Oral Care Products and the Diabetic Patient
Ms. Terrie is a clinical pharmacy writer based in Haymarket, Va.
Approximately 75% to 80% of US adults currently have some degree of periodontal disease, ranging from mild to severe.1,2 Periodontal disease in its mildest form is commonly known as gingivitis. It is characterized by an inflammation of the gingival tissue and may be reversible with proper treatment. 3 If left untreated, however, gingivitis may progress to a more severe, irreversible form of periodontal disease, periodontitis, which can result in alveolar bone loss.3
Whereas practicing good oral hygiene is important for everyone, individuals with diabetes are 2 to 3 times more likely to develop periodontal disease, compared with individuals without diabetes.4 In particular, patients with uncontrolled diabetes are at a greater risk for the development of periodontal disease.5
Diabetic patients who smoke have up to a 20-times-greater risk for developing periodontal disease than nonsmokers, because smoking seems to hinder blood flow to the gums and may affect wound healing in this tissue area.6,7 Furthermore, according to the American Diabetes Association, an estimated one third of diabetic individuals have severe periodontal disease accompanied with loss of attachment of the gums to the teeth measuring 5 mL or more.8
Signs and Symptoms of Periodontal Disease2,9,10
? Tender, swollen, edematous gums
? Signs of receding gums
? Episodes of bleeding after brushing or flossing or eating hard food
? Persistent episodes of halitosis or altered taste
? Any signs of formation of pus between teeth and gums
? Signs of loose or shifting teeth
? Ill-fitting partial dentures or changes in the way teeth fit together when biting
? Pain or sores in the mouth
Pharmacists can increase awareness about the importance of good oral hygiene and its role in reducing or preventing periodontal disease, especially when counseling diabetic patients. Pharmacists can assist diabetic patients in the selection of suitable oral health care products by always recommending toothpaste and mouth-rinse products that have been shown to be effective in reducing plaque and gingivitis (Table). They can encourage patients to seek the advice of a dental professional when warranted. Pharmacists also can provide patients with information about other oral health care problems--such as xerostomia, candidiasis, and dental caries--that may be exacerbated by poorly controlled diabetes as well as improper oral hygiene.
1. Gum Disease. Medscape Web site. Available at: www.nlm.nih.gov/medlineplus/gumdisease.html. 2. The Health Perils of Gum Disease. MedicineNet.com Web site. Available at: www.medicinenet.com/script/main/art.asp?articlekey=50510.
3. Klasser G, Colvard M. Prevention of hygiene-related oral disorders. In: Berardi RR, Kroon LA, McDermott JH, et al, eds. Handbook of Nonprescription Drugs. 15th ed. Washington, DC: American Pharmacists Association; 2004:649-676.
4. Vernillo A. Dental considerations for the treatment of patients with diabetes mellitus. J Am Dent Assoc. 2003;134(suppl 1):24S-33S. Online version available at: http://jada.ada.org/cgi/content/full/134/suppl_1/24S. 5. Mouth Body Connection. American Academy of Periodontology Web site. Available at: www.perio.org/consumer/mbc.top2.htm.6. Dental Care and Diabetes. WebMD Web site. Available at: www.webmd.com/content/Article/108/108968.htm. 7. Smoking and Oral Health. WebMD Web site. Available at: www.webmd.com/oral-health/guide/smoking-oral-health.8. Complications of Diabetes in the United States. American Diabetes Association Web site. Available at: www.diabetes.org/diabetes-statistics/complications.jsp. 9. Prevent diabetes problems: Keep your teeth and gums healthy. National Diabetes Information Clearinghouse Web site. Available at: http://diabetes.niddk.nih.gov/dm/pubs/complications_teeth/#healthy.10. Oral Health and Oral Hygiene. American Diabetes Association Web site. Available at: www.diabetes.org/type-2-diabetes/mouth-care.jsp. 11. Cleaning your teeth and gums (oral hygiene). American Dental Association Web site. Available at: www.ada.org/public/topics/cleaning_faq.asp.