Healthy Mouth, Healthy Body: Diabetes and Oral Health

Recap: What is the Oral-Systemic Connection?

New research is revealing the intricate connections between the health of our mouths and the health of our bodies. Conditions like cardiovascular disease (heart disease), diabetes, osteoporosis, Alzheimer’s Disease, and many others have significant connections to oral health.

If you missed it, be sure to read part one of our three-part series, “Healthy Mouth, Healthy Body,” where we cover the connections between gum disease and heart disease. In this post, we’ll travel from the hart through the blood vessels to explore diabetes adn its connections to oral health.

Review: The Oral-Cardiovascular Connection

Gum disease, or periodontal disease, can allow harmful bacteria to enter the blood stream and can cause chronic inflammation. Chronic inflammation is linked to many harmful diseases, like atherosclerosis, an artery disease that can lead to heart attacks and strokes.

Healthy Mouth, Healthy Blood

Gum disease and diabetes are complexly intertwined. Gum disease can increase the risk of diabetes, AND diabetes can increase the risk of gum disease.

Here’s how it breaks down:

To start, diabetes can cause dry mouth (xerostomia). Your saliva is a powerhouse, defending against cavities by cleaning your mouth and controlling its pH balance. So, if you have dry mouth, reduced levels of that cavity-fighting saliva decreases the impact of its antimicrobial functions. And, your mouth’s pH may even become imbalanced, increasing how quickly plaque can develop and build up.

Additionally, since diabetics have delayed healing, one with active oral disease can be at a greater risk of infection following a tooth extraction and other surgical procedures.

On the flip side, gum disease is also linked to multiple causes of diabetes. Unmanaged gum disease can lead to chronic inflammation and increased blood glucose levels, both of which are important risk factors for diabetes.

What Does This Mean?

Our Habits Play a Role in the Oral-Systemic Connection

When thinking about oral-systemic connections, it is important to consider the causes, as well as the connections and outcomes. For example, increased sugar intake is both a risk factor for developing diabetes and a risk factor for developing cavities and periodontal disease. There are many other habits, such as tobacco use, that also impact your oral health and the health of other parts of the body.

Emerging research into the oral-systemic connection and the prevalence of these diseases highlight just how important it is that everyone have access to both oral health care and general health care.

Gum disease and diabetes are both incredibly common conditions. Gum disease affects 75 percent of adults in the United States, and nearly all Americans (about 91 percent of adults over 20) have tooth decay, according to the CDC. More than 100 million (about 33 percent) of Americans have either diabetes or prediabetes.

At NCOHC, we focus especially on those who lack access to optimal oral health care. The demographic characteristics of communities that chronically lack access are very similar to those with higher rates of diabetes. (For more on this, see our post about systemic barriers and oral health equity).

It is incredibly important that we address systemic barriers to oral health care, and to health care in general, to make sure that vulnerable populations get the care they need to live healthy lives.

Additionally, given the links between diabetes and oral disease, medical practices that treat patients with diabetes should understand how to recognize symptoms of oral disease. Conversely, dental practices should be aware of how diabetes plays a role in oral health outcomes.

This is why we support advancing integrated care models, where dental practices and medical practices alike are equipped with the tools necessary to positively impact both sides of the oral-systemic connection.

Stay tuned for the final part of this three-part series, focusing on the connection between oral health and pregnancy. We will publish this final post on February 11.(Follow us on our brand new Facebook page and we’ll let you know when we publish new content!)

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NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!

Additional Sources for Information on the Oral-Systemic Connection


Dental Practice Rule Change and Children’s Oral Health: A Conversation With NC Child’s Sarah Vidrine

On Thursday, January 16, 2020, the North Carolina Rules Review Commission gave its final approval of a rule change to ease restrictions on dental hygienists, increasing access to oral health care for children in high-need settings.

Last week we sat down with Sarah Vidrine, the policy analyst for NC Child, to discuss this rule change and how it will impact children in North Carolina.

What Exactly Does This Rule Change Do?

“It removes barriers to oral health care for kids in school-based settings, and it will ease the burden on the provider community,” said Vidrine. “For dentists and hygienists, it eliminates unnecessary barriers to allow providers to do the work they are trained to do.”

The change to Rule 16W allows hygienists located in Dental Provider Shortage Areas (HPSAs) to provide preventive care based on a written standing order from the supervising dentist rather than a dentist’s in-person exam. By decreasing the administrative burden of a prior exam, more children will have access to preventive dental care.

With 74 percent of North Carolina counties designated as HPSAs, this change opens doors for children across the state and is an important first step toward more equitable access to preventive care.

How Will This Help Children Access Oral Health Care?

Vidrine said that one of the exciting impacts of this rule change will be the increased ability for dental hygienists to go into schools to provide preventive treatment.

“School-based programs are promising because they let us meet kids where they are,” Vidrine said. “It’s a more efficient and cost-effective way to get kids dental care.”

