The right questions about diabetes
Do patients know that blood sugar levels and oral bacteria are linked?
The mouth is the gateway to the body, yet
we often focus on the teeth and gingival
tissues and don’t think as much about
how that tissue health affects the rest of
the body. There are several inflammatory
disease processes that affect the mouth,
and there are conditions we see in the
mouth that might alert us to a patient’s
systemic disease. Diabetes mellitus is a
disease we deal with frequently. Since it
is so common, we need to be familiar with
how it affects the oral health of our patients. Diabetes is the “fourth leading
cause of death in the United States.” 1
As dental health-care professionals,
we know many basic facts about diabetes that we use in our everyday practices. Sometimes we suspect a patient has the disease
before the patient even has it diagnosed. If we ask the right
questions during our medical history review, this might
help patients figure out what is happening to them sooner.
We need to encourage dental teams to connect with the
We need to encourage hygienists to ask more in-depth
medical history questions to find connections to any systemic
diseases patients might have. We can hope that this mindset
will start to spread and make dentistry more involved with
medicine. We should be active partners with medicine to
improve patients’ overall health.
If you have a patient who has been having any of these
symptoms—polyuria, hunger, thirst, dry mouth, fruity smelling
breath, losing weight without trying, eyesight problems, or foot
ulcers that won’t heal—think undiagnosed diabetes.
Positive answers to several of the questions in the chart
could be the first indication of prediabetes. If a patient has
already been diagnosed with diabetes and has been having
higher blood sugar levels than usual, you can help the person
understand why this may be happening. It might be because
of poor oral health. Your investigation might help patients
control their sugar levels better.
It is very important for us to reiterate excellent oral health
in diabetic patients because of their slow-healing wounds and
high risk for periodontal disease. We need to educate our patients more concerning how oral health can affect blood sugar.
When the mouth is healthy, diabetes is easier to control. I think
we do a good job of telling patients to maintain excellent oral
care, but I don’t think we tell them why as often as we should.
We also need to be aware of other oral conditions, such as
angular cheilitis, decreased saliva flow, xerostomia, oral can-didiasis, burning tongue, diminished taste perception, and
high caries rate. 2
The variety of bacteria found in periodontal disease produces inflamed oral tissues that can destroy bone and the
periodontium if left untreated. Diseases will progress much
faster in a diabetic patient than in a nondiabetic patient. When
the bacterial load is high, it can have a negative effect on the
RDH, BS, MEd, PhD, is
the Department Chair of
Dental Education at
Community College in
Winston-Salem, N.C. Dr.
Whisenhunt has taught
since 1987 in the dental
hygiene and dental
assisting curricula. She
has a love for students
and served as the state
student advisor for nine
years and has won the
student Advisor of the
Year award from ADHA in
the past. Her teaching
interests are in oral
cancer, ethics, infection
control, emergencies and
orofacial anatomy. Dr.
Whisenhunt also has a
where she provides CE
courses for dental
practices and local
associations. She can be
reached at jwhisenhunt@
I think we do a good
job of telling patients to
maintain excellent oral
care, but I don’t think
we tell them why as
often as we should.
Some questions you can ask patients to further
discuss their medical history include:
• Have you lost weight without trying lately?
• Have you noticed any sores in your mouth that
take a long time to heal?
• Do your gum tissues bleed easily when you brush or floss?
• Have you noticed a bad smell or peculiar taste
in your mouth in the last few months?
• Have you had any eyesight issues lately?
• Have you had any foot sores that take a long time to heal?
• Have you noticed that you’re hungrier or thirstier than usual
lately? Are you urinating more frequently?
• Have you had higher than normal blood sugar readings?
(Ask this if the patient has already been diagnosed.)