Relationship of Oral and Systemic Health Clinical Case #1

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1. Question
You are a member of an interprofessional primary care team, caring for Mary Smith, a 53 year old patient with a history of well-controlled diabetes mellitus, depression, hypertension, and allergies. Today, she presents for routine follow-up for her multiple medical conditions.

Mrs. Smith is diabetic, so you perform an oral examination at this visit and advise her to see a dental care provider regularly. What is the probable mechanism connecting periodontal disease with diabetes mellitus?
- Diabetics with chronically high blood sugar levels have high salivary sugar levels that promote tooth decay in the same way eating foods high in sugar content cause tooth decay. There is a reciprocal relationship between poor diabetic control and oral disease, particularly periodontitis. Periodontits is a chronic infection, and, like other infections, worsens diabetic control. Similarly, poor diabetic blood sugar control is associated with lowered resistance to infection, in the oral cavity and elsewhere. Thus, the association is probably mediated by chronic infection rather than salivary sugar content and caries.
- The bacterial and host response in periodontitis releases inflammatory chemical mediators into the bloodstream that have distant effects.
- Patients with elevated blood sugars have high levels of oral bacteria that lead to increased rates of decay. Elevation in blood sugars any poorer glycemic control does not impact the level of oral bacteria in the mouth. Increased rates of tooth decay are related to chronic periodontitis and lowered resistance to infection.
- The medications prescribed to treat diabetes mellitus cause dry mouth, which in turn promotes dental decay. Salivary flow is important in normalizing oral pH and washing out residual food so that teeth can re-mineralize between meals. Xerostomia increases the risk of dental caries. Xerostomia (dry mouth) is common side effect of many medications, including antidepressants, antihypertensives, and antihistamines that Mrs. Smith may be taking to control treat those medical conditions.
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Question 2 of 3

2. Question
On today’s visit, you find that Mrs. Smith’s glucose control has recently worsened. The findings on her oral exam are illustrated in the photo.

Robert Henry, DMD, MPH

Which of the following statements is correct?
- This patient has gingivitis which should be treated with brushing, flossing and an oral antibacterial rinse. This patient has periodontitis, which is more severe than gingivitis. Although brushing, flossing and antibacterial rinses may be helpful in improving her oral hygiene, she requires scaling and root planing to control her periodontal infection.
- This patient should be placed on oral antibiotics to reduce the risk of bacteremia when brushing. Oral antibiotics alone are not recommended. This patient requires more definitive treatment that may involve topical antibiotics as part of a comprehensive approach to treating her periodontitis.
- Scaling and root planing performed by a dentist can be expected to result in an improvement in Mrs. Peterson's glycemic control.
- This patient has root caries and should be referred to a dentist for extraction of the affected teeth. Although Mrs. Smith has purulent exudates and calculus along the gumline and exposed roots, frank root caries is not apparent. These teeth do not require extraction.
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Question 3 of 3

3. Question
Mrs. Smith takes multiple medications each day to treat her hypertension, depression, asthma, and allergies. Today you review her medication list, which includes hydrochlorothiazide, citalopram, intranasal fluticasone, albuterol, and loratadine.

Which oral complication is common to all the medications Mrs. Smith takes?
- Cancer of the tongue Cancer of the tongue is associated with use of tobacco products,alcohol consumption, HPV infection, radiation, and immune deficiency.
- Taste alteration Taste alteration can occur as a side effect of medications, but is not associated with all of the medications listed here.
- Oral candidiasis (thrush) Oral candidiasis is associated most commonly with inhaled corticosteroids, antibiotics, and immunosuppressed conditions. However, the other medications on Mrs. Smith’s list are not associated with oral thrush (candidiasis).
- Xerostomia
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The Relationship of Oral and Systemic Health

Relationship of Oral and Systemic Health Clinical Case #1

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