Diabetic management and oral health- a UK perspective?

[aust dental allie]

Hello everyone,

I am from Australia and currently performing some enquiries about the management of diabetes and how oral health is advocated towards patients. Unfortunately, in some Australian communities the importance of maintaining overall health, including oral health is neglected for many reasons. My colleagues and I are aiming to implement some local initiatives to improve the situation and provide better care for diabetic patients.

I am highly interested in learning more about how diabetic patients are cared for in the UK, especially from a patient’s perspective. I am also particularly interested to know who provides the main source of information for newly diagnosed patients – be it a general practitioner, or perhaps another health professional?

Additionally, how often would the topic of attending regular dental appointments or maintaining personal oral hygiene be brought up throughout the treatment process?

Any feedback would help us greatly to gain a better understanding and hopefully direct our visions to some constructive actions.

Thanks

 

[Synonym]

Hi Allie

Dentistry of any kind was never mentioned to me. As for information at diagnosis it was almost non existent with a booklet being handed over and that was it. :roll:

This forum, where we all help each other, is the best asset anyone with diabetes has.

 

[banjo brunette]

Hi Allie
I was never told anything about dental hygiene, etc, as a newly-diagnosed diabetic (some six years ago now...). Just continued to go along to my regular six-monthly NHS dental check-up. However, I did take part last Easter in research that Newcastle-upon-Tyne University were conducting into gum health and diabetes - went along to the dental hospital, had a check-up, bloods taken and had my gums measured and samples of "gum juices" taken. If I remember rightly, they were looking for links between diabetes, gum disease and cardiovascular problems, I think. I was persuaded to go along by my diabetologist. Might be worth chasing this research up?
Cheers, BB

 

[Dippy3103]

Hi
Dental care hasn't been mentioned to me. I am currently trying to find an nhs dentist, but few are taking on new paitents.
I was sent on a two evening course re diabetes care, but over than that I have been given little information. Dental care was not mentioned on my course.
Although I look after my teeth I have not had a check up for 3 years but if I neglect them then I will be able to see an emergency dentist if I am in pain or develop an acute problem.
Not unlke the care I have had for my diabetes really......

 

[jopar]

Dental health isn't a part of diabetic care within the NHS...

Like everybody else, it is your responsibilty, to arrange for your own dental care either from a NHS dentist, if you can find one to register to (and they still charge) or private dentist practice, easier to find but costs a fortune..

 

[aust dental allie]

Hi everyone,

Thank you for replying to my post!

This is the same problem which we face in Australia. The research is out there linking diabetes with oral health conditions such as periodontitis (gum disease), however this information is not being conveyed to the patients.

As a dental hygienist I know the importance of regular dental check-ups for those with diabetes, as factors such as diet, oral hygiene and medications can intensify an individual’s oral health problems.

Nevertheless, there is this gap, where patients are not being regularly informed or supported to see a dentist, until there is a serious problem later down the track. Currently, only podiatrists, dieticians, occupational therapists and diabetes educators are the only health allies who are utilized by most doctors.

I can see this is going to be a long and ongoing push in terms of changing the medical perceptions to make not only oral health, but other health facets available to patients. I am glad hear that you are all at least aware of the dental implications with diabetes and use support sites like this one for your own guidance.

Our plans are inclined to helping our general practitioners with better information packages to give to newly diagnosed diabetics, as well as a ‘referral timeline’. As there are so many new life changes and health assessments involved once a patient has been diagnosed, perhaps a structured plan would benefit both the patient and medical practitioner.

You have all given me some very good food for thought, once again thank-you.

 

[Synonym]

Hello again Allie,

As with all else the folk on here are the proactive ones - the tiny tip of a huge iceberg! Most folk just roll up in a ball and wish it would go away. :roll:

 

[Hobs]

.

I am highly interested in learning more about how diabetic patients are cared for in the UK, especially from a patient’s perspective. I am also particularly interested to know who provides the main source of information for newly diagnosed patients – be it a general practitioner, or perhaps another health professional?

Additionally, how often would the topic of attending regular dental appointments or maintaining personal oral hygiene be brought up throughout the treatment process?

Any feedback would help us greatly to gain a better understanding and hopefully direct our visions to some constructive actions.

Thanks

As a diabetic patient I was not given much info other than advised to seek regular dental checkups: But then they did know I was also a regular visitor to the area cardiac unit and outpatient clinic. It was at my first cardio appointment where good and regular dentistry was explained to me and the dangers of endocarditis. I was already registered at an NHS dentist but as I was not exactly confident in his ability to treat to requirement and not to a NHS timed charging scale, I went over to a private dentist and experienced a whole new apprpoach. I now receive preventative treatment as against only remedial and I cannot fault the service. At first I thought it might turn out to be expensive but amazingy my wife is fully covered as well as me for £26 per month ...money well spent by my reckoning.
I will add that during each diabetes review, I am always asked if I have regualr dental checks and treatment if needed, and then the computer screen has its boxes ticked.

 

[SophiaW]

I don't recall our diabetes team ever mentioning the importance of good dental care for my daughter and they've never asked if she attends regular dental check ups. However I do know that it's important and this is because I have been pro-active in reading about diabetes. Our family dentist (who we see privately) is very good and has explained the importance, particularly for Jess, to take care of her teeth and gums.

