heart disease </li></ul></ul><ul><ul><li>Lung disease </li></ul></ul><ul><ul><li>Stroke </li></ul></ul><ul><ul><li>Low-birth-weight </li></ul></ul><ul><ul><li>Premature births </li></ul></ul>
  3. 3. Periodontal (gum) disease is one of the most common, yet least recognized complications of diabetes.
  4. 4. Why the least recognized? <ul><li>Oral cavity not viewed as a human organ </li></ul><ul><li>Unfamiliarity with the oral cavity </li></ul><ul><li>Little focus in educational literature </li></ul><ul><li>Ambiguous provider role in oral health care </li></ul>
  5. 5. What exactly is periodontal disease?
  6. 6. <ul><li>In a nutshell, it includes gingivitis and periodontitis ….both serious infections that if left untreated can lead to tooth loss. </li></ul>Biology 101
  7. 7. Gingivitis can progress to… ( reversible ) PERIODONTITIS ( not reversible )
  8. 8. Periodontal Disease <ul><li>Red or swollen gums that bleed during brushing and flossing and are tender to the touch </li></ul><ul><li>Gums that have pulled away from the teeth, exposing the roots </li></ul><ul><li>Milky white or yellowish plaque deposits </li></ul><ul><li>Pus between the teeth and gums </li></ul><ul><li>A consistent foul odor from the mouth </li></ul>
  9. 9. What to look for?
  10. 10. Periodontal Disease
  11. 11. Periodontal Disease and Diabetes <ul><li>Nearly 64 percent of adults with diabetes have periodontal disease </li></ul><ul><li>Diabetics are 3 to 4 times more likely to develop periodontal disease </li></ul>
  12. 12. Periodontal Disease: Exacerbation of Diabetes and Potential Initiator <ul><li>PD disrupts glycemic control in diabetics </li></ul><ul><ul><li>associated with pre-diabetic conditions (impaired fasting glucose and impaired glucose tolerance) </li></ul></ul><ul><ul><li>causes insulin resistance (via cytokines) </li></ul></ul><ul><ul><li>impairs glycemic control (increased serum glucose and HbA1c levels) </li></ul></ul><ul><li>Periodontal infections contribute to elevated systemic C-reactive protein (CRP) level </li></ul>
  13. 13. Periodontal Disease (Periodontitis) <ul><li>35% of all Americans have some form of PD (~ 13% have severe disease) </li></ul><ul><li>75% of all Americans have gingivitis </li></ul><ul><li>Progression of gingivitis to PD </li></ul><ul><ul><li>pockets form around the teeth </li></ul></ul><ul><ul><li>pockets gradually deepen and ulcerate </li></ul></ul><ul><ul><li>cumulative surface area of ulcerated pockets increases in size to the palm of a hand </li></ul></ul>
  14. 14. Periodontitis-Induced Hyperglycemia is Reversible <ul><li>Treatment of PD improves glycemic control in diabetics </li></ul><ul><ul><li>~ 1% reduction in HbA1c levels </li></ul></ul><ul><ul><li>~ 50mg/dL reduction in serum glucose </li></ul></ul><ul><ul><li>reduces insulin requirements </li></ul></ul><ul><ul><li>improvements more pronounced in patients with severe PD </li></ul></ul>
  15. 15. Recent Oral Care Guidelines and Screening Tools <ul><li>Primary care provider </li></ul><ul><ul><li>determine date of last oral examination </li></ul></ul><ul><ul><li>emphasize importance of oral hygiene </li></ul></ul><ul><ul><li>educate about diabetes/PD links and effect of PD on glycemic control </li></ul></ul><ul><ul><li>perform oral examination with referral to dentist if PD symptoms present </li></ul></ul><ul><ul><li>advise self-monitoring of oral health and importance of dental visit if symptoms are noted </li></ul></ul><ul><ul><li>promote healthy lifestyle (diet, exercise) and “ABC” goals (A1c, blood pressure, cholesterol levels) </li></ul></ul>
  16. 16. Recent Oral Care Guidelines and Screening Tools <ul><li>Dental provider </li></ul><ul><ul><li>determine date of last medical visit, referral to physician if diabetes symptoms present or if level of control is in doubt </li></ul></ul><ul><ul><li>prevention, early detection, and treatment of PD </li></ul></ul><ul><ul><li>emphasize importance of oral hygiene and provide instruction with regular reinforcement </li></ul></ul><ul><ul><li>advise physician of PD diagnosis and care plan </li></ul></ul><ul><ul><li>monitor response to therapy 4-6 weeks post-treatment and consult physician for reevaluation of HbA1c level </li></ul></ul><ul><ul><li>place patient on recall 2-4 times per year depending on severity of the case </li></ul></ul>
  17. 17. Periodontal Disease and Diabetes <ul><li>Infections affect glucose levels in the blood. </li></ul><ul><li>Diabetes makes periodontal disease worse. </li></ul><ul><li>Treatment of periodontal disease can influence diabetes. </li></ul><ul><ul><li>Decreases insulin needs </li></ul></ul><ul><ul><li>Improves glycemic control </li></ul></ul><ul><ul><li>Decreases complications </li></ul></ul>
  18. 18. Diabetes reduces the body’s resistance to periodontal infections.
