FOCUS | ISSUE 6 | 2010


Allied Health continued from page 40


Random blood sugar (RBS) measures blood glucose regardless of when you last ate. Several random measurements may be taken through- out the day. Random testing is useful because glucose levels in healthy people do not vary widely throughout the day. Blood glucose levels that vary widely may indicate a problem. This test also is called a “casual blood glucose test.”


Oral glucose tolerance test is used to diag- nose prediabetes and diabetes. An oral glucose tolerance test is a series of blood glucose mea- surements taken after drinking a sweet liquid that contains glucose. This test is commonly used to diagnose diabetes that occurs during pregnancy (gestational diabetes).


Blood glucose tests are performed to:


• Check for diabetes. • Monitor treatment of diabetes.


• Check for diabetes that occurs during pregnancy (gestational diabetes).


• Determine if an abnormally low blood sugar level (hypoglycemia) is present. Greater-than-normal blood glucose levels (hyperglycemia) may be a sign of diabetes. In someone with diabetes, it may mean the diabetes is not well controlled.


Elevated blood glucose levels can occur with gross dental and periodontal infections and the stress of painful oral conditions. Spikes in adrenalin output from stress can precipitate elevated BG levels—including endogenous adrenalin output resulting from injection of vasoconstrictors in local anesthetics.


Please advise your patients with diabetes that a temporary spike in their blood glucose levels may occur as a result of local anesthetic ef- fects. Increased levels also may be due to:


• Acromegaly (very rare) • Cushing syndrome (rare) • Glucagonoma


• Impaired fasting glucose (also called “prediabetes”)


• Hyperthyroidism • Pancreatic cancer • Pancreatitis • Pheochromocytoma (very rare)


• Gross dental infection or infection any- where in the body


Patients with diabetes who have gross oral in- fection should carefully monitor their BG levels


42


as the oral interventions reduce and eliminate infection. BG levels may decrease enough to require adjustment in the oral medications or insulin dosages. Lower-than-normal levels (hypoglycemia) may indicate:


• Hypopituitarism • Hypothyroidism • Insulinoma (very rare)


• Over-medication with oral glycemic medi- cations or insulin


• Too little food


Blood glucose meters are readily available from local pharmacies. Representatives of companies that market BG meters may even provide a meter free of cost in order to secure the busi- ness of buying testing strips. Test strips have a limited shelf life and should be discarded after the product expiration date.


Casual BG testing is easy to perform and document. Follow the meter instructions and practice routine asepsis techniques when using the lancets to collect a droplet of blood.


Our patients will appreciate this expanded level of monitoring and concern which adds cred- ibility to our title of ‘doctor’. As well, assess- ment of the whole patient can reveal need for antibiotic therapy coincident with dental and periodontal therapies, or indicate if it is pru- dent to refer to a physician or endocrinologist for more detailed testing (such as A1C) and BG control before initiating dental and periodontal therapies.


SUMMARY


Early identifi cation and intervention mark- edly reduces complications of diabetes. The use of a glucose meter is now a ‘standard of care’ in screening patients who demonstrate risk factors for undiagnosed and uncontrolled diabetes. Casual blood glucose testing in the dental setting can be an invaluable service that will better ensure optimal care. Dentists have an ethical duty to include BG awareness—and necessary monitoring.


The MDA partners with the DHSS Diabetes Prevention and Control Program to promote education in the relationships of oral health to diabetes management. This year’s Ameri- can Diabetes Month theme is “How will you Stop Diabetes?” As a profession, we must ask ourselves that question: “What my role be to stop diabetes?”


Dr. Ed Kendrick is the current chair- man of the Missouri DHSS Diabetes Prevention and Control Program Advisory Board. He may be contacted by email at whole2th@gmail.com.


CONSENSUS SCREENING GUIDELINES


The Missouri Diabetes Preven- tion and Control Program promotes the use of these consensus screening guide- lines in all medical settings in Missouri. The purpose of screening is to identify persons previously not diagnosed with pre-diabetes or diabetes.


These consensus screening guidelines were developed in 2005 by a work group convened by the Missouri Associa- tion of Health Plans Education and Research Foundation. Optimal statewide guidelines for screening and referral for treatment of diabetes was identifi ed by diabetes stakeholders as a high priority when an assessment of Missouri’s diabetes public health system was conducted in 2004. The epidemiologic evidence used to inform the development of the consensus screening guidelines can be viewed at www.dhss.mo.gov/diabetes/ScreeningGuide- linesPresentation.pdf.


“YOUR MOUTH IS TALKING” DIABETES EDUCATION MATERIALS


The MDA, through its “Your Mouth Is Talking” campaign, has as a focus education on oral health and diabetes manage- ment. Through the campaign, the MDA has reached out to diabetes groups to encourage use of the materials specifi c to oral health and diabetes man- agement, and Missourians can fi nd topical information at www.YourMouthIsTalking.org.


Your mouth is talking. Are you listening?


How about checking your gums. People with diabetes have a higher risk of tooth decay and gum disease. Controlling your blood sugar helps. So does brushing and flossing. And please – see that dentist.


YOUR MOUTH www.YourMouthIsTalking.org


The MDA has a diabetes-specifi c PowerPoint presentation available to any member wishing to speak to a com- munity/allied health group, and we can supply you with education handouts to support your eff orts. For details, simply contact Melissa Albertson at the MDA. Members also can purchase diabetes fact sheets to provide as patient education resources in the offi ce.


