What might the therapeutic potential be if physicians recognized that untreated periodontal disease, like any other chronic infection, increased the systemic inflammatory burden, and posed a threat to the diabetic patient? What if the care of a diabetic patient was no longer fragmented and medical and dental providers collaborated on integrating care and shared joint responsibility for clinical outcomes? What if there were guidelines in place that provided the framework for cross referral of the diabetic patient, i.e., dentists’ referral to a physician of a patient suspected to have diabetes which is undiagnosed and physicians’ referral of a diabetic patient who is suspected to have periodontal disease which has not yet been diagnosed?
Evidence validating the bi-directional relationship between diabetes and periodontitis has been recognized in dentistry for decades but traditional medical guidelines for diabetes management have failed to factor in the significance of oral infections. Even the most recently updated guidelines, Standards of Medical Care in Diabetes-2006, 1 made little reference to the priority of oral health in diabetic management. Of note, periodontitis was still not included as a complication of diabetes, and dentists were not included among healthcare providers who should be considered for referral of diabetic patients. Many within the dental profession thought the role of oral diseases and conditions in increasing the risk for diabetic complications would go largely unrecognized by the medical community. That might be starting to change.
With the updated standards for medical care in diabetes published only 4 months ago, it seems the American Diabetes Association (ADA) is already rethinking the importance of oral health. Indeed, the perception of the medical community regarding oral infection as simply a localized threat might be starting to change. According to Nathaniel G. Clark, MD, MS, RD, Vice President of Clinical Affairs for the ADA, the issue of the relationship between diabetes and oral diseases and conditions has risen to the surface and there is now momentum within the ADA to address this practice gap (N. Clark, oral communication, March 2006).
In discussing what prompted the ADA to revisit the importance of oral health in diabetic management, Clark compared the ADA’s new interest in developing oral care protocols to the evolution the ADA went through in revising guidelines that recognized certain risks associated with anti-psychotic drugs. Although psychiatrists had long witnessed the therapeutic challenges associated with placing patients on anti-psychotic drugs (weight gain, development of diabetes), few outside the psychiatry community were as astutely aware of the potential deleterious effects of these drugs in their patients. Similarly,
Nathaniel G. Clark,
MD, MS, RD, Vice President, Clinical Affairs, American Diabetes Association
“The connection between oral health and diabetes care is becoming increasingly clear. Diabetes control affects oral health, and in turn, dental disease affects diabetes control. The American Diabetes Association is very excited about potential collaborations between diabetes care providers and the dental profession.”
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