“We treat cavities as if they are a rite of passage, but they really are preventable. The earlier we can get to kids and provide preventive treatment like fluoride and sealants, the bigger overall improvement I think we will see,” she said.

What Makes School-Based Care Different?

In schools, versus traditional care in a dental office, all kids have the opportunity to directly access care.

“School-based clinics reach kids instead of relying on parents to be able to take time off work, get their child out of school, and get them to a dentist,” said Vidrine. “Especially for families on Medicaid and families without insurance, it can be very difficult to get care, develop a treatment plan, and follow through. In school-based clinics, a lot of those barriers are removed.”

Why Is It Important That Dental Hygienists in Schools Be Able to Provide This Treatment in High Need Settings?

It really boils down to the numbers, according to Vidrine.

“In North Carolina we have both a shortage and a maldistribution of dentists. So, we have too few dentists to meet the need of the population we have, and most of these dentists are practicing in a fifth of the state,” said Vidrine. “Even with great programs through UNC and ECU that are very targeted at getting better access to rural communities, they are not going to graduate enough dentists to meet the need. Plus, we have a rapidly retiring population of currently practicing dentists.”

With the growing shortage of dentists, hygienists are necessary to fill the gaps in high-need settings.

“There are more dental hygiene programs than dental schools in the state, and they stay full and are very competitive,” Vidrine said. “We don’t have a similar shortage of hygienists in North Carolina.”

Along with waiving the prior exam in high-need areas, the rule change also allows dentists to supervise more than two dental hygienists who are practicing in high-need settings and have been duly trained as public health hygienists. Given the surplus of dental hygienists in the state, there is potential to access a much larger workforce focused on early preventive interventions.

“A dental hygienist’s role is to serve as the prevention arm,” said Vidrine. “Dentists spend a lot more time in school on treatment and interventions and less time on prevention, which is really the function of hygienists.”

The Takeaway: This Change Has Been a Long Time Coming, and We Will Keep the Momentum Moving Forward

“Advocates have pushed for similar rule changes for over 20 years, dating back to a 1999 North Carolina Institute of Medicine task force report on dental care access,” said Vidrine. “That happened before my time in oral health, but NC Child has been involved since 2015 when we started to look at policy options in collaboration with NCOHC.”

Years of effort, with the involvement of many different groups, has finally paid off. The final rule change was co-sponsored by NCOHC and the North Carolina Dental Society, the two organization’s first partnership of this magnitude.

Looking forward, the partnerships and collaboration that made this rule change a success will lay the groundwork for future efforts. Vidrine hopes that this is the first of many updates to North Carolina’s regulatory framework to further increase access and equity in oral health care.

“I think that there is an opportunity to look at things that complement this existing school-based prevention system, such as teledentistry,” Vidrine said. “And then there is a lot we can do with perinatal oral health, especially given some of the new research identifying risks for a pregnant mom with poor oral health.”

NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!


Healthy Mouth, Healthy Body: Cardiovascular Disease and Oral Health

Your Mouth is Part of Your Body!

It is easy to view oral health in a vacuum. We do see a dentist for our teeth and a general physician for pretty much everything else, after all.

However, thanks to new research, we are learning about new and interesting connections between health in our mouths and health throughout our bodies. The link between oral health and whole-body health is called the oral-systemic connection, and it can impact an array of conditions, from cardiovascular disease (heart disease) to diabetes, osteoporosis to Alzheimer’s disease, and much more.

Bottom Line: Poor oral health can impact overall health. It is incredibly important to see a dentist regularly, especially if you experience adverse health effects elsewhere in your body.

For dentists and medical doctors alike, it is important to keep the oral-systemic connection in mind when treating patients with periodontal disease and diseases linked to poor oral health.

In a three-part series, “Healthy Mouth, Healthy Body,” the Foundation for Health Leadership and Innovation’s North Carolina Oral Health Collaborative will break down the most prevalent examples of the oral-systemic connection and what you can do to make sure you have a healthy mouth and a healthy body.

Healthy Mouth, Healthy Heart

Cardiovascular disease, or heart disease, is one of the most common medical problems Americans face today. Even if your teeth seem far removed from your heart and arteries, there are important connections between the two.

If you have ever cut your face or mouth, you have seen firsthand just how many blood vessels are in these areas. Our faces and mouths are home to tons of small blood vessels right near the surface of our skin.

With all those surface-level blood vessels, it is incredibly easy for harmful bacteria from gum disease (periodontal disease) to make their way into the bloodstream.

What is Periodontal Disease?

Periodontitis, or gum disease, is an infection caused by plaque build-up that impacts the gum tissue and bone holding your teeth in place. At some level, periodontal disease affects 75 percent of adults in the United States.

Gum disease can release harmful bacteria directly into your bloodstream. Additionally, a side effect of serious gum disease is chronic inflammation, which is linked to medical conditions like atherosclerosis, an artery disease that can lead to heart attacks and stroke.

