Diabetes Mellitus & Dentistry

Periodontal Disease Progression

The evidence is overwhelming that the alveolar bone loss associated with periodontal disease is the result of a complex inflammatory response to plaque antigens. It follows that, if individual patients can be educated and persuaded to fully control their plaque on a daily basis, then the inflammatory reaction will subside. This has been considered in more detail in the series about periodontal disease in Dental Practice earlier this year by Dr Matt Perkins.

However, the question remains why does periodontal disease and bone loss commence interproximally? The answer is quite simple, because that is where patients routinely and persistently leave plaque with their usual brushing technique with conventional brushes. You have only to watch TV toothpaste advertisements, your patients or TV presenters brushing their teeth in a backwards and forwards motion to understand that this is the most manually confortable method of use. However, this will always miss removing plaque in the dental interspace (Fig 1). Up and down brushing methods are not much better. Electric toothbrushes may help but only if sufficient time is allowed when brushing. Again, observing how patients use their toothbrushes is very instructive as so few can demonstrate a systematic approach to cleaning. The usual finding, rather like a certain insurance company advertisement is ‘a little bit here and a little bit there’ with some sites frequently missed. It is no wonder then that periodontal disease progresses, often in an irregular pattern.

Teaching patients to floss where appropriate is another tool in plaque control whose effectiveness will depend on individual manual dexterity.

As interproximal bone is progressively lost then interproximal spaces will develop for which interspace brushing is the obvious method of plaque control. I make no apology for covering this topic again and drawing colleagues attention to my computerised charting method accessed at www.spacemark-d.com. This programme will allow for recording the correct brush diameter prescription suitable for both dentists and patients use. In this regard I take serious issue with dentists or hygienists who tell patients to use interspace brushes without proper professional guidance, or prescribe just one or two sizes in the mistaken belief that their patients cannot remember. Prescribing a small brush in a large space results in neither effective or efficient plaque control.

For the avoidance of doubt, diabetics have to learn to manage their blood sugar levels following suitable education and guidance. That being the case, the vast majority are perfectly capable of managing and controlling their plaque, providing that the dental profession gives them similar individually targeted, detailed, appropriate and written advice.