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Grand Rounds

June 1, 2006
May issue of Grand Rounds in Oral-Systemic Medicine journal focuses on diabetes/periodontal connection.

May issue of Grand Rounds in Oral-Systemic Medicine journal focuses on diabetes/periodontal connection.

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In a pursuit of a more interactive relationship between the medical and dental communities for the treatment of systemic diseases, Grand Rounds in Oral-Systemic Medicine (GR) called for a “tipping point” that would result in a “transformation of the health-care professions ... to become involved in the prevention and active management of diabetes.”

The GR editors - Casey Hein, RDH, and Charley Cobb, DDS - said in the May issue’s Letter from the Editors, “There is evidence to suggest that physicians are not implementing standards of care for diabetic management. Other research draws into question dentists’ and periodontists’ willingness to become involved with active management of diabetic patients.

“To that end, affecting a ‘tipping point’ in the diabetes pandemic will require a transformation of the health-care professions that necessarily begins with a willingness to become involved in the prevention and active management of diabetes.”

The quarterly, refereed journal that is published by PennWell (also publishers of Dental Economics, Dental Equipment & Materials, Woman Dentist Journal, and RDH magazines) offered four articles to support conclusions regarding the “bi-directional” treatment of diabetes. The articles can be viewed in their entirety at

A group of three authors led by New York physician Dr. Maria Ryan published an article titled, “The impact of periodontitis on metabolic control and risk for diabetic complications.” The authors stated that it “was unfortunate that oral health was barely addressed” in protocols established by the American Diabetes Association.

However, Hein said in a separate article in GR that the association is “already rethinking the importance of oral health.” Her conversation with Dr. Nathaniel Clark, vice president of clinical affairs for the American Diabetes Association, indicated the association would be looking for “reasonable conclusions” from the scientific evidence “to support the bi-directional relationship between diabetes and periodontal disease,” according to Hein.

The article by Dr. Ryan and her New York peers offered four cases of “bi-directional” diabetes management that surfaced primarily at the School of Dental Medicine at State University of New York at Stony Brook. One case involving a 34-year-old type 1 diabetic female, for example, noted that periodontal therapy “resulted in improvements in the patient’s metabolic control and may have reduced her risk for cardiovascular disease.”

The article concluded, “Just as physicians closely monitor diabetic patients for metabolic control, compliance, and overall systemic health, it is necessary for the dental providers to do the same ... With newly developed treatment modalities (antimicrobials such as Arestin, Atridox, Periochip, and Periostat) that target both the microbial and host response components of periodontal disease, it is reasonable to expect that metabolic control may improve in diabetic patients simultaneous to improvements in periodontal health.”

The May issue of GR also included a “literature review” on periodontal disease and diabetes mellitus. Two periodontists, Drs. Alan Moritz and Brian Mealey, stated, “Diabetes mellitus and periodontal diseases are chronic, treatable conditions, although neither has a cure, and each requires long-term follow-up and reinforcement for maximum treatment results.”

The authors reinforced GR’s push for greater collaboration between health-care professions.

The article said, “From the medical side, all patients diagnosed with and treated for diabetes mellitus should be routinely referred to a dentist to evaluate their periodontal condition as part of the overall treatment for diabetes mellitus. Physicians should be aware of the potential impact of periodontal inflammation on achieving ideal glycemic control and should concern themselves with their patients’ periodontal status.”

Specifically, Drs. Moritz and Mealey encouraged dentists to:

screen patients’ medical histories for the possibility of diabetes mellitus
ensure related lab tests to verify glycemic status
refer patients to physicians for further diagnosis and treatment

In addition, GR published an article by Hein and Doreen Small, RN. The latter is a diabetes nurse specialist at Long Island Jewish Medical Center in New Hyde Park, N.Y. The two authors examined the “syndemic approach” to obesity, periodontal disease, and diabetes. The authors acknowledged that dental and dental hygiene schools address many dental issues involving diabetics to students. But, in urging “essential” assessment and treatment of periodontal disease discovered in diabetic patients, the authors said a “syndemic orientation” would push for treatment of a “cluster of diseases resulting from multiple forces.”

In addition, Hein and Small found it “exciting” to observe an increasing emphasis on preventive dentistry by insurers, which would enable health-care practitioners to focus more on risk factors such as obesity, as well as other risk factors associated with periodontal disease and diabetes.

In a postscript, Small said, “Nurses also have expanded their focus to include prevention. I see the role of the dental hygienist as undergoing a similar transformation, with both nurses and hygienists expanding their focus and practicing in a more holistic, syndemic manner.”

PennWell launched Grand Rounds in Oral-Systemic Medicine last January. The inaugural issue’s articles also followed a theme, exploring the systemic link between periodontal disease and heart disease. Those articles can also be viewed at