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Medical Forum / General / Dentistry / May 2009

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Should a dentist spot Diabetes?

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one who waits - 05 May 2009 12:34 GMT
Dental ; Periodontal Disease

   * Periodontal (gum) disease is more common in people with diabetes.
Among young adults, those with diabetes have about twice the risk of
those without diabetes.
   * Almost one-third of people with diabetes have severe periodontal
disease with loss of attachment of the gums to the teeth measuring 5
millimeters or more.
   * Persons with poorly controlled diabetes (A1c > 9%) were nearly 3
times more likely to have severe periodontitis than those without
diabetes.

source 'A.D.A.
http://www.diabetes.org/diabetes-statistics/complications.jsp
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Mark & Steven Bornfeld - 05 May 2009 14:15 GMT
> Dental ; Periodontal Disease
>
[quoted text clipped - 10 lines]
> source 'A.D.A.
> http://www.diabetes.org/diabetes-statistics/complications.jsp

    A dentist can rarely "spot" diabetes.  Yes, diabetics (esp. type 1
diabetics) tend to have early and aggressive periodontal disease.  But
not all do.  Furthermore, the prevalence of severe periodontal disease
is so high that it is far from a conclusive sign.
    If a dentist suspects undiagnosed diabetes, a referral to the patient's
physician should be made.  A diagnosis of diabetes is outside the scope
of practice of dentistry.

Steve

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Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

vaughn - 06 May 2009 03:12 GMT
> If a dentist suspects undiagnosed diabetes, a referral to the patient's
> physician should be made.  A diagnosis of diabetes is outside the scope of
> practice of dentistry.

As a routine matter, I saw a retinologist  a while back.  I had no
particular eye problems, I just expected to just get my retinas checked as a
baseline in case of future problems.  What he told me rocked me back on my
heals!  Diabetes damage was visible in one of my eyes.  This happened in
spite of the regular blood tests that my medical doctor insists on.

Long story short, I took charge of the situation, changed my diet, and stuck
myself regularly until my fasting sugars were reliably under 100.  (Lost 30
pounds in the process)  A year later, that same retinologist could not find
the damage that he (and another doctor) had seen before.  That eye doctor
could have ignored my underlying medical condition and just concentrated on
my eyes, relying on some vague principle that diabetes is outside the scope
of his responsibility, but that would have done me (and my eyes) a
tremendous disservice.

What makes dentistry be any different?

Vaughn
Mark & Steven Bornfeld - 06 May 2009 14:31 GMT
>> If a dentist suspects undiagnosed diabetes, a referral to the patient's
>> physician should be made.  A diagnosis of diabetes is outside the scope of
[quoted text clipped - 18 lines]
>
> Vaughn

    Legally, a dentist or ophthalmologist can and should make a referral if
they suspect diabetes (for example).  I'm not certain that diabetic
retinopathy has a specific enough clinical picture to make a diagnosis.
 In any case, it is a condition that is in some cases treated by
retinologists, and certainly is not legally outside the scope of medical
practice.
    A dentist may suspect diabetes based solely on the periodontal
condition, but periodontal disease is a far less specific marker for
diabetes than is diabetic retinopathy.  When we were in school, in the
oral diagnosis section we sent our patients for routine blood tests, and
one of my patients showed a blood sugar of over 300 mg/dL--obviously a
problem.  She was informed and advised that she likely had diabetes and
should go to her physician.  Hopefully she went and got treated.
We don't routinely have bloods drawn for our patients, and I don't
generally send a patient directly to a clinical lab.  I send the
patients to their physician, will sometimes call the physician.  I am
not going to manage a patient's diabetes, and there's no reason for me
to run glucose tolerance tests to diagnose it.
    I actually had thought that diabetic retinopathy was generally
considered irreversible.  I'm glad to hear otherwise.  I also hope that
your general physician checked the other possible complications of
diabetes, such as your renal function.

Steve

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Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

vaughn - 06 May 2009 15:02 GMT
> I actually had thought that diabetic retinopathy was generally considered
> irreversible.

  I don't think that enough patients bother to really control their
diabetes for us to really know if if it is always irreversible.  Mine was
apparently slight, but still the Optomoligist was amazed to see it gone.

> I also hope that your general physician checked the other possible
> complications of diabetes, such as your renal function.

Yes, he did.  Ater reviewing the situation with my physician, it seems that
my fasting blood sugars were persistantly elevated from ideal, but had never
reached the threshold for a diagnosis of type II..  Unfortunately, my eyes
didn't care if I had been diagnosed or not.!

Regards
Vaughn
Happy Oyster - 25 May 2009 13:23 GMT
>After reviewing the situation with my physician, it seems that
>my fasting blood sugars were persistantly elevated from ideal, but had never
>reached the threshold for a diagnosis of type II..  Unfortunately, my eyes
>didn't care if I had been diagnosed or not.!

Hi, Vauhn, how are you?

Greetings from Antares

Aribert Deckers
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New B. - 07 May 2009 16:19 GMT
>That eye doctor
>could have ignored my underlying medical condition and just concentrated on
[quoted text clipped - 5 lines]
>
>Vaughn

Good eye doctor but some symptoms, such as diabetic  retinopathy,
may be pathognomonic whereas periodontal disease is not.
Brian - 06 May 2009 02:28 GMT
>Dental ; Periodontal Disease
>
[quoted text clipped - 10 lines]
>source 'A.D.A.
>http://www.diabetes.org/diabetes-statistics/complications.jsp

And many people without diabetes also have perio disease.

I might well be wrong but it sounds like it was posted by a lawyer
looking to sue.
 
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