By Caron Nelson Glickman
Diabetes affects about 15.7 million Americans and nearly 800,000 new cases are diagnosed each year. If you have been diagnosed with diabetes, you may know that the disease can cause problems with your eyes, nerves, kidneys, heart and other parts of your body. Diabetes can lower your resistance to infection and can slow the healing process.
The most common oral health problems associated with diabetes are:
- tooth decay;
- periodontal (gum) disease;
- salivary gland dysfunction;
- fungal infections;
- lichen planus and lichenoid reactions (inflammatory skin disease);
- infection and delayed healing;
- taste impairment.
Chances are that you are treating patients with diabetes.With 6.2 percent of the US population having diabetes, you can expect to have more than 120 diabetic patient visits per year. This includes the 5 percent of diabetic patients who are Type 1 and the 95 percent who are Type 2. And the incidence of diabetes is growing dramatically.
Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.
There are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, unfortunately, 5.7 million people (or nearly one quarter) are unaware that they have the disease.
Major Types of Diabetes
Type 1 diabetes
Results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes.
Type 2 diabetes
Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes.
Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually, type 2.
Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes.
If a patient presents with oral symptoms of diabetes, then a dental professional can use the glucometer to check the patient’s blood sugar. But first, the dental professional should ask the patient questions relating to the classic signs and symptoms of diabetes. These include frequent urination, excessive thirst, excessive sense of hunger, or recent changes in vision. If in addition to the signs and symptoms of diabetes, the patient’s glucose level reading on the glucometer is very high (a normal glucose level range is between 70 and 100 mg/dl; a fasting glucose level over 125 mg/dl or a nonfasting glucose level of over 200 mg/dl is considered suggestive of diabetes), then the dental professional can advise the patient that he/she is exhibiting symptoms of diabetes and should see a physician for the appropriate tests as soon as possible. Screening is only valuable if the end result is to refer a patient to his/her physician for definitive diagnosis. Otherwise, the glucometer should not be used as a screening tool.
A glucometer is not definitive enough. Many people with type 2 diabetes have a normal blood sugar level in the morning after they fast. Their glucose rapidly increases and stays elevated after they eat. Just because a person has a normal glucose value reading on a glucometer does not mean that he or she does not have diabetes. If a dental professional sees signs and symptoms of diabetes but a glucometer reading is normal, the patient should still be referred to the physician for evaluation.