In 2000, the US Surgeon General referred to a ‘silent epidemic’ of oral and dental diseases, and stressed the importance of oral health as being essential for general health and well-being [84
]. In 2007, the WHO Executive Board acknowledged the intrinsic link between oral health, general health and quality of life [85
]. A recent editorial in The Lancet
stated that ‘oral health is a neglected area of global health’ and indicated that promoting and improving oral health should be part of the routine business of healthcare policymakers and clinicians [86
]. Because poor oral health primarily affects morbidity rather than mortality, policymakers and governments have unfortunately tended to view oral diseases as less important than more life-threatening diseases. However, oral diseases are highly prevalent and are associated with significant morbidity: dental caries is one of the most prevalent diseases worldwide, severe periodontitis typically affects up to 15% of most adult populations, oral cancer is the eighth most common cancer worldwide, and approximately half of people who are HIV positive have oral fungal, bacterial or viral infections [86
The management of diabetes is complex and the prevention of cardiovascular and microvascular disease, through early detection and management of complications, are key components. Lifestyle intervention, education, self-management and self-monitoring are particularly important, in addition to treatments to reduce blood glucose, blood pressure and lipids [87
]. Similar to diabetes, current treatment philosophies for periodontitis strongly emphasise self-management through patient education. A supportive and facilitative approach by the dental team is essential, but there must be a clear understanding that patient-performed plaque control is the vehicle by which to control the inflammation which drives periodontal tissue destruction. Structured education programmes are effective in the management of diabetes [88
], and similar programmes are being developed for the management of periodontitis [91
]. These education programmes all emphasise the importance of engaging with the patient and ensuring that patients develop self-efficacy in managing their disease as the means to effect the lifelong behavioural changes that are required for the successful management of both conditions. The importance of self-efficacy in the control of diabetes and oral hygiene has been demonstrated in a population of diabetic individuals in Finland. Those individuals with better tooth-brushing self-efficacy had lower plaque scores (as might be expected) and lower HbA1c
levels compared with those who had poorer self-efficacy [93
]. Furthermore, diabetic participants who managed their gingivitis successfully also tended to report better glycaemic control and had lower mean HbA1c
1.5%) compared with participants who did not manage their gingivitis effectively (9.0
]. These studies suggest that there are common determinants for both dental and diabetes self-care that could be exploited for improved management of both conditions.
There is, therefore, a cogent argument for involving the dental team in the management of diabetes. Indeed, the dental team is well placed to screen patients for diabetes by virtue of the fact that many people visit their dentist regularly (e.g. every 6 months, often more frequently than they visit their medical practitioner), and the intra-oral findings may raise suspicion of undiagnosed diabetes. The dental team (particularly dental hygienists) are very adept and experienced in instituting behavioural changes in their patients, and may represent an untapped source of support for medical colleagues in this role.