Oral Care Products

Incorporating a good oral health hygiene regimen into one's daily routine is important for the overall health of every individual. Certain disease states, such as diabetes, can increase an individual's risk for developing various oral health problems, especially if diabetes is not well controlled. According to the American Dental Association, the most common oral health problems associated with diabetes include dental caries; gingivitis; periodontal disease; xerostomia (dry mouth); salivary gland dysfunction; increased susceptibility to bacterial, viral, and fungal (oral candidiasis) infections; lichen planus; and lichenoid reactions; as well as taste impairment, loss of teeth, and inability to wear dentures properly (due to salivary dysfunction). ^1,2

Periodontal disease is often referred to as the sixth complication of diabetes and is the most prevalent oral complication associated with diabetes.² Patients with diabetes are 2 to 3 times more likely to develop periodontal disease, when compared with individuals without diabetes, especially when the diabetes is uncontrolled.^2-5 In addition, when an individual with diabetes smokes, the risk of developing periodontitis with loss of supporting bone is 20 times more likely, when compared with individuals without diabetes.² Furthermore, according to the American Diabetes Association, an estimated one third of diabetic individuals have severe periodontal disease accompanied with loss of attachment of the gums to the teeth measuring at least 5 mm or more, and individuals with poorly controlled diabetes (A1C>9%) were nearly 3 times more likely to have periodontal disease, when compared with those without diabetes.⁶

Currently, a variety of oral care products are available on the market to aid patients with diabetes in maintaining good oral health, including toothpastes with fluoride, various oral rinses for prevention of plaque and tartar buildup, as well as products for preventing/treating dry mouth. One mouth rinse product on the market specifically for patients with diabetes is DiabetAid Therapeutic Mouth Rinse (Del Pharmaceuticals). The line of Biotene products for dry mouth, which are manufactured by Laclede Inc, include toothpastes, mouthwashes, moisturizing gels, and gums. Because dry mouth can lead to dental cavities and mouth ulcers, the Biotene products can be useful for the diabetic population.

Pharmacists can increase awareness about the importance of good oral hygiene and its role in reducing or preventing periodontal disease, especially when counseling the diabetic patient. Pharmacists can assist patients with diabetes in the selection of suitable oral health care products by always recommending toothpaste with fluoride and oral rinse products that have been shown to be effective in reducing plaque and gingivitis. They also can recommend the products available for treating or preventing dry mouth, such as the Biotene line of products, as well as various saliva substitutes on the market. In addition to recommending proper oral health care products, pharmacists can provide the patient with tips about proper oral hygiene, encourage patients to seek the advice of a dental professional when warranted, and remind them to make sure their blood glucose levels are well controlled.

For more information on oral care and diabetes, visit the following Web sites:

• Diabetes and Oral Health. American Diabetes Association Web site: www.diabetes.org/type-1-diabetes/diabetes-andoral-health-problems.jsp
• National Diabetes Education Program Web site: ndep.nih.gov/diabetes/WTMD/oral.htm

References

• Diabetes and Your Oral Health. American Dental Association Web site. www.ada.org/public/topics/diabetes_faq.asp. Accessed July 31, 2008.
• Vernillo AT. Dental considerations for the treatment of patients with diabetes mellitus. J Am Dent Assoc. 2004;134(1):24S-33S. American Dental Association Web Site. jada.ada.org/cgi/content/full/134/suppl_1/24S.
• Assemi M, Morello CM. Diabetes Mellitus. In: Berardi RR, Kroon LA, McDermott JH, eds. Handbook of Nonprescription Drugs. 15th ed. Washington, DC: American Pharmacists Association; 2006:658-662.
• Oral Health and Oral Hygiene: Diabetes and Oral Health Problems. American Diabetes Association Web site. www.diabetes.org/type-1-diabetes/diabetes-and-oral-health-problems.jsp. Accessed July 31, 2008.
• Oral Health and Diabetes. National Diabetes Education Program Web site. ndep.nih.gov/diabetes/WTMD/oral.htm. Accessed July 31, 2008.
• Complications of Diabetes in the United States. American Diabetes Association Web site. www.diabetes.org/diabetes-statistics/complications.jsp. Accessed July 31, 2008.