Diabetes Mellitus & Dentistry
Individual Preventive Strategy
The emphasis for individuals is to improve their personal plaque control, to reduce the numbers of bacteria and biofilm both supra- and sub- gingivally using toothbrushes, floss and interspace brushes.
These patients will also require frequent professional interactions, in depth education, and consistent educational reinforcement.
This means that all diabetic patients should be advised by their General Medical Practitioners that they are at increased risk of developing periodontal disease and need to seek regular dental care. However, unless there is other publicity, I have serious doubts that this will happen. I have offered my own teaching practice doctors a short talk on this, without response. If this is the national pattern then the long term implications for dentistry are huge.
We know that approximately 15 per cent of the present population have major periodontal problems requiring care from either specialists or GDP’s with a special interest in the treatment of periodontal disease. How will they cope with an influx of 5, 10, 15 or 20 per cent increase in workload? If this potential explosion in numbers of patients requiring an enhanced level of care is not met, then more teeth will be lost, and consequently more people will require dentures. Alveolar bone loss can be extensive in these cases leading to very flat ridges and greater clinical difficulty in providing satisfactory prostheses. This will create other problems, as the numbers of both dentists and dental technicians with extensive experience in denture making has fallen. This is a direct result of professional achievement in helping patients keep their natural dentitions for longer (see the Salisbury/Darlington comparisons). There is thus a significant risk that these achievements will be reversed in future.
Secondly, implants can often help patients with alveolar bone loss achieve retentive and stable dentures. Where will the appropriately trained and experienced clinicians to treat these cases come from and who will bear the cost given the severe constraints on NHS budgets that are expected to be a constant feature for the foreseeable future?