Diabetes is a chronic metabolic disorder characterized by lifelong hyperglycemia due to defect in insulin secretion or action. It has been observed that the percentage of people diagnosed with diabetes, from year 1980 through 2011, has gone up by 167% in the age group of 0-44 years. In the same period, the increase was found to be 118% in the age group of 45-64years; 140% in age group 65-74years; and 125% in those 65years and above. For the same time period, it was found that the age-adjusted percentage of people with diabetes increased by 153% in those with less than high school education; 213% with those with high school education; and 168% with those with educational level higher than high school. In short, the age-adjusted percentage was higher in those with less education.
Diabetes Mellitus is associated with wide range of complications and their onset and progression is strongly linked to the presence of hyperglycemia. Research has clearly shown the relationship between the microvascular disease and hyperglycemia. In microvascular diseases are typically associated with retina, kidney, and blood vessels. In context of blood vessels, the injuries cause altered blood flow, extravascular protein deposition and coagulation resulting organ dysfunction. This is the underlying mechanism behind diabetic retinopathy, nephropathy, and blood pressure. Therefore, classic triad such as – nephropathy, neuropathy, and retinopathy – along with microvascular complications, such as coronary artery disease, peripheral vascular disease, and stroke forms the injurious effect of diabetes.
Many systemic diseases, including diabetes, have oral manifestations. Poor oral hygiene increases the number of bacteria, which can be aspirated leading to other systemic infections. In this study, oral health issues were found to be common in patients hospitalized for acute care infection. Most of the issues were around “tooth cleanliness, dryness of mouth, and colour alterations of tongue and mucous membrane”. Therefore, there is need for increased awareness of oral health among hospitalized patients. So, there is need to implement a standardized method of assessment of oral health to detect conditions, which otherwise might go unnoticed. This makes oral health an important component of nursing care. Nurses play in important role in maintaining oral health during and after hospitalization.
Nurses play a critical role in oral management of diabetes. But, the situation is complicated by the inadequacy of human resources: in this situation, the availability of nurses. According to researchers, taking into account only the unmet needs, without factoring economic, social, and cultural aspects can lead to miscalculation. This miscalculation in amount of dental care that is expected to be used, can lead to miscalculation in workforce planning. This can be exemplified by our experiences from 1983 to 2001, where we have seen fluctuation between oversupply and undersupply. In conclusion, expanding the scope of dental hygienist with dental practice and in underserved areas can help improve accessibility.
Coming back to the original topic of diabetes mellitus, we found that a large number of associated oral disorders. The data supports that the primary complication is periodontitis. Also patients with prolonged poor oral hygiene are susceptible to development of oral candidiasis. Evidence also supports that periodontitis is a risk factor in the development of poor glycemic control; also of other clinical complications associated with diabetes. Therefore, periodontal changes are among the first sign of development of diabetes. This necessitates maintaining oral health from early childhood. In a study, it was found that the mean score for the secondary school children was 60.8, and the difference between male and female students was statistically significant. Therefore, they concluded that the mean knowledge was poor. They recommended integration of health education program within the school curriculum, with special emphasis on oral health.
References
CDC. (n.d.). Age-Adjusted Percentage of Civilian, Noninstitutionalized Population with Diagnosed Diabetes, by Education, United States, 1980–2011. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/diabetes/statistics/prev/national/figbyeducation.htm
CDC. (n.d.). Percentage of Civilian, Noninstitutionalized Population with Diagnosed Diabetes, by Age, United States, 1980–2011. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/diabetes/statistics/prev/national/figbyage.htm
Fitzpatrick, P. G., & Duley, S. I. (2012). Lack of Access in Healthcare Delivery: A Model for Using Dental Hygienists in a Cost Effective Manner to Help Address the Oral Healthcare Problem. Hospital Topics, 82-90.
Hanne, K., Ingelise, T., Linda, C., & Ulrich, P. P. (2012). Oral status and the need for oral health care among patients hospitalised with acute medical conditions. Journal of Clinical Nursing, 2851-2860.
Khamaiseh, A., & AlBashtawy, M. (2013). Oral health knowledge, attitudes, and practices among secondary school students. British Journal of School Nursing, 194-199.
Lamster, I. B., Lalla, E., Borgnakke, W. S., & Taylor, G. W. (2008). The Relationship Between Oral Health and Diabetes Mellitus. The Journal of the American Dental Association, 19S-24S.
Meetoo, D. (2014). Diabetes: complications and the economic burdon. British Journal of Healthcare Management, 20(2), 60-68.