It is important to note that while scientists studying the connection between gum disease and heart disease have not found a causal role (one directly affects the other), there are numerous studies finding strong links between poor oral health and worsening outcomes for cardiovascular health.

What Does This Mean?

Our Habits Play a Role

When you think about the oral-systemic connection, it is important to consider causes as well as connections and outcomes. For example, consuming a lot of sugary foods on a day-to-day basis puts you at risk for diabetes, cavities, and periodontal disease. There are many other habits, such as tobacco use, that also impact your oral health and the health of the rest of your body.

The oral-systemic connection doesn’t mean that one cavity will cause an overall health crisis, but it does highlight how important it is to see a dentist regularly, especially for people who traditionally lack access (read more about systemic barriers to oral health care here).

Additionally, the oral-systemic connection highlights the need for more integrated models of health care. Traditionally, medical professionals are siloed within their area of expertise. With how interconnected the body is, it is important that health care reflect those links, with provider networks equipped with the tools necessary to assess and diagnose health problems from head to toe.

Be sure to stay tuned. Part two of this three-part series, focusing on the connection between oral health and diabetes, will be published on January 28.

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NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!

Additional Sources for Information on the Oral-Systemic Connection


Expanding Access: Pending Rule Change Will Allow More Children to Receive Preventive Oral Health Care

Oral health care will soon be more accessible for young North Carolinians who have been systemically underserved.

On December 13, 2019, the North Carolina Board of Dental Examiners unanimously voted to approve an important rule change that will increase access to quality, affordable oral health care. The change to Occupational Licensing Boards and Commissions Rule 16W will allow dental hygienists to further practice to the full extent of their licensure. The rule change has the potential to increase preventive services such as sealants and fluoride treatments to children, in high-need settings, without a dentist’s prior exam.

“With 74 of 100 North Carolina counties deemed as dental health provider shortage areas (HPSA), the state has a crisis of access to oral health services, primarily affecting our most vulnerable populations. This rule change means that we will have a real opportunity to increase access for those who are chronically underserved and ultimately prevent detrimental oral health outcomes later in life.”

—Dr. Zachary Brian, director of the North Carolina Oral Health Collaborative (NCOHC), a program of the Foundation for Health Leadership & Innovation

Before it goes into effect, this rule change, co-sponsored by the FHLI’s NCOHC and the North Carolina Dental Society (NCDS), must receive final approval from the Rules Review Commission. Approval is currently anticipated in mid-January 2020.

Here’s what the rule change means and how it could impact oral health care in North Carolina.

A Preventable Oral Health Crisis

Tooth decay is the single most common chronic childhood disease, disproportionately affecting low-income populations. Nationwide, roughly 50 percent of children in low-income families experience tooth decay, and dental disease is responsible for a collective 51 million hours of school missed each year.

Only 16 percent of children ages 6 to 9 have received a sealant on a permanent tooth.

Cost of care is a significant barrier that prevents children and families from accessing oral health care. At one-third the cost of a cavity filling, dental sealants are a low-cost solution that can dramatically reduce the likelihood that an individual will develop a cavity during childhood.

Unfortunately, North Carolina’s requirement that a child have a prior exam from a dentist before a dental hygienist can apply a sealant adds additional cost and delays to the process.

Dental Sealants and Dental Hygienist Licensure

A dental sealant is a thin coating applied to the chewing surfaces of a child’s back teeth. The application of a sealant is a simple and painless procedure that adds an extra layer of protection to the molars, teeth which are most susceptible to decay because of the pits and grooves on their chewing surfaces. A dental sealant protects against 80 percent of cavities for two years, and 50 percent of cavities for up to four years.

In 39 states across the country, dental hygienists can apply dental sealants without a prior exam or direct supervision from a dentist. This procedure is part of a dental hygienist’s education, but in states like North Carolina, hygienists can be hindered due to administrative barriers of the prior examination requirement.

How Will This Rule Change Impact Access to Care?

Without the requirement for a prior exam by a dentist, dental hygienists can offer sealants in alternative settings like schools or after-school clinics rather than at a dentist’s office. School sealant programs, in particular, are a very effective method for reaching children who would otherwise not see a private dentist.

According to the CDC, each tooth sealed saves more than $11 in treatment costs down the road. With just over one million low-income children in North Carolina, expanded access to dental sealants has the potential to prevent costly restorative treatment needs like dental fillings later in life.

What Comes Next?

NCOHC and NCDS have engaged in a new and productive partnership to co-sponsor this rule change, and NCOHC will continue to engage NCDS for productive changes to North Carolina’s oral health care landscape.

Similar to the restrictions on providing sealants and other preventive services, dental hygienists in North Carolina are also hindered in the ability to administer local anesthesia, a clinical skill that is valuable to patient comfort and whole-person care. In fact, North Carolina is one of just six states that prevents dental hygienists from administering anesthesia. NCOHC is currently evaluating this regulation for potential advocacy engagement in the future.

NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!