Presentation Group: Jennifer Anderson, Kristin Brenkus and Madelyne Smith

Course: Public Health Dental Hygiene 1

 
Topic: Fighting the oral changes that come with aging, the link between diabetes and
periodontitis

Title: Age in Style with a Healthy Smile: How to Fight the Oral Changes that Come with Aging
 
Audience: Dental Hygiene Students 

Goal: To educate dental hygiene students about the oral hygiene of the elderly population, and
the effects of periodontal disease on their dentition. The elderly population is growing, and due
to the oral health changes that come along with this age group, it is important to understand the
connection between periodontal and diabetes.

  Instructional
Objectives: Upon completion of the lecture, the student should be able to:
1.     Define diabetes and identify the differences between Type 1 and Type 2.
2.     Describe the disease process of periodontitis. 
3.     Analyze the effects of diabetes on the disease process of periodontitis.
4.     Explain the oral hygiene instructions for maintaining optimal oral health for a patient with
diabetes.
5.     Justifies the benefits of controlling the patient’s diabetes to maintain a healthy
periodontium.

 Instructional Materials/ Teaching aids: 

 PowerPoint Presentation 
 Computer equipment
 Informative poster pdf
 Student handout  
 Kahoot app
 Prize for Kahoot winner
                           
References:
 
1.    Lamster, I. B. (2016). Geriatric periodontology: How the need to care for the aging
population can influence the future of the dental profession. Periodontology 2000, 72(1), 7–12.

2.    Singh S, & Bajorek B. (2014). Defining ‘elderly’ in clinical practice guidelines for
pharmacotherapy. Pharmacy Practice, 12(4), 489.

3.    Huang, D., Chan, K., & Young, B. (2013). Poor oral health and quality of life in older U.S.
adults with diabetes mellitus. Journal of the American Geriatrics Society, 61(10), 1782-1788. 

4.    Torpy, J., & Golub, Robert. (2011). Diabetes. JAMA, 305(24), 2592-2592.
 5.    Chiniwala, N., & Jabbour, S. (2011). Management of diabetes mellitus in the elderly.
Current Opinion in Endocrinology, Diabetes, and Obesity,18(2), 148-152.

6.    Saini, R., Saini, S., & Sugandha, R. (2011). Periodontal disease: The sixth complication of
diabetes. Journal of Family & Community medicine, 18(1), 31. 

7.    Bissett, S., Preshaw, P., & Pumerantz, A. (2015). Periodontal disease and diabetes. Journal
of Diabetes Nursing,19(4), 134-140.

8.    Preshaw, P.A., Alba, A.L., Herrera, D., Jepsen, S. Konstantinidis, A., Makrilakis, K., &
Taylor, R. (2012). Periodontitis and diabetes: A two-way relationship. Diabetologia, 55(1), 21-
31. 

9. Croitoru, G. A., Tilişcan, C., Carmen Marina, M., Victoria, A., Daniela, I., & Aramă, S.
(2012). The role of diabetes mellitus in periodontal disease and rheumatoid arthritis pathogenesis:
The dentist’s point of view. Therapeutics, Pharmacology & Clinical Toxicology, 16(3), 177–180. 

10. Demmer, R. T., Holtfreter, B., Desvarieux, Moïse, M.D., Jacobs, David R, J.R., Kerner,
Wolfgang, Nauck, Matthias, Kocher, Thomas. (2012). The influence of type 1 and type 2 diabetes
on periodontal disease progression: Prospective results from the study of health in pomerania
(SHIP).Diabetes Care, 35(10), 2036-42.

11. Siddiqi, Zafar, Sharma, Quaranta, & Siddiqi, A. (2019). Diabetic patient's knowledge of the
bidirectional link: Are dental health care professionals effectively conveying the message.
Australian Dental Journal,doi: 10.1111/adj.12721

12. Evert, A. B., Dennison, M., Garder, C. D., Garvey, W. T., Lau, K. K., MacLeod, J., Mitri, J.,
Pereira, R. F., Rawlings, K., Robinson, S., Saslow L., Uelmen, S., Urbanski, P. B., & Yancy Jr,
W. S. (2019). Nutrition therapy for adults with diabetes or prediabetes: A consensus report.
Diabetes Care, 42, 731-754. 
 
