Welcome to Julian Webber's blog where he muses on a range of topics including some of his most interesting cases,
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When diabetes and dentistry meet

The world’s first diabetes prevention programme has just been launched by NHS England  with the aim of identifying patients who are most at risk of Type 2 diabetes. This is welcome news. Within the dental profession there has been growing evidence of links between diabetes and dental health and this is now being communicated directly to patients. A major online diabetes forum in the UK tells visitors that problems with teeth and gums can be more common and more serious in people with diabetes.

While periodontists treat gum disease, it falls to endodontists to treat apical periodontitis. This is disease in the bone area mainly  around the tip of the tooth (periapical lesions) caused by bacteria in the dental pulp.  The disease process can lead to considerable pain and  and swelling requiring root canal treatment. A possible connection between diabetes and endodontics makes sense. There have already been some studies which indicate that in diabetic patients there is a higher prevalence of Endodontic disease with associated apical periodontitis.

Studies also show that these areas of infection – lesions – may be bigger and take longer to treat or may even be more difficult to treat in diabetics. Slow healing of wounds can be a feature of diabetes. Certainly, among my diabetic patients, post endodontic healing is likely to take marginally longer than healing in other patients.

What does this mean for people with diabetes? Well, it’s worth bearing in mind that there are around 4 million people in the UK with diabetes and about 500,000 of those have the condition and aren’t aware of it. The vast majority of diabetic patients – around 90% – have Type 2 diabetes. They are more likely to be over 40 and may have heavily filled teeth. Endodontic infection can begin when an old filling fails and decay penetrates into the dental pulp.

So, what I’m suggesting is that the 500 people every day being diagnosed with Type 2 diabetes may well include a cohort prone to endodontic infection and they will need extra care taken in their management. The medical history form that dental patients are asked to fill in and then keep up to date has never seemed so important.

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