Diabetes and the Dentist
In the future, it seems we may become more of an oral and general health screener, and possibly less of a general dentist. The mouth can be the first indicator of systemic disease, and we need to be aware of this. Diabetes makes a perfect case in point.
Some patients may present with abnormal recession or periodontal problems when everything else appears to be excellent. Diabetes increases the risk of perio diseases and could be the culprit. Of interest, this also works the other way around- inflammatory perio diseases may increase insulin resistance in a way similar to obesity, so aggravating glycaemic control. Put simply, by improving the gums, you can also improve the diabetes. This fact can be helpful regarding patient compliance, especially if they can understand how regular hygiene treatment can improve the overall quality of life.
Oral candidal infection, or thrush, can be an indicator of undiagnosed diabetes. Diabetes has also been linked appearance of lichen planus, and should always be on the list of suspects when investigating the aetiology of this autoimmune disease. The onset of diabetes can even be the cause of taste disturbance.
Returning to lichen planus, two of my patients have recently taught me an excellent alternative therapy to the conventional use of steroids. The plant purslane, unfairly considered a weed and very common in the Wairarapa, is a common ingredient in Chinese medicine. It is remarkably high in Omega-3 fatty acids, great for the vegetarians among us, and chewing the leaves has been shown to be surprisingly effective in reducing the symptoms of lichen. A 2010 peer-reviewed study found that 83% of patients had partial to complete improvement of symptoms following the application of purslane. Seeds are available to buy from the Koanga Institute website.
As general health practitioners, we must not forget that those pesky teeth are actually attached to a body. We can be a real help to a patient, and to their GMP. We can punch well above our weight in diagnosis, and screening for diseases like diabetes may become part of our normal working life. This can only be good for everyone, and help to make our occupation more varied and interesting.
By Dr Laurence Fisher