 

[hanadr]

Hi Allie
number one hurdle for British patients is just finding an NHS dental practice to take them. This is the same for non-diabetics.
i pay a private insurance policy[difficult on a limited income, since I pay for test strips too] and receive an excellent service. My dentist also has a full list of all my medications with my notes
Hana

 

[catherinecherub]

I was told about the importance of oral hygiene by my GP following my diagnosis.
I have been for a check up this morning and it cost me £16.40. My dentist likes to see me every three months as he feels that diabetics need extra care. I can always arrange an appointment if I have any worries. I do have to travel 15 miles as I could not find a NH one at my new address when I moved but the one I had previously was happy to continue seeing me.

 

[aust dental allie]

These are very interesting thoughts.

It seems like many of you find it hard to find a "NHS" dentist. I gather that these types of dentists provide cheaper or free services as they are subsidised by the government?

We have a similar system here, however dental care is not covered, so for most diabetics, they have to pay for their own dental expenses. This just opens a whole new can of worms in regards to the affordability of regular dental care and how much governments can contribute to cover the costs.

now remember to keep brushing!

 

[catherinecherub]

The NHS provide dental care at a subsidised rate but there is a shortage of dentists so it is very difficult to find an NHS one is some areas. Some established dentists have decided that they will only treat private patients as they feel the Government do not understand the financial implications and restriction of treatments when they are providing NHS care. NHS provides basic care. You can pay for some treatments even if you are NHS as the NHS will not fund some more specialist treatments.
Hope that makes sense.

 

[neysa62]

I was given no help from my GP, just a diagnosis and some tablets - my first hypo was a bit of a shock! I only found out gum problems was a complication of diabetes when I attended a course on managing type 2 diabetes a couple of months ago - 10 years after i was diagnosed! I must be prone to it as inspite of regular check ups and good hygiene I have lost most of my back teeth

 

[etmsreec]

I was diagnosed as a type 1 diabetic in 1981. My hospital at that stage ************** took responsibility for my dental care after I needed a LOT of work doing. I later transferred to a local NHS dentist who I didn't like and took a long break from effective dental treatment.

Since then, I've had various treatments at dental hospitals having had my wisdom teeth out at ********* dental hospital, several teeth out at *********** dental hospital, several crowns at *********** and to cap it all (sorry for the pun) a partial denture.

In summary, nobody was really telling me that dental care was as important as the rest of my diabetes care though a consultant at **********r did tell me that I'd had an awful lot of work done over the years (which I knew) and that my tooth enamel seemed to be very soft (which I didn't know.)

What I'm not really sure, in hindsight, is whether my dental state would have been any better if I hadn't had a diet of biscuits and that kind of thing for my mid-morning, mid-afternoon and bedtime snacks through my teenage years. At that time, manual mixing of insulins meant that snacks were essential to stop hypos. How different would it have been if I was on basel bolus at that time??

Steve

 

[copepod]

I'm lucky that I found a good NHS dental practice, which doesn't insist I go for a check up every 3 months, which would be expensive and difficult to find the time. In fact, recently went back for a check up, having not been for about 3 years, and was expecting a bit of a lecture, but dentist was happy and said the niggling tooth (felt odd to my tongue, but not painful) didn't need any attention. He referred me to dental hygienist for scale & polish, which did remove a lot pf scale, despite having followed advice about brushing twice daily and using tiny brushes between teeth.
Fortunately, I've been on basal bolus since a first few months on bimodal regime, so haven't had to have too many snacks. I did raise issue of occasionally needing sweets in middle of night for hypos, and dentist was quite laid back, saying it was OK if not too often and if I brushed teeth first thing in morning anyway, and I could drink water to wash out mouth after sweets, if concerned.
But, no member of diabetes team at hospital has ever mentioned dental hygiene / care to me.
I think that pregnancy teams do mention dental care to all pregnant women, as they get free NHS care during pregnancy (and for year after birth, I think) due to calcium demands of growing baby and lactation. I've never been pregnant and can't be bothered to look on web for free NHS dental entitlement, but it would be worth OP doing that.

 

[josie38]

I can remeber when i was diagnosed 13 yrs ago that my dsn told me about dental hygiene and a link to the heart but she didnt go into it in great detail!!!

Fortunately i have a good nhs dentist who only requires me to have the usual six monthly check ups unless i have any problems!

 

[aust dental allie]

Well our submission has been made! Fingers crossed that someone out there will like our proposal and potentially form some action on our recommendations.

I value all of the imput everyone has shared here. Although there seems to be "gaps" in the health systems, you all have an awareness of dental health, which is fantastic! The more promotion and education about this issue, the better.

Thanks for all your help!

 

[hanadr]

AAust D Allie
Diabetes UK have funded some reseach on this subject. If you search you can track it down.
My personal knowledge of this is that my own dentist has said that some treatments are not effective in diabetics[eg dental implants], because the bone is in poor condition and that they are very prone to gum disease., I seem to be hte exception.I keep my blood glucose in the non diabetic range pretty much all the time.

 

[clearviews]

From all the reading I have done over the last 2 years I believe that if we have a higher level of BGs than what is considered the 'normal' range (perhaps that would be non-diabetic?) our gums run the risk of fostering bacteria that is detrimental to dental health.
Yet another reason to keep our BGs as close to a non-diabetic as possible?
I spent my first 18 years under the NHS regime and then I came to Australia.
Diagnosed in Australia, I too never had it hammered home or even mentioned that dental care was more important now I was a T2. I still take care of my teeth through my own private health care fund. My non-diabetic younger sister and mother both have had dramas with periodontal gum disease (I don't) and I suspect that they both have higher BGs than I do.
One of the reasons that I work hard to keep non-diabetic HbA1cs.
Alison