Of note, oral health can influence the dietary habits of diabetic patients, affecting their ability to eat and their choice of foods. The cornerstone of diabetes management is patient empowerment. Educating the patient so she or he can make health-promoting choices has proven to be a better approach.
Promoting healthy habits like toothbrushing after every meal and using dental floss are in harmony with preventive regimens recommended by physicians to prevent high blood sugar levels. Infection arising from neglect of oral hygiene can raise blood sugar levels and precipitate acute diabetic ketoacidosis episodes, just as can a missed dose of insulin or excessive carbohydrate intake.
Oral health plays an added and essential role in the social functioning of the diabetic patient. Self-reported impact of oral conditions on social function includes limitations in verbal and nonverbal communication, social interactions, and intimacy, which is especially important in young individuals.[pq]Poor appearance due to missing or decayed teeth can result in poor self-image and low self-esteem.[/pq]
It can lead to anxiety, depression and social stigma. Indeed, poor compliance to good diabetes habits can be influenced by low self-esteem.
Another reason why it is not surprising that diabetic patients have poor oral health lies in the obstacles that hinder their access to oral health. As mentioned earlier, the role of inadequate financial resources is significant on the patient’s ability to seek and obtain dental treatment. Fear of dental procedures is another. Diabetic patients often ask whether tooth extraction can be performed safely due to concerns about excessive bleeding or delayed healing occurring after treatment.
This fear of complications after tooth extraction is also common, yet often unwarranted, among dentists. Diabetic patients typically complain of the difficulty in finding dentists who are willing to treat them. Some patients complain of dentists who routinely ask for a medical clearance prior to every dental procedure, even for simple procedures such as cleaning of teeth.
Other patients recommend that medical clearance be requested sparingly as it entails additional consultation cost, transportation cost and time away from work, all of which are unacceptable to them. Some physicians join the patients in complaining against this practice of some dentists. The fact is that there is no widely accepted guideline on the safe delivery of dental treatment to diabetic patients.
For example, there is no agreement as to what blood sugar levels are appropriate for out-patient dental treatment, whether blood glucose determination is appropriate in the dental office, what procedures can be performed on an out-patient basis, and even when a medical clearance should be requested. Indeed, some patients have resorted to hiding their diabetic status from their dentist in order to obtain dental treatment. Patient acceptance, treatment affordability and accommodation are key issues that must be addressed in order to bring diabetic patients into the dental clinic.
It seems clear to me that as healthcare professionals, we no longer can simply label diabetic patients as non-compliant and non-adherent and blame them for their oral health problems. We must meet them more than halfway and provide them with a comfortable environment to seek not just dental treatment but also to appreciate the benefits of preventive dental care. To do this, we must address the barriers that prevent diabetic patients from seeking dental treatment.
I suggest that…[pq]…in order to improve the health of diabetic patients we must discard old standards of treatment and employ a new paradigm, i.e., change our way of thinking.[/pq]
The dentist’s role in diabetes management is no longer just to treat dental problems when they do occur.
The dentist can and should do a lot to promote positive health behaviors to improve blood sugar control among diabetic patients. The physician, on the other hand, can and must change the perception of diabetic patients about oral health, and consider it an integral part of general health.
To do this the physician must be able to recognize key oral health problems in their diabetic patients and acknowledge the possible deleterious effects such problems can cause in the overall health of these patients. Together, we can embark in new preventive approaches that are less costly, require less professional involvement and offer greater opportunity for overall health benefits for diabetic patients, as compared to the current therapeutic approaches employed.
It is time to examine the way we do things and find better ways of giving our patients better health, better oral health.
– Dr. Edmund Julian L. Ofilada
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