Revitalizing the Guidelines for Interprofessional Care of Patients with Type II Diabetes & Periodontitis

Abstract

Type II diabetes mellitus (T2DM) is a chronic systemic condition caused by the inability of the body to regulate blood glucose levels. Periodontal disease is a common comorbidity of T2DM caused by an inflammatory reaction to an oral biofilm. This reaction causes gingival inflammation that leads to irreversible deterioration of the alveolar bone, loosening of the teeth, and in severe cases, tooth loss. Patients with T2DM are two to three times more likely to suffer from periodontal disease, and proper treatment of either condition improves the prognosis of the other. Despite this well-known association, patients seldom receive coordinated medical and dental care. In addition to the need for coordinated care, these patients frequently have limited economic resources. Patients with T2DM have a higher tendency towards falling into the category of lower-income populations with limited resources. Due to majority of the population that have T2DM falling into a lower SES dental care often falls to the back burner. With majority of patients being in this lower SES category there needs to be coordinated care for these patients with the proposed treatment guidelines. People of lower SES typically reside in lower-income neighborhoods with limited access to medical or dental care. Dental Hygienists have recognized limited access to care and have lobbied for law change from indirect access to care to direct access to care in 42 states. This legislative change has improved access to care for underserved populations. However, the quality of patient care for T2DM and PD is still lacking due to the deficit of referrals from the treating physician to dental health care providers for this patient population. Current clinical trials have established that the proper treatment of periodontitis can lower hemoglobin A1c and facilitate the treatment of systemic inflammation. The dental hygienist represents a potential entry point into periodontal care that may be more generally accessible and affordable. The dental hygienist is well positioned to bridge the gap between medical and dental treatment by aiding in managing both diseases to improve care for those afflicted.