I'm Really Upset and You Should Be Too
Oral care more than a risk factor for people with diabetes
If you're reading this, then you appreciate the importance, or want to learn about the importance, of oral health to overall health, specifically how it relates to people with diabetes. Good for you.
I wish everyone appreciated the importance and interconnection. Even most health professionals don't.
I just finished a new, nearly 100-page report by the International Diabetes Federation titled: Managing Older People with Type 2 Diabetes.
It's an exhaustive report and guide to the care of older people with diabetes. I am sure that your primary healthcare givers have read this report and if they haven't, they should. You should too. Even if you're not "old" it gives great preventative strategies, relevant to all with diabetes, type 1 and type 2.
The stated goal of the guideline is to address the shortfall in diabetes care by providing a comprehensive review of all related issues.
Indeed, it appears to be a comprehensive and well-structured report. It even has complete chapters on "Screening for diabetes eye disease" and "Diabetes foot disease."
Strikingly missing, however, is mention of dental care except in two, brief, easily missed areas. First, hidden in chapter 8, "Nutrition, Physical Activity and Exercise," where it discusses the risk for malnutrition (it just lists "dental disease"). The second time is in chapter 10, "Cardiovascular Risk," where it lists Periodontitis as an "emerging" risk factor.
Emerging risk factor? You've got to be kidding me? That's like saying the U.S. is an emerging superpower. Hey guys, get the news, gum disease is a real problem for people with diabetes. It's the most common form of inflammatory disease in man. Not only does it increase the risk for cardiovascular disease, but gum disease makes controlling diabetes more difficult. And, if you can't control the diabetes, everything goes downhill.
And when it comes to nutrition, they talk about malnutrition as a real problem in the elderly. Of course it is. How many elderly can properly chew their food? Yet, the report lists "dental disease" as something that increases the risk of malnutrition but gives no explanation of what that means nor makes any recommendation of how to prevent it.
Here are some things you can do:
• Keep your teeth and gums healthy by having regular dental care,
• Replace missing teeth so that you can chew properly.
• Make sure your gums don't bleed and if they do, get help.
Bleeding gums are NOT normal and should not be tolerated by anyone, let alone a person with diabetes!
I'm getting tired of swimming upstream. When will organized medicine and the diabetes community realize that oral health is just as important as eye health? In fact, I'll go out on a limb and say that it's actually more important. That's right, oral health is more important.
Why? Because as important as eyesight is, poor or no vision doesn't cause diabetes to get worse. It's a one-way relationship. Diabetes affects eyesight, not the other way around. With oral disease, it's a 2-way street. Diabetes affects oral health and oral health affects diabetes. Dental disease affects your ability to chew and digest nutrients, which is so important to people with diabetes. Gum inflammation is made worse by uncontrolled diabetes and visa versa. So there, I said it. If you're a person with diabetes, your mouth is at least as important as your eyes, if not more so.
If you can't chew good, nutritious food, your diabetes will suffer. Soft, mushy, easy-to-swallow foods most often contain lots of carbohydrates. Mashed potatoes, pastas, and applesauce are easy for one without teeth to eat. Fibrous foods that are glycemic-friendly like apples, salads, and fresh veggies require teeth to process.
I'm sorry for going on like this, but enough is enough. If you're reading this, spread the word. Your mouth is a part of your body. It's not some disconnected organ. It's the beginning of your digestive system, it's an opening to your respiratory (breathing) system and it's connected to your circulatory system. Oral malfunction affects everything.
I'm tired of physicians asking people to stick their tongues out and looking right past a vital organ, the oral cavity. I'm tired of healthcare professionals not caring if their patients have seen a dentist or not. And I'm tired of dentists who don't realize that there's more to taking care of people's mouth than just filling holes and spaces. I don't care that insurance companies don't cover preventative strategy discussions. I won't let some bean counter get in the way of my relationship to the person seeking my help and advice. There's a person attached to that mouth and as dentists, we have a responsibility to care for that whole person.
Until things change, it's up to you. You have to demand that your healthcare team talk to one another. You have to know your numbers and make sure everyone involved in your care does. You have to tell everyone on the team what medications you're currently taking. You have to insist on being told how to prevent complications from diabetes. You have to take charge.
Gum disease and tooth decay are the number 1 and 2 most common diseases in mankind. As they say, " be true to your teeth or they'll be false to you."
To your health and wellness,
Dr. Goldberg loves helping people and is here to answer your questions about diabetes and your mouth. Just submit your Dental Issues questions for the doctor to Ask an Expert or email him at: firstname.lastname@example.org.
Dr. Michael J Goldberg is the former Director of Columbia Presbyterian Hospital's General Practice Residency Program and a principal in Manhattan Dental Health. He is the author of "What The Tooth Fairy Didn't Tell You" (Barber, Cosby).
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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