Prevention: we LOVE it! Over the past few decades, treatment planning has continued to change, and preventative and minimally-invasive dentistry are at the forefront.
I was diagnosed with Type 1 Diabetes Mellitus (T1DM) when I was three years old, and have controlled it with insulin ever since. Fortunately, management of the condition has also continued to change over the 20 years, and where I would constantly have to chase my insulin doses by eating more to prevent episodes of hypoglycaemia (low blood sugar levels), with programmes such as DAFNE, I have much more freedom with eating choices and timings. DAFNE (Dose Adjustment For Normal Eating) means that you take your insulin to match your carbohydrate intake, rather than the opposite way around.
“Why is this relevant to dentistry?”, I hear you ask!
We’re so programmed to look out for periodontal disease when we think of diabetes, and a common assumption with the public is that people with T1DM do not eat ANY sugar. In fact, I have been asked on many occasions if I am, indeed, allergic to sugar! I will take this opportunity to say NO, diabetic people are NOT allergic to sugar! It can be quite the opposite at times, but that’s for a whole new blog post!
As I said earlier, growing up, I would have to keep snacking to make sure there was enough carbohydrate in my system to match the insulin that I had taken. This was the case for almost all people with T1DM. Digestive biscuits were usually the weapon of choice while at school, as they were quick and easy to eat, provided a long-acting form of carbohydrate as well as the initial sugar burst, and were easy to store for long periods in a classroom. But, as we all know, the FREQUENCY of sugar intake is what increases the risk of caries, NOT the actual amount.
Can you IMAGINE what this constant grazing does to teeth?! My mother was always embarrassed when she would take me for my 6-monthly dental check-ups, and would get withering looks from the dentist who would assume, unfortunately, that my diet was awful and that my mother just did not care! When in fact, she was being OVER-cautious. Subsequently, 3 out of 4 of my first molars (that erupt age size), are restored, and goodness only knows what my deciduous teeth were like.
There have been studies into whether sugar is carried in the saliva of people with diabetes when their blood sugar is higher than optimum, which would also suggest a reason for the higher caries risk. The correlation is such that now, a rough idea of blood glucose level can be attained from saliva samples! Please click here to find out more.
So, what can we do?
As a dentist, I always put my Type 1 diabetes on a high caries-risk plan, prescribing high fluoride toothpastes where appropriate, fissure-sealing and fluoride-varnishing, and keeping up-to-date with their radiographs and recalls. Type 1 diabetes can be difficult to manage, so it’s important that we do our part as dental professionals to alleviate any extra complications, of which there can be many. With that in mind, it’s incredibly important that your patients feel like they have autonomy; ask your patients about their control and diet habits, and NEVER assume! Make suggestions about adjuncts, and work together on a plan; one of my teenage patients now chews sugar-free gum after her post-netball-practice snacks, to encourage a more neutral pH and some remineralisation. In today’s society, conditions need not RULE your life the way that they used to.
A little extra consideration of how to avoid problems can make all the difference!