  19. 19. Periodontal disease affects the control of diabetes.
  20. 20. Other Dental Complications
  21. 21. Candidiasis <ul><li>Sore white or red areas in the mouth </li></ul><ul><li>Not enough saliva and too much sugar in the saliva allow the fungus to cause candidiasis or thrush </li></ul>
  22. 22. Candidiasis
  23. 23. Treatment for Candidiasis <ul><li>Topical Rinses </li></ul><ul><li>Topical Creams </li></ul><ul><li>Pastilles/Troches </li></ul><ul><li>Systemic Drugs </li></ul>
  24. 24. Lichen planus
  25. 25. Treatment for Lichen Planus Pain <ul><li>Topical Steroid rinses/ointments </li></ul><ul><li>Steroid Injection </li></ul><ul><li>Systemic Steroids </li></ul>
  26. 26. Xerostomia/Dry Mouth <ul><li>Diabetes affecting the salivary glands so they don’t produce enough saliva </li></ul><ul><li>Affects chewing, tasting and swallowing </li></ul><ul><li>More difficult to control blood sugar </li></ul>
  27. 27. Xerostomia
  28. 28. Xerostomia and Burning Mouth Syndrome Treatment <ul><li>Alter the drug regimen: </li></ul><ul><li>Consult with physician to change xerostomia-causing drugs. </li></ul><ul><li>Salivary Substitutes </li></ul><ul><li>Symptomatic Treatments: </li></ul><ul><ul><li>Water </li></ul></ul><ul><ul><li>sugar-free candies, mints, and gum </li></ul></ul><ul><ul><li>Eliminate mouthwash, tobacco, acidic liquids </li></ul></ul><ul><ul><li>Different toothpaste </li></ul></ul><ul><li>Cholinergic agonists: </li></ul><ul><ul><li>Pilocarpine hydrochloride 5 mg qid </li></ul></ul><ul><ul><li>Cevimeline hydrochloride 30 mg tid </li></ul></ul>
  29. 29. Other oral manifestations <ul><li>Dental caries </li></ul><ul><li>Gingivitis </li></ul><ul><li>Taste dysfunction </li></ul>
  30. 30. Oral Surgery Complications <ul><li>Remind the dentist that they have diabetes </li></ul><ul><li>Eat before surgery </li></ul><ul><li>Take the usual medications </li></ul><ul><li>Plan for eating needs after surgery </li></ul><ul><li>Wait until the blood sugar is under control </li></ul>
  31. 31. Prevention!
  32. 32. Recommended Professional Dental Care <ul><li>Regular dental examinations at least 2 times each year </li></ul><ul><li>Periodontal evaluation and treatment (SRP), 2 to 4 times each year </li></ul>
  33. 33. Recommended Home Dental Care <ul><li>Brush at least 2 times a day to remove plaque, using a soft brush </li></ul><ul><ul><li>Tilt the brush to a 45-degree angle against the gum and brush gently in a circular motion </li></ul></ul><ul><ul><li>Brush the front and back and chewing surfaces </li></ul></ul><ul><ul><li>Brush the top of the tongue </li></ul></ul><ul><li>Clean between the teeth with floss or interdental cleaner daily </li></ul><ul><ul><li>Gently wrap the floss around the tooth in a C-shape </li></ul></ul><ul><li>Power brushes and floss aids </li></ul>
  34. 34. http://health.utah.gov/oralhealth