Th 247073

The diabetes connection

May 1, 2007
As dental professionals, hygienists are often the first to notice subtle differences in the mouth that could indicate a change in a patient’s systemic condition.

by Ann-Marie C. DePalma

As dental professionals, hygienists are often the first to notice subtle differences in the mouth that could indicate a change in a patient’s systemic condition. Over the past several years, research has grown in regards to the periodontal-systemic connection. Although we do not fully know exactly what these relationships are, we do know that the oral cavity is a reflection of total body health. Many hygienists have seen evidence of this relationship between periodontal disease and uncontrolled diabetes. But are hygienists aware of the latest research and information on diabetes?

Cynthia Stegeman, RDH
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Cynthia Stegeman, RDH, MEd, RD, CDE, provides dental professionals with research and knowledge in her program “A Practical Approach to Diabetes Care for the Dental Team.” All members of the dental team are encouraged to attend. But the course is designed for hygienists since it is the hygienist who often refers the patient for systemic care.

A patient with uncontrolled diabetes presents many medical and oral concerns that the dental professional needs to assess prior to any invasive treatment. Additionally, a bidirectional relationship exists between infectious dental diseases and uncontrolled hyperglycemia. Dental professionals should be essential members of the diabetes health-care team for complete patient care. The goal of Cynthia’s course is to provide all members of the dental team with practical ideas for managing, treating, and educating patients with diabetes. Upon completing the course, the dental professional will be able to:

  • update and review concepts of diabetes
  • explore the relationship between diabetes and dentistry
  • formulate recommendations for patients with diabetes
  • synthesize a treatment plan for a patient with diabetes

The relationship of systemic disease on oral health and the impact of poor oral health on the progression of systemic diseases date back to the times of Hippocrates. Yet much is still not known about the effects of diabetes on dental health and how dental health affects diabetes.

Furthermore, since most dental treatments are invasive, the incorporation of bacteria from procedures can increase the risk of infections, impair the immune response, and slow wound healing. Since dental professionals perform many health-related procedures such as blood pressure and oral cancer screenings, it seems appropriate to monitor the blood glucose levels of patients with diabetes prior to treatment. However, many dental professionals are unaware of their knowledge and ability to perform such procedures. Educating dental health professionals by initiating a diabetes protocol for their offices is a great way to begin.

Cynthia is an associate professor in the dental hygiene program at the University of Cincinnati, where she attended, and has been a registered hygienist for 27 years. She continued her studies at Indiana University for her bachelor’s in public health dental hygiene while practicing clinically for 10 years. She then began her adventure to receive her master’s in dietetics from the University of Cincinnati. She is currently a doctoral student in the College of Education at the University of Cincinnati, as well as a registered dietitian and certified diabetes educator.

As a diabetes educator she completed a five-year certification program offered only to specified health professionals. For this certification she had to complete at least 1,000 hours of direct patient contact and two years in diabetes education. Due to its intense nature, only a small segment of dental professionals have achieved this distinction. Cynthia, with co-author Judi Ratliff Davis, wrote the book “Dental Hygienists’ Guide to Nutritional Care” (Elsevier Saunders Publishers, St. Louis, 2005). Judi is a dietitian who wrote a proposal for a book for hygienists on nutritional care. A co-author hygienist was needed and Cynthia was in the right place at the right time. At the time (1993), there were only general nutrition textbooks available for dental hygiene students, which didn’t connect nutrition to dentistry. Cynthia and Judi found a need and focused the book on the application of nutritional principles for dental patients. Cynthia is also working on a DVD of a case presentation of a patient with diabetes in the dental environment that experiences a medical emergency. In large or small groups, course participants will be able to assess and manage the situation like the hygienist in the practice would. She is planning to pilot the DVD to her dental hygiene students this fall and then bring her program to other venues.

The oral-systemic connection has become an integral part of the dental hygiene focus of care. Cynthia’s programs enable dental professionals to become more aware of the role that diabetes and nutrition play in the overall health of patients.

For more information about Cynthia or her programs contact [email protected].

After spending more than 25 years in private practice, Ann-Marie C. DePalma, RDH, BS, FAADH, is currently a faculty member at Mt. Ida College’s dental hygiene program. She is a Fellow in the American Academy of Dental Hygiene and is also pursuing a master’s degree in education in instructional design. Ann-Marie has written numerous articles and provides continuing education programs for dental hygienists and dental team members. She can be reached at [email protected].