Oral health needs for type 2 diabetics

type 2 diabetes
Michael Watson questions why dentists aren’t included in the treatment plan for diabetics and why any treatment isn’t available on the NHS

Dentists should be included in the treatment plan for type 2 diabetics, Michael Watson says.

With the diabetes ‘time bomb’ threatening to bankrupt the NHS, this week’s blog is going to be personal.

England looks set to reach five million type 2 diabetes diagnoses by 2020 – five years sooner than previously thought – prompting the British Society of Dental Hygiene & Therapy (BSDHT) to call on health ministers to ‘take dentistry seriously’.

Personal perspective

This blog will be personal because, 14 years ago, I became one of that five million when I was diagnosed with type 2 diabetes.

At that appointment my GP told me two things.

The condition was not curable, but could be managed.

How well it was managed was down to me.

He would prescribe the necessary medication and his team would monitor the condition twice a year.

But whether I avoided complications and kept away from hospital care was very much down to me.

As an aside, I wonder if dentists had a similar honest talk with their patients, instead of promising them a ‘Hollywood smile’ we might avoid complaints and lawyers.

Managing diabetes

To help me manage my condition, I am closely monitored within the practice and given support mainly by a practice nurse.

Then there is a wider team outside the practice, the pharmacist, optician and podiatrist and others when needed.

Diabetes UK lists 15 ‘essentials’ to provide you with the best healthcare.

But to me there is one glaring omission, the dental team.

I am not talking about sugar, something that seems to have exercised some dentists’ minds recently.

Yes, sugar can lead to obesity, but so can lots of other foods and, of course, alcohol.

I am talking about periodontal health.

Professor Philip Preshaw from Newcastle University wrote some years ago: ‘There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycaemic control.’

I agree with Michaela O’Neill, president of the BSDHT, when she says the increasing incidence of diabetes ‘should serve as a warning to the government who must now invest time, money and energy into raising awareness of the importance of dental hygiene’.

But I would go further – awareness of the link between diabetes and dentistry should extend to the medical profession, bodies like Diabetes UK and, I believe, the dental profession need to look at what it can do.

Preventive dentistry

Michaela O’Neill again: ‘Oral health education is the cornerstone of preventative dentistry and can have a positive impact on not only the health of the British population’s teeth and gums, but on their overall health, too’.

The profession needs to stop blaming everything on the government and ask itself what can dentists and hygienists do to sort out the oral health needs of the growing numbers with type 2 diabetes.

Anyone diagnosed with the condition needs to be seen and assessed by a dentist and embark on a programme of oral health education and periodontal treatment.

I can hear the objections, ‘you can’t do this with the UDA contract’, but is there any guarantee you can do it with a capitation contract and can our patients wait that long?

The profession needs to persuade commissioners locally that this needs to be given some priority.

And there is something the government can do.

There is no logical reason why a diabetic should have free treatment at their GP surgery, free prescriptions at their pharmacist, free retinal screening at their optician, but have to pay charges for their dental care.

So let’s see the exemption from charges for such medical conditions extended into dental care.

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