Talk to Your Dentist
2-way communication vital in effective oral care
In a previous article, I wrote about finding a dentist who is knowledgeable about diabetes. Why is that important? Because not every dentist knows everything YOU may need them to know about diabetes, prediabetes, the medications, the complications and interactions with your mouth, and the treatments you may require. Here's the list of the things you need your dentist to be able to do for you.
1. Take a thorough medical history.
2. Speak to your physicians and other members of your health care team (such as your nutritionist or diabetes educator) about your healthcare status.
3. Perform a thorough periodontal assessment at every visit.
4. Teach you how to prevent inflammation.
5. Perform procedures and give you strategies that can reduce plaque accumulation, remove irritations and reverse gum inflammation.
6. Give you tips for at-home oral care techniques that will assure optimal health.
Since we looked at #1 in a previous article, let's look at #2 and 3.
#2: Your dentist should be able to speak to the rest of your healthcare team.
This should be a 2-way conversation.
In my office, we send a report to a patient's physician when they first come in for an initial exam and again when they come in for periodic evaluations. I must sadly admit that such communication is rare and even in my practice it is usually 1 way. I rarely get replies to the faxes I send out to physicians. That's unfortunate because knowing a person's risk factors is important for the dentist, the physician and the diabetes educator.
Imagine that you have a chronic, non-painful infection in your body. It will almost certainly affect how your body uses insulin and responds to the inflammation. It will probably affect your HbA1c and your CRP. Wouldn't that be important to know if you're getting medication? I think so and I'm sure your physician would agree.
Yet, how many physicians ask their patients if they've seen a dentist and how many dentists call or fax a physician to tell them that their mutual patient has a chronic infection? How many physicians look at a patient's mouth? Most often they take a tongue depressor and look right passed the mouth and into the throat!
By the way, that chronic, non-painful infection is called GUM DISEASE and it's the most common infection in humans. That's right, gum disease is usually NOT painful until it reaches its last stages. You might have it and not even know it! That's why your dentist or hygienist should be using a probe to measure your pockets.
What does the probe tell you? It measures the space between where the gum lays on the tooth to where it attaches to the tooth. That space is called the "periodontal pocket" and in healthy gums, it shouldn't hurt when probed, it shouldn't bleed, and it should ideally measure 3 millimeters or less.
X-rays too are an important part of the exam because gum disease affects the bone that supports the teeth. Any thorough examination should determine how much bone supports the teeth. Plus, there are hidden infections that can only be seen with properly taken x-rays.
A word about x-rays; I'm passionate about trying to reduce the amount of radiation people receive. There are all together too many x-rays taken in most dental practices. Your dentist or hygienist should NEVER just say that you're "DUE FOR X-RAYS." That phrase just makes my blood boil. It shows a lack of personalized care and caring. X-rays are needed for specific reasons and you should be told what those reasons are. You should have the information that allows you "informed consent." So please, don't let anyone take x-rays on you unless you understand why they are needed.
Today, digital x-rays can give far less radiation than traditional x-rays, with just as much information. If I went to an office that didn't use digital x-rays, I'd turn around and go elsewhere. I'm a pretty savvy dental consumer and you should be too. After all, that's why you're reading this article…right?
Number 3 on the list of things you need your dentist to be able to do for you is an assessment. It has to be done! You shouldn't have to ask, it should be routine. And if it's not, you just might be in the wrong dental office.
Forgive me for digressing just a bit. The unfortunate part of our entire medical system is that doctors and dentists are not paid enough for examinations and diagnosis. They are monetarily rewarded for ‘treatments' and ‘procedures,' so some don't spend the time needed to do a thorough work-up (it can often take more than a single visit). Insist on a thorough examination. If you're a person with prediabetes or diabetes, it could be a matter of life or death.
Would you have to ask your diabetes physician to take your blood sugar or your blood pressure? Of course not. It's what we call the "standard of care." And the standard of care for all dentists is to perform a thorough periodontal (gum) screening. If a probe isn't used on you…BEWARE.
While #3 should be routine, #2 - communication between your dentist, physician and diabetes educator - usually isn't. Here, you might have to take the initiative and act as your own advocate. Be persistent. Dentists and physicians have many patients and little free time, but this is YOUR health we're talking about and no one's going to care about it as much as you. That's just the plain truth.
We'll next talk about specific treatments and strategies that can be used to help reduce inflammation and treat gum disease.
To your health and wellness,
P.S. I love helping people and am here to answer your questions about diabetes and your mouth. Just email me 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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