Figure 3

Case 2. Radiographic presentation of severe periodontal disease, generalized caries and abscesses in a 46-year-old female with type 2 diabetes.

 

ing a sterile needle and pressure to drain the abscesses. to comply with the recommendations of a nutritionist but
She was diagnosed with periodontitis and caries in 2003. the patient was unable to eat fruits and vegetables due
Her current medications included: metformin, Lantus^®i to the status of her dentition. She met with a surgeon to
(insulin glargine), Synthroid^®ii (levothyroxine sodium), determine if she was a candidate for gastric bypass, but
Altace^®iii (ramipril), atenolol, aspirin, and folic acid. The the procedure was contraindicated due to her dental con-
patient developed a penicillin allergy due to repeated use dition. She was hospitalized twice in the first 3 months of
for acute dental infections. Antibiotic coverage included 2006 with bilateral pneumonia which was treated with
clindamycin (300 mg t.i.d.) or levofloxacin (500 mg q.d.). intravenous antibiotics. It was suspected that her dental
Her history revealed both parents have type 2 diabetes diseases contributed to her respiratory condition.
and wore dentures by the age of 40. Genetics, diabetes,
obesity, and smoking were clearly risk factors to be con- In discussions with the patient she indicated she was very
sidered in this patient. The patient also reported a history worried about the possibility of dying from her dental in-
of gestational diabetes with all 3 of her pregnancies from fections, and it was difficult to reassure her otherwise.
1980-1992 (many gestational diabetics eventually devel- The physician recognized the need for dental care but
op type 2 diabetes). ²⁹ She was diagnosed with diabetes in none of her healthcare providers were able to assist in
1999 and managed solely with oral hypoglycemics until securing the funds to obtain appropriate care. This case
2005, when insulin therapy was initiated. presents us with many unanswered questions regard-
ing the optimal management of the diabetic patient. This

Her HbA1c was 8.8% ( 4. 1-6.5% is normal) and her C-re- patient’s dental disease likely contributed significantly to active protein level (CRP) was 12.60 (low risk = < 1.0 mg/L, her medical needs, which begs the question: Should medi-average risk = 1.0 to 3.0 mg/L, high risk = > 3.0 mg/L) indi- cal insurance cover dental treatment as an integral part cating a significant pro-inflammatory status contributing of diabetes management? Recognizing this patient was at to insulin resistance and increased risk for CVD. She was an impasse, the School of Dental Medicine at Stony Brook referred to an oral surgeon and restorative dentist for made a commitment to support her complete oral rehabil-consultation but was unable to pursue the recommended itation, regardless of ability to pay. Sadly, for many cases dental treatment plan due to a lack of insurance and fi- like this one, there are no financial mechanisms in place nancial resources. The lack of regular dental care impeded to cover critically needed dental care in diabetes manage-the patient’s attempts to improve her diet. She attempted ment, including provisions within medical insurance.