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Identifying valuable risk indicators – Deborah Lyle

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  Posted by: The Probe      4th June 2018



In the UK the number of people with diabetes is increasing rapidly[1]In order to stem this escalation, raising awareness to help reduce the risks and prevent type 2 diabetes as well as readily available diabetes education is urgently needed.

The other pressing issue is that an estimated 630,000 people in the UK have undiagnosed or untreated type 2 diabetes2 and the longer they live without intervention the worse their health outcomes are likely to be.

As dental professionals will be aware if the body is unable to efficiently metabolise glucose circulating in the blood stream and glucose levels remain elevated for long periods (hyperglycaemia), it can cause permanent damage to the eyes, nerves, kidneys and blood vessels.[2]  In addition, if blood sugar levels are poorly controlled salivary flow can decrease and encourage bacterial growth and/or dry mouth, which may lead to ulcers, soreness, halitosis, infections and tooth decay.[3]Uncontrolled diabetes can also impair the function of white blood cells and cause reduced blood flow around the body including the oral cavity, where the gingiva and teeth can become weak and more susceptible to infection.[4]

Over the last two decades, the profession has seen more and more evidence to suggest that diabetes heightens the chances of developing periodontal disease[5],[6]and increases periodontal destruction.[7]It seems that the link between these two chronic diseases is more complicated that we first thought as further a study also reveals that periodontal infection can adversely impact glycaemic control[8],[9]making it more difficult for diabetic patients to control their blood glucose levels.  Interestingly, a recent systematic review tentatively suggests that when periodontal treatment is maintained for at least three months it can affect glycaemic control and improve the general health of type 2 diabetic patients.[10]

As with most serious diseases, successful treatment to reduce the risk of complications depends on swift diagnosis – but, regrettably, it is possible for individuals to have abnormal blood glucose levels for some time and be fairly asymptomatic. Equally, it may be hard for people to notice the early symptoms of diabetes or simply disregard them as being the result of fatigue or stress. The dental practice however, has been recognised as a suitable location for identifying patients with pre-diabetes and undiagnosed diabetes.

Research conducted in the last year has revealed that a considerable number of patients with severe gum disease have undiagnosed diabetes. A study at the University of Amsterdam confirmed that periodontitis is an early sign of diabetes and, therefore, could serve as a valuable risk indicator to help prevent more severe complications.[11]Similarly, as patients attend the practice routinely, practitioners are ideally placed to discuss diabetes. If a patient mentions dry mouth, ulcers or increased thirst, or indeed any of the other early signs or symptoms of diabetes,[12]dental professionals should advise them to visit their GP for screening.

As well as making patients aware of the risks of diabetes and possibly helping to identify undiagnosed or untreated cases, dental professionals can also arm patients with the skills and guidance they require to make a positive impact on both their oral and general health. This includes offering dietary advice and helping them to enhance and maintain excellent oral health. Practitioners can also teach brushing techniques and recommend consistently effective adjuncts like the Waterpik®Water Flosser, which has been clinically proven to be twice as effective as dental floss for improving gum health.[13]In fact, the Waterpik®Water Flosser can remove plaque biofilm from treated areas in just 3 seconds[14]and can significantly reduce gingivitis and bleeding for patients with diabetes.[15]

It is hoped that by raising awareness of the risks of diabetes, as well as providing strategies to improve both general and oral health, patients maybe able to live longer and fitter lives.

 For more information on Waterpik International, Inc. please visit Waterpik®products are available from Amazon, Costco UK and Superdrug stores across the UK and Ireland.


[1]Diabetes UK. Number of people with diabetes reaches over 4 million. January 2016.[Accessed 20thMarch 2017]

[2]NHS Choices. Hyperglycaemia (high blood sugar).[Accessed 20th March 2017]

[3]Awatif Y et al. Oral Manifestations and Complications of Diabetes Mellitus. Sultan Qaboos Univ Med J. 2011 May; 11(2): 179–186.[Accessed 20th March 2017]

[4]Rajkumar D et al. Diabetes and periodontal disease. J Pharm Bioallied Sci. 2012 Aug; 4(Suppl 2): S280–S282.[Accessed 20th March 2017]

[5]Dr. Guglielmo Campus et al. Diabetes and Periodontal Disease: A Case-Control Study

 Journal of PeriodontologyMarch 2005, Vol. 76, No. 3, Pages 418-425 , DOI 10.1902/jop.2005.76.3.418 (doi:10.1902/jop.2005.76.3.418). [Accessed 20th March 2017]

[6]Ira B Lamster et al. The relationship between oral health and diabetes mellitus. J Am Dent Assoc. October 2008, Volume 139, Supplement 5 Pages 19S-24S.[Accessed 20th March 2017]

[7]Mealey BL. Periodontal disease and diabetes. A two-way street. J Am Dent Assoc. 2006 Oct;137 Suppl:26S-31S.[Accessed 20th March 2017]

[8]Mealey BL. Diabetes and periodontal disease: two sides of a coin.Compend Contin Educ Dent. 2000 Nov;21(11):943-6, 948, 950.[20th March 2017]

[9]Taylor GW et al. Periodontal disease: associations with diabetes, glycemic control and complications. Oral Dis. 2008 Apr;14(3):191-203. [Accessed 20thMarch 2017]

[10]Teeuw W J et al. Effect of Periodontal Treatment on Glycemic Control of Diabetic Patients. A systematic review and meta- analysis. Diabetes Care. 2010 Feb; 33(2): 421–427.[Accessed 20th March 2017]

[11]Teeuw W J et al. Periodontitis as a possible early sign of diabetes mellitus. BMJ Open Diabetes Research and Care 2017;5:e000326. doi:10.1136/bmjdrc-2016- 000326.[Accessed 20th March 2017]

[12]Diabetes UK. What are the signs and symptoms of diabetes?[Accessed 20thMarch 2017]

[13]Rosema NAM et al. The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol 2011; 13(1):2-10.[Accessed 20thMarch 2017]

[14]Gorur A et al. Biofilm removal with a dental water jet. Compend Contin Ed Dent 2009; 30 (Suppl 1):1 – 6.{Accessed 20thMarch 2017]

[15]Al-Mubarak S et al. Comparative evaluation of adjunctive oral irrigation in diabetics. J Clin Periodontol 2002; 29:295-300.[Accessed 20th March 2017]

 Biographical Information for Deborah M. Lyle, RDH, MS

Deborah received her Bachelor of Science degree in Dental Hygiene and Psychology from the University of Bridgeport and her Master of Science degree from the University of Missouri – Kansas City.  She has 18 years clinical experience in dental hygiene in the United States and Saudi Arabia with an emphasis in periodontal therapy.  Along with her clinical experience, Deborah has been a full time faculty member at the University of Medicine & Dentistry of New Jersey, Forsyth School for Dental Hygienists and Western Kentucky University.  She has contributed to Dr. Esther M. Wilkins’ 7th, 8th, 9thand 10theditions of Clinical Practiceof the Dental Hygienistand the 2ndand 3rdedition of Dental Hygiene Theory and Practiceby Darby & Walsh.  She has written numerous evidence-based articles on the incorporation of pharmacotherapeutics into practice, risk factors, diabetes, systemic disease and therapeutic devices.  Deborah has presented numerous continuing education programs to dental and dental hygiene practitioners and students and is an editorial board member for the Journal of Dental Hygiene, Modern Hygienist, RDH, and Journal of Practical Hygiene and conducted several studies that have been published in peer-reviewed journals. Currently, Deborah is the Director of Professional and Clinical Affairs for Waterpik, Inc.

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