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How dental hygienists can help spot diabetes early

The benefits of maintaining proper oral care stretch far beyond having a sparkling white smile. Taking good care of your teeth and gums also helps prevent a number of systemic diseases, including diabetes. More than 100 million adults in the US have diabetes or prediabetes and only half of diabetics are aware they have the disease. This life-changing condition can lead to blindness, stroke, heart disease, kidney failure, nerve damage and periodontal disease.

In addition to taking oral x-rays and cleaning patients’ teeth, a dental hygienist is also responsible for educating patients about oral care, helping to prevent diseases and detecting  oral manifestations of diabetes. A dental professional in this role may be the first person to recognize the presence of the condition in a patient — even before their regular healthcare practitioner. Early detection is massively important when it comes to diseases such as diabetes in order to prevent the associated negative health effects. 

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The connection between diabetes and periodontal disease

Having diabetes doesn’t automatically mean poor oral health. The positive news is that people who successfully control their diabetes have no more tooth decay or increased risk of periodontal disease than people who don’t have diabetes at all. So if the condition is diagnosed early and proper treatment is received, a patient with diabetes can have a bright and healthy smile, just like anyone else.  

However, it’s not all good news. The American Academy of Periodontology and the European Federation of Periodontology state there’s a clear synergistic relationship between diabetes and periodontal disease. Dr Stuart J. Froum, DDS, Director of the Clinic Research in the Department of Periodontics and Implant Dentistry at New York University Dental Center explains, “The relationship between periodontal disease and diabetes is a bit of a catch-22. People living with diabetes are more likely to develop periodontal disease. At the same time, periodontal disease makes it more difficult for people with diabetes to control their symptoms because it can impair the body’s ability to process and/or utilize insulin.”

When a patient develops periodontal disease, blood sugar levels can increase, causing a heightened risk of developing diabetes or complications in patients who already have diabetes. 

Diabetics are more likely to suffer from periodontal disease because they’re more susceptible to contracting infections. Unlike type 2 diabetes which is often detected in adulthood and is associated with obesity, type 1 diabetes is often recognized in children and young adults. This variation of the condition is an autoimmune disease and people suffering from type 1 diabetes will usually develop other autoimmune disorders over time. Out of all type 1 diabetics, almost 25% will be affected by a codisorder, such as Hasimoto’s disease, celiac disease or periodontal disease. People who don’t have their diabetes under control are especially at risk.

How dental hygienists can help

Since January 1, 2018, dental practices have had a CDT code to carry out chairside testing for HbA1c to already diabetic patients or patients they believe are at risk of developing diabetes. The goal of this code is to provide dental offices with the freedom they require to identify patients suspected of being prediabetic or diabetic then make the appropriate referral to a physician. The overall objective is to aid in an early diagnosis to prevent full-blown diabetes and the health complications that come with it.

The HbA1c test is a screening which only takes minutes to complete that you can include in a general assessment or check-up. The ADA suggests chairside HbA1c testing for all patients who are overweight, experience a sedentary lifestyle, have a family history of diabetes and come from an ethnic background associated with an increased risk of diabetes. The test doesn’t require fasting and can be carried out at any time of day. 

Things to look for in a patient

When assessing a patient you believe could be at risk of diabetes, here are four indicating factors to look out for, according to RDH:

  • Dry mouth — Uncontrolled diabetes often decreases saliva flow, which causes dry mouth. If left untreated, dry mouth can lead to soreness, infections, ulcers and tooth decay.
  • Gum inflammation (gingivitis) and periodontitis — Diabetes causes blood vessels to thicken, which in turn slows down the flow of nutrients to body tissues and waste products from body tissues, including the mouth. This results in the body losing its ability to fight infection. Because periodontal disease is a bacterial infection, people suffering from uncontrolled diabetes are likely to experience more regular and severe gum disease.
  • Poor oral tissue healing — Since blood flow to the treatment site is often damaged, people with uncontrolled diabetes don’t heal quickly after oral surgery or other dental treatments. 
  • Fungal infections — People with diabetes often take antibiotics to fight infection, leaving them prone to developing other infections, such as fungal infections of the mouth and tongue. The type of fungus which causes this infection also thrives on high glucose levels in saliva, another symptom of diabetes.

Remember to be kind

Being a people person is one of the top skills of every excellent dental professional. When investigating the possibility of diabetes with a patient, it’s even more important to remember to be as kind and empathetic as possible. No one wants to hear they have a life-altering disease — especially if they’re just expecting a routine 6-month check-up. So it’s essential you behave appropriately so your patient feels like they can open up to you and take on board your medical suggestions.

When talking about diabetes with a patient, don’t say, “research says” or “studies show”. These phrases will fall on deaf ears. Don’t answer emotional feelings with cold facts. Instead, connect with your patient as a person, all the while remembering to be present and engaged without lecturing. 

Jodi Hapern, PhD, author of From Detached Concern to Empathy, explains, "Clinical empathy plays an essential part in effective health care. Studies show that because patients trust empathetic doctors, they communicate much more honestly with them about their physical and emotional issues. As a result, empathetic doctors recognize health problems that others might miss. Patients trust emotionally engaged doctors."

The odds of you recognizing diabetes and supporting your patient to seek further medical help is significantly increased if they feel comfortable enough to talk to you openly and honestly. 

Invest in your team

If your current dental hygienists aren’t experienced in recognizing signs of diabetes in patients, it’s important they develop this skill. There are two primary ways you can go about it. You can invest in your dental team and send your hygienists on courses or sign them up for workshops which cover how to spot the disease. Alternatively, you can expand your team by hiring temporary dental hygienists from an online cloud-based matching platform.

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With Cloud Dentistry, you can scan the profiles of 100s of dental professionals in your area and chat directly with those with experience recognizing diabetes in patients. After your new dental hygienist gets settled, you can have them train your other staff in disease detection. This gives you an additional service you can add onto your portfolio of treatments to help you stand out from the competition, retain your current patients and attract new ones.

If the additional expertise the temp dental hygienist brings into your dental practice increases your number of treatments, you can hire them permanently from Cloud Dentistry without any additional fees. Or if you decide your current staff are capable of handling the increased patient numbers, you can simply hire the temp dental hygienist just for the hours and days you require them. With Cloud Dentistry, you’re always in control. 

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