The WholeTooth: Diabetes testing in the dental office?


Years ago, when my book on athlete’s nutrition was just published, I gave a talk to my daughter’s kindergarten class on the benefits of eating well. Never too early to start them on the right path, I reasoned. And maybe they would have second thoughts about eating those fried baloney balls for lunch. Throughout my “lecture,”  I felt I had their rapt attention. Gee, I thought to myself, I am really making an impact on these kids. I finished with a flourish, telling them the importance of a healthy diet, not only for their minds but for strong bones and teeth, as well.

Then it was time to answer any questions. A little girl’s hand went up. “Mrs. Michael,” she chirped, still staring intently at my face, “how many teeth do you have?”

So much for my health talk!  “Thirty two,” I said, with a laugh, “and they are in good condition because I also brush and floss and have twice-a-year cleanings and checkups with my dentist.”

What I didn’t tell her was that those appointments were not exactly on my list of favorite things to do. And that holds true to this very day. As my readers know all too well, I am a confirmed hypochondriac whose blood pressure rises to dangerous levels at the sight of anyone in a white coat, even a butcher. (Odd, I know, for a lifestyle columnist and author who hosts a weekly radio show about health!) In fact, to prepare for a recent visit, I tried to reassure myself by thinking, “It’s just a cleaning.” Read: No shots or needles.

So imagine my horror when the hygienist asked if she could poke my finger to get a blood sample to measure my A1C levels and check for diabetes. “Diabetes?” I was incredulous. “In the dentist’soffice?” Turns out, I never made the connection.

“Gum disease is hard enough to treat on its own, but in people with diabetes, it’s like wrestling a gorilla with one hand tied behind your back,” says Dr. Susan Maples, a top innovator in U.S. dentistry and an advocate for the connection between oral and systemic health. “It’s a two-way relationship. Uncontrolled diabetes can lead to more severe, earlier onset periodontal disease with more complications, and having periodontal disease makes it very hard for diabetics to achieve glycemic control.”

The reason? “Since diabetes is a vascular disease, it causes narrowing of the blood vessels (arteries). This leads to decreased blood flow and oxygen to the infected gum tissue and subsequently white blood cells that aren’t as strong at fighting infection. There is also some evidence that the healing cells (fibroblasts) become altered as a result of poor blood nourishment. As a result, the infection worsens, the gums unzip from the tooth, and the supporting bone deteriorates.”

November was American Diabetes Month —not that there should only be one month devoted to bringing awareness to the No. 3 killer of Americans. Managing the disease is tough enough when you know you have it. But what’s astounding is the number of people who are in the dark about their own health. Indeed, 28 percent of patients with diabetes and 93 percent with prediabetes are clueless. Alas, with sugar consumption increasing and obesity on the rise, the U.S. Centers for Disease Control and Prevention estimates one in three adults will be diabetic by 2050.

Dr. Saleh Aldasouqi, chairman of Michigan State University’s Division of Endocrinology, partnered with Maples to develop the “Diabetes Detection in The Dental Office” assessment, a 14-question diabetes risk survey that doesn’t include the topics that patients rarely like to discuss, such as body weight and BMI.

“We tested 500 random dental patients with no history and found 20 percent of them had diabetes or prediabetes,” Aldasouqi continues. “Some 60 to 70 percent of the population visits a dentist once or twice a year, and many don’t even have a family doctor. This is true preventive medicine. I see great opportunity for diabetes screening in the dental office.”

Dr. Maples adds that only 2 percent of dental practices are also total health practices. So being it’s unlikely you’ll get an A1C screening at your next cleaning, she offers the following advice for taking control of diabetes:

  1. Get screened. Take Drs. Aldasouqi’s and Maples’ risk assessment test at “If your score places you at moderate or high risk, get a diagnostic blood test. Diabetes can take years off your life and cause kidney failure, blindness and limb amputation. It also increases your risk of heart disease and stroke by up to four times compared to non-diabetics.”
  1. Treat periodontal disease. Have gum disease treated immediately. Several studies show that chronic gum wounds negatively impact blood sugar levels. “Therefore, it is hypothesized that treatment would improve glycemic control. and unstable diabetes usually results in more severe and rapidly progressing bone loss around your teeth.”
  1. Eat to live. Diet is critical to controlling blood sugar, lipids and weight. Focus on lean protein, whole grains, fruits, vegetables and low-fat milk. Increase fiber to reduce insulin spikes, and restrict the intake of refined carbs and sweets, including all sugary beverages.
  1. Get moving. Exercise can immediately reduce high blood sugar levels. Over time, it can also help you lose weight and increase insulin sensitivity. Both of those positive effects, in turn, can halt the progression of the disease.
  1. Take it off. One study showed that losing 7 to 10 percent of body weight and exercising five times per week for 30 minutes reduced the incidence of type 2 diabetes by 58 percent over three years, compared to a control group that made no lifestyle changes.
  1. Work it out. With your physician and dentist, that is. Know your blood sugar numbers. Due to the strong association between uncontrolled blood sugar and periodontal disease, you need to work closely with both of them to manage diabetes.

“We hope this kind of testing will be implemented in dental offices around the country,” Dr. Maples concludes. “People don’t realize it, but what goes on inside your mouth really does play a role in the quality of your overall health. We are truly bridging the gap between medicine and dentistry.”

As for me, well, happily my dental phobias only come around but twice a year. But those visits are not optional. They are mandatory. In the meantime, I’ll go back to my health and beauty writing and doing interviews for my radio show. I try not to pass my fears on to others, however. But I lost a lot of credibility ever since I pronounced a man dead on the bus when it turned out that he was just taking a nap in his seat.