JADA FOR THE DENTAL PATIENT: DIABETES


For The Dental Patient: Diabetes is a full page of oral health information that dentists can use a patient handout. Updated in July 2010, it covers Periodontal Diseases, Fungal Infections and Tips for Maintaining a Healthy Mouth. Go to www. ada.org/993.aspx.


References and resources • Healthforwardus.com


• Diabetes.org FOR THE DENTAL PATI ENT . . .


Diabetes Tips for good oral health


resistance to infection, you also are more prone to developing oral infections. Controlling blood glucose (blood sugar) levels can reduce the risk of these effects.


I PERIODONTAL DISEASES


When plaque is not removed regularly through brushing and cleaning between the teeth, bacteria in the plaque can cause the gums to become infected and pull away from the teeth, leading to periodon- titis. If periodontal diseases are left untreated, they can cause the bone supporting your teeth to break down, eventually resulting in tooth loss. It is not clear why, but periodontal diseases occur


more often and can be more severe in people with diabetes. This seems to be especially true for those whose glucose levels are not well controlled. Some evidence also suggests that treating periodontal dis- eases might help improve blood sugar control. It is important to have healthy blood sugar levels, eat a well-balanced diet and practice good oral care. In addition to good oral care at home, regular visits


to the dentist are needed to prevent periodontal dis- eases. Plaque can harden into a rough porous deposit called “calculus” (tartar) that forms on the teeth above, along and below the gum line. Unless calculus is removed during a professional cleaning, it can trap plaque and food particles, increasing the risk of devel- oping periodontal diseases. See your dentist if you notice any of these symp-


toms of periodontal diseases: gums that bleed easily; red, swollen or tender gums; gums that seem to have pulled away from the teeth; pus between the teeth and gums when the gums are pressed; persistent bad breath or taste; permanent teeth that are loose or separating; any change in the way your teeth fit together when you bite; any change in the fit of par- tial dentures.


FUNGAL INFECTIONS


Some types of fungi occur naturally in the mouth. A healthy immune system and regular oral hygiene usually keep these in check. However, people with


926 JADA, Vol. 141 http://jada.ada.org July 2010 Copyright © 2010 American Dental Association. All rights reserved. Reprinted by permission.


f you have diabetes, you are at greater risk of developing some oral health problems than are people who do not have diabetes. Diabetes increases your risk of developing periodontal (severe gum) diseases. Because diabetes lowers


diabetes have compromised immune systems and may be prone to developing fungal infections. Oral candidiasis, or thrush, is a fungal infection


that occurs in the mouth. Thrush produces white or red patches that may be sore and can progress into ulcers. It may attack the tongue, causing a painful burning sensation, and it also can cause difficulty in swallowing. Thrush seems to occur more frequently among people who smoke, wear dentures or need to be treated often with antibiotics. High glucose levels also increase this risk. If you develop a fungal infection, see your dentist.


He or she may prescribe antifungal medications to treat the infection.


TIPS FOR MAINTAINING A HEALTHY MOUTH


Maintaining good oral hygiene at home is critical to achieving a healthy mouth. Brush your teeth twice a day and clean between your teeth with dental floss or an interdental cleaner once a day. Look for prod- ucts that display the ADA Seal of Acceptance, a symbol that the product is safe and effective when used as directed. Regular visits to the dentist for checkups and pro- fessional cleanings are important. Tell your dentist that you have diabetes, noting whether it is well controlled, and let him or her know about any med- ications you are taking. Also, discuss any oral prob- lems you may be having, including dry mouth. To reduce your risk of developing fungal infections,


maintain good control of your blood glucose levels. If you wear dentures, remove and clean them daily. Generally, it is not advisable to wear dentures around the clock because tissues that are covered constantly with denture material can become irritated. If you smoke, stop. Smoking increases the risk of developing periodontitis and fungal infections, such as thrush. Good oral care at home and regular visits to your


dentist provide a solid foundation for maintaining a healthy smile. Talk with him or her about your cur- rent health status and any oral health concerns you may have. Together you can develop a personalized oral health plan. ■


Prepared by the American Dental Association (ADA) Division of Science. Copyright © 2010 American Dental Association. Unlike other portions of JADA, the print version of this page may be clipped and photocopied as a handout for patients without reprint permission from the ADA Publishing Division. Any other use, copying or distribution of this material, whether in printed or electronic form and including the copying and posting of this material on a Web site, is strictly prohibited without prior written consent of the ADA Publishing Division.


“For the Dental Patient” provides general information on dental treatments


to dental patients. It is designed to prompt discussion between dentist and patient about treatment options and does not substitute for the dentist’s pro- fessional assessment based on the individual patient’s needs and desires.


• Stopdiabetes.com • WebMD.org


• 1-888-DIABETES (will connect you to the nearest American Diabetes Association offi ce)


• American Diabetes Association. Standards of medical care in diabetes 2009. Diabetes Care. 2009;32:S13-S61.


• jada.ada.org/cgi/content/full/134/suppl_1/4S • dhss.mo.gov/diabetes/FinalScreeningGuidelines.pdf


• dhss.mo.gov/diabetes/ConsensusGuideOnPregnancy- andDiabetes.pdf


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