Through observation of our patients' soft tissue response to periodontal therapy, dentists are in an ideal position to detect alterations which may result in an earlier diagnosis of diabetes.
In addition to the basic diagnostic tools for periodontitis, analysis of subgingival bacteria is another important diagnostic tool for the extended management of periodontal disease in diabetics. Subgingival cultures are frequently helpful in identifying these pathogens.
Recognizing other unexpected soft issue treatment response patterns may also lead to the discovery of diabetes, including dry mouth, and sporadic, aching pain in the lower anterior teeth without apparent cause.
It is best to treat controlled, insulin-dependent diabetic patients about 90 minutes after a meal and insulin dose. Ordinarily, this would be mid-morning to allow blood sugar levels to drop and to reduce the risk of diabetic complications during treatment. In addition to an appropriate postoperative diet, diabetic patients usually require antibiotics concomitant with treatment due to their lowered resistance to infection. The diabetic patient requires close monitoring the shorter maintenance intervals. Because glucose concentrations in diabetics are elevated in gingival fluid and saliva, the diabetic patient with root exposure has a substantially increased incidence of root caries. Fluoride rinses, gels or NaF varnishes may be helpful.
Initiating periodontal care for the diabetic patient should be a foremost concern of physicians as it may make their task easier and reduce insulin requirements. A close cooperation between the endocrinologist and the periodontist is vital to manage the patient's periodontal problems and diminish the detrimental effects of inflammatory disease on diabetes control and cardiovascular health. Working in concert, these two disciplines have a greater success in the diagnosis and control of diabetes and periodontitis.
Dr. Versman and Dr. Heller are Periodontists at Periodontal Associates in Aurora, CO and serve the entire Denver Metro and surrounding area. For more information, please visit www.periodontalhealth.com.