I really enjoyed working in my operatory today. All of my clients were nice people, and that makes my stress level manageable. One adult client was in a hurry. I heard it in his voice and detected it in his body language. As he settled in the dental chair, his headphones were already in position. He was eager to finish the health history update so that he could tune in to the Rush Limbaugh radio talk show.
I thought that I would have only myself to talk to as I performed his three-month periodontal maintenance debridement. He finally lifted the padded earpiece away from his ear when I asked him, “So, what’s Rush got to say today?”
The client didn’t hesitate and belted out: “Today’s topic is those wishy-washy Republicans who are conservative one day, and then start moving to the left the next. They don’t want to get solidly behind the Republican agenda.”
As I was going through the motions of micro-ultrasonic debridement followed by air polishing, I contemplated about how many clinical days in the past I may have been wishy-washy, too? How often have I been ineffective as a health-care provider, just going through the motions? On the days when I felt this way, perhaps these thoughts were triggered by sleep deprivation, a bad hair day, or preoccupation with a personal problem or office politics. We’ve all been there before, and we know when we are not functioning at an optimal level. We all need to think about how to improve our effectiveness on those clinical days when we are feeling wishy-washy and not quite up to the task.
Now here’s a topic that all practicing hygienists can really sink their teeth into and get excited about. Consider the following headline: “Diabesity, a Crisis in an Expanding Country.” The March 29 New York Times article was written by Jane Brody.
For those of you who are unfamiliar with Jane Brody, she has been the personal health columnist for the New York Times since 1976. She has written at least nine books on personal health, fitness, and nutrition. She practices what she preaches and always makes time for daily physical activity.
Jane’s recent column talks about what she and others perceive as a runaway epidemic that has hit particularly hard in the United States - seriously overweight teenagers and adults. Jane doesn’t understand why the United States does not yet have a national initiative to control this particular problem.
In a new book titled, “Diabesity: The Obesity-Diabetes Epidemic that Threatens America, and What We Must Do to Stop It,” Dr. Francine Kaufman, a pediatric endocrinologist, provides us with some eye-opening statistics, and a comparison of teenagers and adults of yesteryear to those of today. She notes that the prevalence of diabetes, particularly type 2, has almost doubled in the American adult population from 1990 to 2002.
Dr. Kaufman recounts how she rarely saw young patients with type 2 diabetes in her first 15 years of practice back in the late 1970s and 1980s. She now sees teenagers who weigh 200 to 400 pounds with large accumulations of fat around the abdomen and blood sugar levels that are unprecedented. At the Diabetes Center at Columbia University, type 2 diabetes was diagnosed in 10 to 20 percent of the Center’s new pediatric patients, compared to less than 4 percent only five years ago. About one-third of this new class of individuals with diabetes are non-Hispanic whites while the rest are African-American, Native American, and Hispanic/Latino Americans.
Dr. Kaufman emphasizes in her book that lifestyle changes can prevent diabetes. That’s not easy in our fast-paced, fast-food world! Dietitians and fitness trainers frequently remind us that we must create a new culture that focuses on eating right, losing weight, and becoming physically active. Whether we like it or not, our society has become seriously flawed when looking at the percentage of money that is spent on prevention. According to Dr. Kaufman, the United States spends less than 1 percent of the billions that are budgeted annually for health care.
What, specifically, can you screen for when examining teenagers who fit the type 2 diabetes profile? Teens, in particular, are sometimes aware of diabetic symptoms but the disease is often undiagnosed until a regular physical exam is performed. Teens who are obese may present with complaints of polyuria, (frequent urination), polydipsia (excessive thirst), and weight loss. It would be appropriate to question them about these conditions when reviewing the medical history.
In addition, we should screen these overweight teens for hypertension and be on the lookout for a condition called acanthosis nigricans, which is present in 60 percent of cases of type 2 diabetes. Acanthosis nigricans usually presents as a gray-brown thickening of the skin and is commonly located at the base of the neck and other parts of the body. Sometimes you will see skin tags around the neck. You will see this more often in adult type 2 individuals with diabetes. The dark lesions are most often secondary to insulin resistance that is related to obesity. Sometimes, parents dismiss these lesions as an indication that a child has not washed his or her neck. Question the teenager’s guardian about a family history of type 2 diabetes and also be aware that about 25 percent of females suffer from a vaginal monilial or yeast infection before being diagnosed.
Several months ago, I was introduced to three lovely new clients, a father and his two early-teenage children. Until recently, the children’s mother had been raising the children on her own. The father decided that it was time for him to assume his role as father and return to live nearer to his children. Both teenagers were obese. The father had already told me beforehand of his suspicion that his children had become, in his words, “couch potatoes.” He was worried about the condition of their teeth. Sure enough, both children had teeth that were seriously neglected, and the microbial count must have been off the charts! The children’s father and I became good friends eventually, and his kids are now making some progress in many areas.
Early onset of type 2 diabetes among adolescents can have particularly devastating effects on long-term periodontal and general health. Gingival inflammation increases if diabetes is poorly controlled. Large epidemiological studies of type 2 individuals with diabetes reveal that diabetes increases the risk for destruction of the periodontium, including alveolar bone. In a study of the Pima Indian population in Arizona, which is reported to have the highest prevalence of type 2 diabetes in the world, “the prevalence and severity of periodontal bone loss was greater among individuals with diabetes than nondiabetic subjects in all age groups.”1 Prolonged hyperglycemia in type 2 people with diabetes in a large group of adult Pima Indians (N=628) showed that about 60 percent had severe periodontal disease and 70 percent of those adults with severe periodontal disease were edentulous!2 In this same study, the researchers who studied the Pima Indian population group concluded that periodontal disease in these adults was a strong predictor of death from heart disease and diabetic nephropathy (chronic kidney disease).2
Common sense also tells us that adolescents who are obese and who live a sedentary lifestyle with a poor diet are also more likely to consume more carbohydrate in the form of sucrose in soft drinks and other cariogenic foods. This particular diet leads to increased risk for dental caries and dental demineralization, especially when oral hygiene is poor. Education for these individuals has to be ongoing and must involve the entire family. Latchkey kids binge on high-fat, high-sugar, low-fiber foods, and our society’s higher standard of living provides these teens with more and more opportunities for bingeing and eating huge quantities of the wrong foods.
Who better to recognize and provide information to teens and their guardians than the dental hygienist? If our society is going to reverse this alarming “diabesity” trend, there needs to be a well-coordinated effort of all members of the community. As preventive-care specialists, we can empower a family to take the necessary steps toward a healthier and longer life.
1 Mealey BL. Diabetes and periodontal disease: two sides of a coin. Compendium 2000; 21(11):943-954.
2 Saremi A et al. Periodontal disease and mortality in type 2 diabetes. Diabetes Care 2005; 28(1): 27-32.
Lynne H. Slim, RDH, BSDH, MSDH, is a practicing hygienist/periodontal therapist who has more than 20 years experience in both clinical and educational settings. She is also President of Perio C Dent Inc. (Perio-Centered Dentistry), a practice management consulting firm that specializes in creating outstanding dental hygiene teams. Lynne is a member of the Speaking and Consulting Network (SCN) that was founded by Linda Miles and has won two first place journalism awards from ADHA. Lynne is also owner/moderator of a periodontal therapist yahoo group: http://yahoogroups.com/group/periotherapist. She can be contacted at [email protected].