The Impact of Vascular and Cardiovascular Diseases on Oral Health, 4th Edition _ _____________________
health implications of diabetes, the inter-relationship between diabetes and periodontal disease, and the importance of regu- lar dental assessments and the need to maintain optimal oral hygiene at home (Zhang et al., 2023).
CASE SCENARIO (Continued)
Intraoral examination findings include generalized severe gingival inflammation and hypertrophy with multiple periodontal probing depths between 6 and 9 mm. Bleeding on probing is present around nearly every tooth. Class I and II mobility is found on the upper and lower incisors, with anterior “flaring” of the teeth and multiple diastemas. Subgingival calculus deposits are generalized, with local- ized heavier deposits around the lower incisors and upper molars. Plaque levels are mild on the teeth, but the dorsal surface of the tongue is coated with a visible biofilm. Radiographic examination reveals no active caries, but alveolar bone levels are irregular and approximately 2 to 6 mm below ideal levels. Points to Consider 1. Based on the clinical evidence, to what degree is Harold’s diabetes under control? It appears that Harold has poor control of his diabetes. Without actual information regarding blood-glucose levels, it can only be assumed that Harold’s oral health and periodontitis are evidence of uncontrolled diabetes. 2. How are Harold’s systemic and oral conditions interrelated? Harold clearly has an advanced and aggressive case of periodontal disease, which is likely exacerbated (but not necessarily caused) by uncontrolled type 2 diabetes. On the other hand, the poor quality of his oral health plays a negative role in the outlook of his diabetes and cardiovascular health as periodontal pathogens can be carried throughout the body via bacteremia. 3. What are some key steps that Dr. Morgan can take toward improving Harold’s overall health? First, Dr. Morgan should recognize his role as a healthcare provider to educate Harold on the relationship between his conditions. Harold needs to know the exact nature and outlook of his current periodontal disease and the role that uncontrolled diabetes plays in its acceleration. He should be strongly encouraged to seek medical care as well as to increase his physical activity. Periodontal therapy should begin with scaling and root planing before surgical therapy is considered. Harold should clearly understand that he is at risk of losing teeth, even with therapy, due to advanced bone loss. Improving his oral health will have a positive systemic effect, and helping Harold obtain the medical care he needs should lead to better control of his diabetes, which should in turn positively influence his oral health.
Self-Assessment Quiz Question 4
As a dental professional, it is almost certain that you will treat a patient with a history of diabetes. Which of the following statements is true? A) Diabetes mellitus was the eighth leading cause of death in the United States in 2021. B) Approximately 38.4 million people in the United States (11.6%) have either diagnosed or undiagnosed diabetes, and an estimated 97.6 million people have prediabetes. C) Over the past three decades, the number of people who have been diagnosed with diabetes in the United States has nearly quadrupled. D) All of the Above. The correct answer is D. Rationale : Diabetes mellitus was the eighth leading cause of death in the United States in 2021 (CDC, 2024a). Approximately 38.4 million people in the United States (11.6%) have either diagnosed or undiagnosed diabetes, and an estimated 97.6 million people have prediabetes. Over the past three decades, the number of people who have been diagnosed with diabetes in the United States has nearly quadrupled. If the trend continues, by 2050 nearly one of every three U.S. adults could have diabetes. 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. CASE SCENARIO Harold is a 68-year-old African American male. He presents to Dr. Morgan’s office as a new patient, having gone for more than 10 years without visiting a dentist. Harold’s chief complaint is swelling in his gums and bleeding when he brushes and flosses. His medical history indicates that he is 5 feet 10 inches tall and weighs 260 pounds. Harold was diagnosed with type 2 diabetes mellitus at the age of 60, and he also has high blood pressure. His current medications include metformin, atenolol, hydrochlorothia- zide, and a daily 81 mg aspirin tablet. There are no other significant conditions listed on his medical history. Dr. Morgan mentally notes that Harold walks with some difficulty and displays shortness of breath after being seated in the dental operatory. continued ►
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