Personnel: Group members include Jennifer Anderson, Kristin Brenkus and Madelyne Smith
 
Time: 20 minutes
Time Lesson Content Notes/Media

2 Slide 1 cover page

minutes Introduction Slide 2 Intro 
The world's population is aging, and it has been estimated that
by 2050, the number of elderly people 65 years of age and
older will reach 1.5 billion (1). According to Shamsher Singh
and Beata Bajorek, “Aging, an inevitable process, is commonly
measured by chronological age and, as a convention, a person
aged 65 years or more is often referred to as ‘elderly’” (2). 
The aging population will be affected by noncommunicable
chronic diseases, including diabetes mellitus (1). These
individuals may suffer from oral disease as they have a greater
risk of periodontal disease and subsequent tooth loss (3). A
study revealed that these individuals have worse dentition and
higher prevalence of edentulism than those without diabetes
(3). The connection between systemic and oral health embodies
the need to explore the role of diabetes and its effect on the oral
health of the growing elderly population (Fig 1).

Slide 3 (intro
cont’d)
2
minutes About Diabetes and the Differences between Type 1 and Type 2
Diabetes mellitus is a chronic medical condition that causes
blood glucose levels to rise, which can lead to other serious and
life-threatening problems (4). Following the 2007 Center for Slide 4
Disease Control fact sheet, the prevalence of diagnosed
diabetes in age group 60 or older is 12.2 million, that is, 23.1%
of people in this age group (5). There are two types of diabetes,
type 1 and type 2, with type 2 being the most common. 
Type 1 diabetes is when the pancreas does not produce enough
insulin, a hormone that produces glucose. Type 2 diabetes is
when there is a resistance to insulin, the body produces insulin
but is unable to process glucose appropriately (4). Diabetes
mellitus can affect the whole body, but what a lot of people do
not consider is how it affects oral health and the periodontium.
Periodontitis is considered the sixth complication of diabetes
(6). Both type 1 and type 2 diabetes are predictors of
periodontal disease when diabetes is not properly under control
(6).

Slide 5

2 Slide 6
minutes Disease process of periodontitis
The periodontium consists of the supporting structures of the
teeth including the gingiva, periodontal ligament, and alveolar
bone (7). Periodontal diseases are a group of inflammatory
conditions which directly affect these important structures (7). 
People with diabetes are three times more likely to develop
periodontitis, which increases even more in those with poor
glycemic control (8). One study found results stating
uncontrolled type 1 and type 2 diabetes were associated with
significant attachment loss when compared to those who were
diabetes free (9). There was a direct correlation between
uncontrolled type 2 diabetes and unfavorable pocket depth
changes (9). However, controlled diabetes did not result in
progression of attachment loss (9). Slide 7
2 Slide 8
minutes Diabetes on the disease process of periodontitis
It was proven that treating periodontal disease can result in
reductions of individual’s A1C levels (8,9). Research indicates
that the potential effect of diabetes on periodontal disease is
linked to a hyperinflammatory response to infection,
disconnection of bone destruction and repair, and the effects of
advanced glycation end products (9,10). The diabetic elderly
population are more likely to report tooth loss due to
periodontal disease and were less likely to have received any
dental care in over one year (3). It is important to implement
proper oral health care for these individuals as a prevention of
both periodontitis and diabetes.

2 Slide 9
minutes Oral hygiene instructions for maintaining optimal oral health for
a patient with diabetes

Studies have shown that about 73% of diabetic patients were

not aware of the link between their diabetic systemic condition
and their periodontal health and vice versa (11). Many
individuals do not know they are living with diabetes, and due
to this lack of knowledge, they are not aware of all the health
risks associated with the disease (11). This study also revealed
the strong need for implementation of guidelines for the mutual
care of diabetic elderly patients between medical and dental
professionals in order to improve the patient’s overall health
(11). A dental professional may provide nutrition counseling as
a beneficial intervention in the prevention and control of type 1
and type 2 diabetes (12). Health care professionals have the
ability to care for their patients by offering nutrition counseling
as a cost effective and beneficial way to manage diabetes as
well as caring for their oral health.

