Diabetes care in a state of decay when it comes to oral health

Integration of dental and diabetes care could address unmet oral health care needs in people with diabetes and feed back into better diabetes management, researchers say.

A University of Queensland study has shown the concept is supported by both patients and staff at a public diabetes clinic.

The study, published in the Australian Dental Journal, collected quantitative and qualitative data from 41 patients and seven staff members at West Moreton Health in Ipswich.

And the picture wasn’t pretty when patients had dental screening performed while waiting for their regular diabetes appointment.

Four (9.8%) patients were edentulous and the mean number of remaining natural teeth for the other patients was 17. Thirteen (42%) patients wore dentures.

“Half (51%) of survey participants were not aware that diabetes affects oral health. Of the 28 patients who were eligible for public dental care, only nine (32%) had seen a dentist in the past 12 months, predominantly for emergency care.”

Of the patients with remaining natural teeth, 31 (84%) required a full periodontal assessment.

“Three patients (7%) were identified as having acute dental abscesses during screening and were given urgent referrals to West Moreton Oral Health Service, and 17 (46%) patients had multiple advanced carious lesions.”

The most common reasons for not seeing a dentist in the previous 12 months were cost (48%), fear (30%) and lack of perceived need (22%).

Follow-up interviews with the patients referred to the local oral health service also highlighted some additional barriers including lack of transport, lack of a clear pathway to access public dental care services, and appointment fatigue.

A focus group of medical, nursing and allied health staff indicated their support for a formal oral health referral pathway as the new standard of multidisciplinary care.

The study team, led by Dr Kelly McGowan from West Moreton Health and the University of Queensland, said their intention had been to focus on periodontal disease given “the well-reported bidirectional relationship between diabetes and periodontitis”.

However the unexpected high prevalence of dental decay in the diabetes clinic – admittedly in an area of socioeconomic disadvantage – changed their focus.

“Efforts to integrate oral health care into diabetes management should not be focused specifically on periodontal disease and instead incorporate comprehensive dental care.”

“This is consistent with national and international data that shows unmet dental needs are frequently reported and increase with age and socioeconomic disadvantage.”

They noted that despite a high rate of dental disease, only a minority of patients reported pain.

“This may be partly attributable to diabetes-related complications or neuropathy, or due to the use of regular pain medications. These findings indicate dental screening is of increased importance for patients with diabetes who may not be seeking dental treatment, even in urgent cases.”

“Incorporating oral health into the range of multidisciplinary treatments at West Moreton Diabetes Clinic, which includes podiatry, optometry, and dietetics, may also increase the perception of its importance in diabetes management,” they said.

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