The link between diabetes and periodontal disease is well known to dental professionals, but not to diabetics – Aisha Ramadan shares her experience of training in dental hygiene with diabetes.
Diabetes. Periodontal disease. Diabetes and periodontal disease. These are common words to hear as dental practitioners. From the bidirectional relationship, the complications and the severity to the importance of good oral hygiene and blood glucose control, having a good understanding of diabetes is key.
For my final project at Dublin Dental University Hospital (DDUH), I decided to focus on ‘Diabetes mellitus and oral health – healthcare practices in providing oral health education and support’.
Knowledge is power
In my two years of dental hygiene, I was bombarded with information on diabetes and periodontal disease. Though this was clearly not the intention, it was extremely overwhelming as a newly diagnosed type one diabetic. I got sick of hearing about the link, the complications and the negativity.
I already knew that I would have to take on the complicated role of my pancreas for the rest of my life. I would have to take injections multiple times a day. I would have to make an extra 180 decisions a day in comparison to non-diabetic.
I knew all about the complications, but this planted another worry at the back of my mind – periodontal disease.
Diabetes doesn’t get easier. Some days are good, some bad. But the more I learn about my body, my overall health and my oral health, the more manageable it gets and the better I feel, both mentally and physically. We can’t downplay the power of knowledge.
As dental hygienists, we have the perfect opportunity to help our patients. Oral health promotion is probably the most important role we have.
The power of adopting a holistic approach and taking the time necessary to educate and motivate our patients cannot be underestimated. This builds rapport and encourages patients to take their health into their own hands.
How can we do this? Currently, dental hygienists cannot work without the prescription, and in certain cases, supervision of a dentist. We need to consider how much value the practice and the leading dentist place on oral health promotion.
But, more importantly, we need to consider how much value we as dental hygienists place on education and promoting positive behavioural change. How much time during our appointment will we allocate to our patients’ oral health education? How can we provide a little extra help and support to our at-risk patients?
Diabetes and perio
When I was diagnosed, I heard about all of the risks – neuropathy, nephropathy, retinopathy, cardiovascular disease, stroke and peripheral vascular disease. Wait, maybe not all of them – I never heard of periodontal disease.
Despite the prevalence of diabetes and periodontal disease, despite the strong evidence that has been building for years, no general nurse or doctor, no specialist diabetes healthcare staff or endocrinologist ever mentioned it.
It wasn’t until I was in my first year of training that I heard those two words side by side: diabetes and perio, perio and diabetes.
It was overwhelming, it was scary and, worst of all, it made me wonder if my fellow diabetics were even aware.
What is our role?
Once again, this brings me back to the same question, what can we do? What is our role?
We can raise awareness. We can pass on our knowledge. We can promote positive behaviour change, instil good habits and work together with dentists, doctors and nurses.
We could also push for direct access. Imagine: we would have a lot more freedom in going out into the community and healthcare practices, educating diabetics and diabetic specialists on oral health. I strongly believe that this is an area that should be researched further and advocated for.
Maybe then, we could take the initiative.
One strategy could be to create groups to target high-risk patients in GP practices, hospitals, clinics and community centres.
These would focus solely on prevention of oral disease, promotion of good oral health habits and education. We could talk to the patients, listen to their struggles and tailor our approach to their needs. Oral health is not one size fits all.
Unless we take the time and change our mindset, it will inevitably remain the same.
Prevention over treatment, a holistic approach, investment of time and empathy – always. These are the values that I chose to instil in myself. They are the values I go by, day after day, patient after patient.
So, I urge you as clinicians to see past just the oral cavity, past a treatment-only approach, and look at the wider picture. Don’t be afraid to spend more time – simply talking, listening and passing on your knowledge.
The IDHA Back to the Future conference will be held at the Midlands Park Hotel, Portlaoise on 17 and 18 November 2023. Visit www.idha.ie to register.
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