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  Chat Transcript
Open Q & A and good dental health - Cassie Writght, C.D.E. and Sangeeta Gajendra, D.D.S., May 21, 2013

 Cassie@Unity:
 Welcome to the Unity Diabetes Online Community! I’m Cassie Wright, a certified diabetes educator from Unity Diabetes & Endocrinology Services, and I’ll be hosting today’s chat. Tonight we have a special guest – Dr. Sangeeta Gajendra, Clinical Chief of Community Dentistry at the Eastman Institute for Oral Health. I’m glad you could join us today and we’re excited to answer all of your dental health and diabetes questions.
 Dr. Sangeeta:
 Hello everyone. It’s a pleasure to join your chat room to discuss oral health and diabetes.
Cassie@Unity:
Before we get started let me just tell you how we’ll address your questions and comments today. I answer questions one at a time, in the order that they are posted to the site, and there might be a slight delay as I respond to each question. It may take a few minutes for me to type answers to your questions, so please stay logged-in to the chat to see my response, even if it takes a few minutes.  
 Cassie@Unity:
 And you might need to refresh every few minutes to keep up with the latest posts in the chat if you switch to another application on your computer.
 Cassie@Unity: 
 Let's get started!
 Cassie@Unity: 
 Welcome Dr. Gajendra. Thank you for joining us!
 Dr. Sangeeta:
Pleasure is mine! Thanks for having me. 
 sassy35:
What dental health risks do people with diabetes need to worry about? 
lucyblue:  
Why do high blood sugars effect the teeth and gums?  
 Cassie@Unity:  
 Dr. Gajendra, would you like to share your expertise on dental health risks people with diabetes have?
 Dr. Sangeeta:
The most common oral health problems associated with diabetes are tooth decay; periodontal (gum) disease; salivary gland dysfunction; fungal infections such as Oral Candidiasis, soft tissue lesions, infection and delayed healing; taste impairment. 
Dr. Sangeeta:
Lucyblue, high blood sugars reduces the body’s resistance to infection and the gums are among the tissues likely to be affected.
lucyblue:
Is there anything to do in addition to watching blood sugars to improve the body's resistance to infection? 
Cassie@Unity:
What symptoms might indicate someone has an oral infection or periodontal disease?
sassy35:
Are cleanings 2x a year enough?
Dr. Sangeeta:
Lucyblue, to continue answering your question – there is a link between poor glycemic control and gum disease. Research shows that there is a bidirectional relationship between oral health, gum disease and diabetes. What I mean by that is that, as we improve someone's oral health we can improve their glycemic control. And research also shows that if we improve someone's glycemic control, we can improve their oral health.  
lucyblue:  
Wow – that's pretty interesting! So if you practice good dental care, it can help manage your diabetes?
Dr. Sangeeta:
Sassy35 – for the majority of people, 2x a year cleaning is good enough. However, in cases of people with gum disease, we may recommend 3 to 4 times a year. 
Cassie@Unity:  
Lucyblue, a well balanced diet, consistently getting enough sleep and regular exercise, say 3-5 times per week, are also great ways to improve your resistance to illness and infection.
lucyblue:  
Thanks Dr. Sangeeta and Cassie!  
Cassie@Unity:  
Dr. Gajendra, do you recommend a special toothbrush or toothpaste for patients with diabetes? Or are there particular recommendations you share with your patients with diabetes to help prevent oral problems?
jack34:
Hi everyone – sorry I'm late ... just got home. Question: Can eating and/or drinking the wrong stuff one day have any impact on my blood glucose readings during the next day?
Dr. Sangeeta:
Brushing twice a day with fluoride toothpaste and cleaning once a day between your teeth with floss or an interdental cleaner helps remove decay-causing plaque. We recommend using a soft toothbrush.
Dr. Sangeeta:
You can also use an antimicrobial mouthrinse or toothpaste to control gingivitis.
Cassie@Unity:  
Welcome Jack, glad you could join us! Our dietary habits very well could have an impact on our blood sugar readings the next morning depending on what/how much you ate, how much you exercised and many other factors. Do you have a specific example to ask about?
Cassie@Unity:
Very good information Dr. Ganjendra, thank you!
Dr. Sangeeta:  
For more information please check these websites:
http://www.nidcr.nih.gov/OralHealth/Topics/Diabetes/DiabetesDentalTips.htm
http://diabetes.niddk.nih.gov/dm/pubs/complications_teeth/index.aspx
http://www.cdc.gov/diabetes/pubs/tcyd/dental.htm
http://www2c.cdc.gov/podcasts/player.asp?f=9406 
 jack34:
No, not really, just in general. Another question – my first-thing-in-the-morning (fasting) readings have been averaging 136 for the past few months. My most recent A1c reading (about three weeks ago) was 7.5. Are these numbers I should be concerned about? I have Type 2 diabetes.
Cassie@Unity:  
Jack34, an A1c of 7.5 reflects an average blood sugar of 169. Your fasting values are recommended to be under 130 daily, you are very close to this guideline. That is excellent!!
Cassie@Unity:  
I might suggest testing your blood sugars after meals to determine if you are running higher than the guidelines. A value under 180, 2 hours after a meal, is a good marker to aim for. It's likely your A1c is showing an average blood sugar of 169 because you are running high after meals. This would be a dietary adjustment.
Jane@Unity:
No. She said the dentist has not mentioned that she has gum disease.
 jack34:
Really? These numbers are OK? WOW ... I'm surprised. I have been thinking they were too high. Two hours after meals, depending on what I have eaten, I have been getting some numbers anywhere from about 150 to 243 (my highest ever). What do you think? 
Dr. Sangeeta:  
I'm sorry Jane; I misread. Your patient probably has gum disease. Gum Disease is infection of the gum and bone that hold the teeth in place. There's loss of bone and that's why she is losing her teeth.
Jane@Unity:
Thank you for your expertise!
Cassie@Unity:
Jack34, an A1c of 7.5 shows considerable hard work and commitments on your behalf. Keep up the good work. Blood sugars ranging from 150-240's after meals indicate you may have some work to do on your carbohydrate intake. I would suggest meeting with a diabetes educator to determine the right amount of carbohydrates per meal for you! Good job!!
Cassie@Unity:
Sadly, that’s all the time we have for today. I’ve really enjoyed our conversation and hope that I was able to provide some insight for you. If we didn’t get to your question today or if you think of another question later on – feel free to jump into the conversation in the forum, or submit a question using our “Ask an expert” feature. Be sure to join us for our next chat Tuesday, June 4 at 8 p.m. with Karen Baker. She will be holding an open Q&A session and talking about insulin pump basics.
Cassie@Unity:
Thank you very much Dr. Gajendra for participating in our chat, as well as everyone else who asked great questions tonight.
lucyblue:
And thank you to both of you!! 
Dr. Sangeeta:
 I've enjoyed chatting. Please practice good oral hygiene at home, follow your physician’s instructions regarding diet and medications, and schedule regular dental checkups to maintain a healthy smile.
 jack34:
 OK. I will definitely work on the numbers by watching more closely the carbohydrate intake. Also, I realize that some additional exercise is in order, and will partake accordingly. Thanks for all your information. Good night.
 
 
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