2 Slide 10
minutes Benefits of controlling the patients diabetes to maintain a healthy
periodontium

Improving or maintaining glycemic targets, achieving weight

management goals, and improving cardiovascular risk factors
are key points that a health professional should include in their
nutrition counseling. Reported A1C reductions from nutrition
counseling can be similar to or greater than what would be
expected with treatment using currently available medication
 for type 2 diabetes (12). 
Strong evidence supports the effectiveness of nutrition
counseling interventions provided by Registered Dietitian
Nutritionists for improving A1C, with absolute decreases up to
2.0% (in type 2 diabetes) and up to 1.9% (in type 1 diabetes) at
3–6 months (12). Nutrition counseling needs to include a
current dietary intake as well as personalized guidance on self-
monitoring carbohydrate intake to optimize meal timing and
food choices and to guide medication and physical activity
recommendations (12). 
Dental professionals play a key role in caring for the elderly
with diabetes by: offering nutrition counseling, providing Slide 11
therapeutic services for periodontal disease, educating patient
and caregiver with oral hygiene instructions ways to better care
for their oral health at home.

Slide 12

4 Conclusion Slide 13
minutes As the population of elderly individuals continues to increase,
combined with the increase in levels of diabetes due to poor
health and diet, healthcare professionals must be educated and
equipped to handle this population of patients with specific
health needs. The dental team plays an important role in
educating patients on the harmful effects of diabetes in relation
to oral health (Figure 2). Specifically, dental hygienists can
inform patients on the link between oral health and overall
systemic health. Patients with diabetes have a decreased
immune system that negatively impacts their immune system
and the ability to maintain a high level of oral health. It is
crucial that elderly patients are aware of their health conditions,
 receive proper education and treatment in order to best care for
their health.
Discussion
1. Has the information presented today altered your opinion
about diabetes in the elderly population?
2. What would you tell your diabetic patients about periodontal
disease?
3. What do you think the role of the hygienist is in educating
patients with diabetes and periodontal disease? 
4. Do you have any questions?
 

4 Questions? Begin KAHOOT

minutes using app on cell
phones

Test Questions

1. Objective #1: Define diabetes and identify the differences between Type 1 and Type 2.

Test Item: (True or False) Type 2 diabetes is when there is a resistance to insulin, the body
produces insulin but is unable to process glucose appropriately

a. True
b. False 

2. Objective #2: Describe the disease process of periodontitis. 

Test Item: All the following supportive structures are affected by periodontitis except?

a. Gingiva
b. Periodontal Ligament 
c. Pulp Chamber
d. Alveolar Bone 

3. Objective #3: Analyze the effects of diabetes on the disease process of periodontitis.

Test Item: Research indicates that the potential effect of diabetes on periodontal disease is linked
to a                          response to infection.
 a. Hyperinflammatory
b. Hypoinflammatory 
c. Genetic 
d. Latent 

4. Objective # 4: Explain the oral hygiene instructions for maintaining optimal oral health for a
patient with diabetes

Test Item: Offering                        is a cost effective and beneficial way to manage diabetes as
well as caring for their oral health.

a. Fluoride tray
b. Arestin 
c. Athletic mouth guard
d. nutrition counseling

5. Objective #5: Justifies the benefits of controlling the patient’s diabetes to maintain a healthy
periodontium

Test Item: The diabetic elderly population are more likely to report tooth loss due to periodontal disease
and were less likely to have received any dental care in over one year. Therefore, it is important to
implement proper oral health care for these individuals as a prevention of both periodontitis and diabetes.

a. Both statements are false

b. Both statements are true
c. Statement one is false, statement two is true
d. Statement one is true, statement is one is false.