Th 162548

Oral medicine and diabetes

Nov. 1, 2004
Between medical advances and the aging population, a greater number of dental clients are medically compromised. Staying current with medical protocols, medications and oral management involving so many disorders can be overwhelming.

by Ann-Marie C. DePalma

Between medical advances and the aging population, a greater number of dental clients are medically compromised. Staying current with medical protocols, medications and oral management involving so many disorders can be overwhelming. Nevertheless, an in-depth understanding of clients' diseases is essential if hygienists are to provide effective treatment and prevent complications. This is especially true with clients who present with diabetes mellitus.

Diabetes is a chronic health condition that can present a variety of oral manifestations. Research is beginning to show a link between diabetes and oral health. Whether it is the diabetes affecting oral health or vice versa, we are still learning, but now know there are distinct links, not only with diabetes, but in all areas of medical/dental inter-relationships. Therefore, the more research that is conducted, the more we will know about medically compromised clients.

JoAnn Gurenlian, RDH, PhD, empowers hygienists to learn more about their clients' health in two of her programs --- Diabetes Mellitus and Oral Medicine. JoAnn also offers programs related to oral pathology, dental hygiene diagnosis, women's health, and leadership and professional development.

All members of the dental team can benefit from the diabetes and oral medicine programs. Throughout both programs, JoAnn addresses individual concerns, from how to handle a client when they call to schedule to treatment completion. Invariably, there are participants in the audience who have the diseases being discussed. By incorporating their experiences into the program, JoAnn provides a variety of real life information.

The diabetes program discusses types of diabetes, differences between pre-diabetes and diabetes, signs and symptoms of the disease (including subtle signs which may go unnoticed), risk factors, diagnostic studies, oral manifestations, systemic/perio link, guidelines for oral health, and the role of the hygienist as an interdisciplinary team member. She also explains the significance of the A1c study in determining glycemic control, and the relationship that glycemic control has on oral health. The diabetes program can be called Diabetes and Oral Health, in which JoAnn co-lectures with Drs. Maria Ryan and Louis Rose, or Diabetes Mellitus: Strategies for Providing Comprehensive Care, which she presents alone. She also facilitates a diabetes symposium with a podiatrist, optometrist, pharmacist, and dentist.

The oral medicine program discusses a variety of systemic diseases and their affects on oral health. Each of the major organ systems - respiratory, endocrine, gastrointestinal, musculoskeletal, etc. - are reviewed. Guidelines for providing oral care - including assessment, medical consultation and treatment planning considerations - are addressed. Goals of the oral medicine program are to identify signs and symptoms of disease and its oral manifestations, and how to coordinate medical treatment protocols with oral health treatment plans. Knowing that hygienists treat clients with increasingly complex medical situations, JoAnn feels it is important to stay current with medical protocols, medications, and oral management strategies.

JoAnn has been a hygienist for 27 years in general, pedodontic, orthodontic, and periodontal practices. She served as faculty member and chairperson of the Department of Dental Hygiene of Thomas Jefferson University (TJU) in Philadelphia. On the faculty of TJU, JoAnn taught both oral pathology and continuing education programs to health care providers. During the mid-1990s it became clear to JoAnn that the wave of the future was oral medicine, and that hygienists needed to treat their clients from a broader perspective. So she developed the oral medicine course based on the changes that were occurring in medicine, diagnosis, treatment, and technology. Three years ago JoAnn was appointed by the American Dental Hygienists' Association to serve with the National Diabetes Education Program, whose focus is to help individuals and health care providers better prevent and manage diabetes. Although her primary focus is still oral pathology and the prevention and early detection of oral cancer, JoAnn has become truly passionate about addressing diabetes and pre-diabetes.

JoAnn's presentations are an informal mix of lectures. She likes for participants to share their stories about how they handled medical conditions in their practice. JoAnn provides extensive handouts so that participants have comprehensive information to use when they return to their practices. These include signs and symptoms of disease, diagnostic studies, treatment information, and guidelines for providing oral health care.

JoAnn has offered both the oral medicine and diabetes programs to numerous dental and dental hygiene associations, and received excellent reviews. One particular evaluation comment came from a dentist. After the program the dentist and his wife approached. The wife had to meet the "woman who had kept her from lunch with her husband." They explained that usually, due to the fact that he had Attention Deficit Disorder (ADD), the doctor could only sit through a short program. He then took his wife to lunch or shopping. But the wife wanted to meet the speaker who had kept her husband through a three-hour program! The dentist said that JoAnn was informative, entertaining, instructive, and did not talk down to the audience.

JoAnn is a life member of ADHA, having served as president in 1990-1991. Her passions are her children, Laura and TJ, books, and watching the dental hygiene profession become self-regulated and autonomous. To aid in this, JoAnn recently waged an unsuccessful bid for a seat in the state assembly for the 6th legislative district in New Jersey. She has always been interested in politics, and dental hygiene prepared her for the role. JoAnn sees the run as a learning experience and will seek another campaign run in the future.

In addition, JoAnn recently completed co-authoring a textbook with Frieda Pickett, RDH, titled The Medical History: Clinical Complications and Emergency Prevention in Dental Settings. The text is published by Lippincott, Williams & Wilkins, and is now available.

Whenever JoAnne gives a course, she's pleased that she spent time with fellow hygienists who believe they are special and want to give the best care possible to their clients.

JoAnn's future presentations include:
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• Greater New York Meeting, Nov. 30

• Yankee Dental Congress, Jan. 27

• Leading Edge in Professional Education, Blue Bell, Pa., March 19, and Nanticoke, Pa., April 2005

• Berks-Schuylkill Dental Hygienists Association Spring Meeting, April 2005

• New Jersey Dental Association Annual Meeting, June 2005

• ADHA Annual Session, June 2005

For more information regarding JoAnn's programs, contact her at [email protected]

Ann-Marie D. DePalma, RDH, BS,has been a clinical hygienist for more than 25 years and is a graduate of the Forsyth School for Dental Hygienists, is active in the Massachusetts Dental Hygienists' Association, and is a Fellow of the Association of Dental Implant Auxilliaries and Practice Management. Ann-Marie has written articles and presents programs on dental implants, TMD, and development delays and can be reached at [email protected]