Proper oral care can lead to better management of diabetes
By Deb Utacia Krol, Native Health News
Alliance; © Native Health News Alliance
Jeanne Eder Rhodes didn’t realize
how the simple acts of regularly brushing
and flossing her teeth could lead to better
health for diabetics.
Rhodes, 66, who recently retired as
head of the University of Alaska’s history
department, was diagnosed with type 2
diabetes in 1998.
“I didn’t learn about the importance
of oral care until 2004,” says Rhodes, a
Dakota Sioux from the Fort Peck Reser-
vation in Montana. “My dentist said that
he could tell how my diabetes was doing
just by examining my teeth. That’s when
I started paying attention to my gums
and teeth.”
Oral health and diabetes experts
universally agree that proper oral care
is an essential tool in managing diabe-
tes. The American Diabetes Associa-
tion (ADA) reports in its online journal
that “periodontal treatment leads to an
improvement of glycemic [blood sugar]
control in type 2 diabetic patients for at
least three months.”
In a population where one-third of
all Native diabetics and 25 percent of all
American Indians and Alaska Natives
age 65 and older have lost all their teeth,
maintaining good oral health is vital to
the health of all Native people.
Too many Natives, however, are not
seeing a dentist regularly.
“Just as you have to get an annual
physical examination, you also need to
get a dental examination,” said Dr. Anh
Thu Becker, a dentist at Native Health, a
Phoenix community health facility that
serves many Phoenix-area Native people.
“Most people think ‘if it doesn’t hurt, I
don’t have a problem.’”
Dr. Alex Cota, a dentist with Sun Life
Family Health Centers in Sun City, Ariz.,
says he can tell a new patient has diabetes
with just a simple diagnostic instrument
– his nose.
“A basic sign of diabetes is breath
that smells like a rotten apple,” said Cota.
Reduced resources in communities
served primarily by Indian Health Service
Openings for Siletz
Tribal Court Judges
An announcement accepting
applications for the judges’ positions
in the Siletz Tribal Court is available
for those interested in applying.
All judge positions are coming
to term end on June 30, 2015, so
recruitment for the positions of chief
judge, associate judges and appellate
judges for the Tribe’s District Court,
Gaming Court and Community Court
will occur.
Applications are available on the
Tribal website (ctsi.nsn.us) in the
Employment section or by contact-
ing the Tribe’s Human Resources
Department at 541-444-2532 or 800-
922-1399.
facilities also can contribute to less oral
care. IHS is aware of the connection,
though, and it offers information for both
patients and providers on including oral
care education and evaluation in diabetes
management programs.
However, “by the time people have
symptoms (like inflamed and bleeding
gums),” Becker says, “it’s too late to
prevent periodontal disease” and the pos-
sibility of bone and tooth loss that can
result from delaying treatment.
Cota adds that bone loss is especially
worrisome for diabetics as dentures are
harder to fit. Also, he warns diabetic
patients that gum care is still a priority
even after losing healthy teeth to peri-
odontal disease as a fungal infection
known as candidosis can occur.
Failing to maintain good oral health
has other pitfalls for diabetics.
“Because diabetes lowers a patient’s
resistance to infection, periodontal
disease is harder to treat in diabetics,”
Becker says. “Uncontrolled blood glucose
is very worrisome.”
In fact, chronic inflammation, such
as uncontrolled gum diseases coupled
with diabetes, also contributes to a host of
other diseases linked to diabetes, such as
thrush, canker sores and eventually, life-
threatening conditions like coronary heart
disease and kidney disease, said Cota.
Becker notes that periodontal disease,
which starts as gingivitis or inflamed
bleeding gums, is caused by bacterial
growth in the mouth.
“We all have these bacteria in our
mouth,” she says. “Controlling the bac-
teria levels in your mouth will control
gum disease. There is a balance between
healthy teeth and a healthy body.”
Home care is the basis of good oral
care for all.
“Patients have to be the ones to care
for their teeth,” said Becker. She recom-
mends that people brush their teeth at least
twice a day, floss daily and visit a dentist
twice annually for cleanings and exams.
