Dental Hygienist with Type II Diabetes

By: Jan Lazarus RDH

January 17, 2018

The Challenge:

Knowing the scientific information that clearly confirms the bi-directional relationship with diabetes and periodontal disease, our goal is reduce the periodontal pathogens to improve the diabetic status.

The Background:

  • Age: 38
  • Sex: F
  • Medical History: Recently diagnosed with Type II Diabetes. See Nutrition Notes.
  • Family History: Type II Diabetes & Periodontal Disease
  • Last Dental Exam: 8 weeks ago
  • Home Care: Meticulous consisting of electric toothbrush 2x/day, flossing daily and water piking 1x/d
  • Nutrition Notes: Her physician agreed to her commitment to diet and lifestyle changes before considering medication to control her Diabetes. These changes included regular exercise and eliminating sugar.
  • Chief Complaint: “When it comes to my diabetes, I know what to do, I just have to do it!” Also the patient is a dental hygienist, she wants to know she is doing everything possible orally.
  • Periodontal Assessment: No bleeding on probing, scattered 4mm posterior areas of 1 mm recession, no visible inflammation and excellent plaque control. Grayish tissue color (most likely due to lack of circulation) w/ lack of stippling around crowns. Residual light calculus around crown margins. Radiographic evidence of posterior bone loss.

The Solution:

  • Performed initial MyPerioPath® on 9/10/2015
  • Periodontal therapy: Removal of residual marginal calculus around crowns and complete biofilm disruption with ultrasonic slim line inserts, hand scaling with curettes and subgingival airpolish conducted in two appointments
  • No systemic antibiotics were administered due to patient wanting to see what her body could do first.
  • Lifestyle & Diet changes
  • Home Care: Remained the same
  • Performed follow up MyPerioPath® post therapy 3/10/2016

Questions:

  • Would she have gotten the same great reduction in pathogens if she had not changed her diet and lifestyle?
  • Did the pathogens contribute to her diabetes or did the imbalance of blood sugar contribute to the proliferation of pathogens?

The Result:

The periodontal changes were favorable; the color and texture of tissue presented healthy and the 4 mm pockets reduced to 3mm. The MyPerioPath® post-therapy results (MyPerioProgress®) showed a dramatic shift in the bacterial load. More importantly, when the patient presented to her medical doctor to evaluate her diabetic control, she had reversed her diagnosis. Her lab tests confirmed a normal A1C and blood glucose levels.

Comments:

This patient is most grateful that she had the opportunity to test for periodontal pathogens and had a relatively simple treatment to eliminate the pathogens and positively influence her diabetic diagnosis! This case highlights the role of dental care with overall health, the need to comanage patients and the need for patient cooperation.

About the Author:

Jan Lazarus RDH, Certified Health Coach is known as a thought provoking speaker, influencer, consultant, trainer and internationally recognized pioneer in the field of comprehensive continuing education in Dentistry. As the owner and President of JP Consultants Institute, Jan has developed life changing curriculum for patients, dentists, hygienists and dental teams. Programs have included custom agendas for private in-office training, train the trainer for consultants, coaches, speakers, and large Dental Corporations. The key foundational element of all of their programs since 1979 has been the understanding that the mouth is a “window” to overall health of the body. As a board member of the American Academy for Oral Systemic Health she is part of an organization of health care leaders and scientists dedicated to expanding awareness of the relationship between oral health and whole body health. “Communicate from your heart and speak the truth”