______________________ The Impact of Vascular and Cardiovascular Diseases on Oral Health, 4th Edition
The prevalence and severity of periodontitis are increased in people with diabetes compared with those without the disease (Zhao et al., 2023; Herrera et al., 2023). Some researchers have reported an approximate threefold greater risk for those with diabetes (Genco & Borgnakke, 2020). Periodontitis also progresses more quickly in patients with diabetes. Compared with patients without diabetes, those with diabetes have a higher percentage of teeth with mobility and gingival recession (Graves et al., 2020). They also have more teeth with recession in the esthetic zone; more decayed, missing, and filled surfaces due to caries; and more missing teeth due to caries (Coelho et al., 2020). Patients with poor blood sugar control often have severely inflamed gum tissues and spreading of teeth caused by loss of tooth support (Graves et al., 2020). Common among diabetic patients with poor glycemic control is increased periodontal inflammation, increased attachment loss, increased bone loss, and impaired tissue healing. Other studies have also reported an increase in bone loss in individuals with uncontrolled or poorly controlled diabetes (Graves et al., 2020). Fortunately, there are ways to reduce risk for periodontal disease for persons with diabetes. Oral health practices vary considerably among diabetic patients. Data from several studies of diabetic patients indicate that only about 18% brush spo- radically, only about 25% flossed at least once daily, and about 54% had regular dental visits in the last 12 months (Alhazmi et al., 2022; Zhang et al., 2023). However, those patients with diabetes who did brush their teeth and floss regularly had better periodontal health and less caries than patients with diabetes who did not follow these oral healthcare regimens regularly. Furthermore, nonsurgical periodontal treatment has been shown to help improve glycemic control for patients with diabetes (Zhang et al., 2023). Patients with diabetes can have a higher rate of caries and tooth loss than non-diabetic populations. Infections, especially candidiasis, are more common in diabetic patients. Occasion- ally, dry mouth may be the main symptom due to dehydration. The initial intraoral signs of diabetes mellitus may be dry mouth, glossodynia, persistent gingivitis, rampant caries, or Candida infection. Patients with diabetes have an elevated incidence of slow wound healing and alveolar osteitis. Therefore, oral ulcers and open wounds may persist despite therapy. Other oral features of diabetes include “acetone breath,” large deposits of calculi that form rapidly after removal, increased salivary viscosity, asymptomatic sialosis, and unexplained odontalgia. Dental professionals can also play an important role in the management of their patients’ diabetes in terms of education related to improved lifestyle choices (e.g., healthier eating) and oral hygiene (e.g., importance of brushing). It is vital that diabetic patients are educated about the oral and overall
CASE SCENARIO (Continued) 2. What treatment should be performed prior to heart surgery, if any? Stabilizing Glen’s oral health and reducing the presence of periodontal pathogens should be the focus. This will likely include removal of tooth 2 and scaling and root planing. Depending on the speed at which Glen can obtain needed dental treatment, restoration of the root surface caries may be considered postoperatively so as not to unnecessarily delay Glen’s surgery. Any dental treatment undertaken should be done in consultation with Glen’s cardiologist with consideration of risk versus benefits. 3. What considerations should be given to subsequent dental care after the valve replacement surgery? Any dental work that will involve manipulation of gingival tissues, such as fillings or cleanings when instruments will be used subgingivally, should begin with antibiotic premedication to reduce the risk of bacteremia. Premedication protocols should adhere to the most current American Heart Association guidelines. In addition, appointments should be kept short, and measures should be taken to minimize stress. DIABETES Diabetes mellitus was the eighth leading cause of death in the United States in 2021 (CDC, 2024a). Approximately 38.4 mil- lion people in the United States (11.6%) have either diagnosed or undiagnosed diabetes, and an estimated 97.6 million people have prediabetes (CDC, 2023d). Over the past three decades, the number of people who have been diagnosed with diabe- tes in the United States has nearly quadrupled. If the trend continues, by 2050 nearly one of every three U.S. adults could have diabetes (Assuane & Golubnitschaja, 2020). Risk factors for type 2 diabetes, the most common form of the disorder, include increased age, obesity, family history of diabetes, race, ethnicity, hypertension, and certain socioeconomic conditions (CDC, 2023d; Mohebi et al., 2022). High blood sugar is a major characteristic of diabetes. A patient with diabetes either does not make enough insulin or cannot use the insulin effectively. Insulin is a hormone that helps lower blood sugar. If the body cannot control the levels of blood sugar, complications such as heart attack, stroke, amputations of the legs and feet, end-stage renal failure, visual impairment, and deaths due to hyperglycemia (high blood sugar) result (CDC, 2022a). Fortunately, advances in medical care, greater availability of preventive health care, better control of risk factors, and increased awareness of potential complications have reduced the rates of diabetic complications among U.S. adults (CDC, 2022c).
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