“Simple treatments like cleanings
don’t cost nearly as much as treating
advanced oral diseases,” Cota added. “It’s
like paying $100 for a filling or $1,000 for
a root canal from not getting the filling.”
People with periodontal disease,
which like diabetes is a chronic, incurable
condition, will need to have deeper clean-
ings three to four times a year. Antibiotics
also can be prescribed in some cases,
Becker said.
He also stressed, “Don’t smoke –
smoking causes basal constriction of
blood vessels and smokers are 20 times
more prone to get periodontal disease.”
Just as diabetics are urged to keep
their blood sugar under control, Becker
says that keeping oral bacteria in check
prevents a host of health threats.
“It’s all about control,” she said.
Indeed, maintaining good oral health
contributes to good overall health. The
ADA notes that a 1 percent change in A1C
levels contributes to an average 35mg/dl
drop in blood glucose.
Dentists now routinely take medical
histories of new and regular patients, and
regularly check for signs that might indicate
undiagnosed diabetes or other diseases.
A 2014 American Dental Association
study encouraged dentists and other medi-
cal providers to collaborate as part of a
chronic care model. A collaborative model
might include dental office screenings for
diabetes and pre-diabetes, which in the
study were found to provide important
health benefits.
When Cota sees signs of diabetes, he
refers his patients to a Sun Health Center
physician; Becker refers to a Native Health
provider. They also will refer a patient with
other warning signs, such as changes in the
tongue, to a physician for evaluation.
Patients also should notify their den-
tists of any health concerns, said Cota.
“Even if diabetes is in a patient’s
medical records, they should still tell their
dentist before having work done,” he said.
“We can be ready to properly treat our
diabetic patients if we know.”
Rhodes, who has private insurance
but was treated at an innovative diabetic
management program for Native people
477-Tribal TANF Plan
Comment Period:
March 13-April 27, 2015
Please submit comments to:
Kurtis Barker
477 Self-Sufficiency Program Director
P.O. Box 549
Siletz, OR 97380-0549
Fax: 541-444-8334
kurtisb@ctsi.nsn.us
Thus, the A1C test, unlike the
blood sugar test that many diabet-
ics self-administer daily, reveals
the patient’s average levels of
blood glucose over the past three
months. A1C testing has become
the primary test used for diabetes
management and research by physi-
cians and researchers.
Healthy people have an A1C
level of 4 to 6 percent and the ADA
recommends that diabetics aim for
an A1C level of 7 percent or less.
while in Alaska, says that after her den-
tist educated her about how maintaining
her dental health enhances her diabetic
management, she “got on the program.”
She purchased an electronic vibrating
toothbrush and WaterPik water flosser.
She also added oral care to her health
regimen, which includes diet, exercise and
checking her blood sugar four times a day.
She sees her dentist regularly for
exams and cleanings, and while living in
Alaska, her A1C level, which provides a
person’s average level of blood glucose,
dropped from 10 percent to 7 percent.
“I could actually feel the difference”
that proper dental care makes in general
health, said Rhodes, who also is exploring
pre-contact dental care means like willow
toothpicks and sage teas.
What you should know 40 years later
TOWNHALL
May 8, 2015 – 6 p.m. – The Newport Armory
May 9, 2015 – 1 p.m. – Florence Elks Lodge
Public Comment
Notice
Siletz Tribal 477 Self-Sufficiency
Program
The primary test used to deter-
mine longer-term control of blood
sugar levels is the A1C test. This test
measures hemoglobin A1C, a blood
cell that attaches itself to glucose for
the cell’s lifetime of about 120 days.
Purpose
1. Outreach to all affected veterans and their families
2. Outreach to health practitioners and disability-related service agencies
3. Medical care for affected children and grandchildren
4. A fresh approach to research
5. Direct service to veterans and their families, intheir communities
We want to hear your stories!
Contact: Tony Molina – 541-444-2828 (Newport)
Paul Gargis – 702-286-6969 (Florence)
April 2015
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