FYI

As the population of seniors continues to grow, dental providers are increasingly encountering patients with complex health conditions, including diabetes. Diabetes, a prevalent chronic condition among older adults, can significantly impact oral health. Proper dental care for these patients not only helps in maintaining their oral health but also plays a crucial role in managing their diabetes. 

We asked Delta Dental’s Chief Dental Officer, Dr. Daniel Croley, DMD, for what you should know about the unique challenges of dental care for senior patients with diabetes and best practices you can implement to deliver effective and compassionate care.
 

Understand the connection between diabetes and oral health

Diabetes can have a profound impact on oral health, particularly among seniors. High blood sugar levels contribute to an increased risk of oral health problems, including gum disease, dry mouth, thrush, and delayed healing.
 
Given these risks, dental providers need to adopt a proactive approach to care for senior patients with diabetes, ensuring both their oral and overall health needs are met.

“I like to advise dentists and staff to verbally discuss a diabetes diagnosis with their patients. They should find out things like the type of diabetes they have, Type 1 or 2, or if they have pre-diabetes. They should ask patients how they are monitoring their glucose levels—are they doing continuous glucose monitoring, using a finger stick, or not monitoring?” advises Dr. Croley.

Best practices for dental providers working with senior patients

To provide the best care for seniors with diabetes, dental providers should implement the following practices:
 

1. Complete comprehensive patient assessments.
   Begin with a thorough assessment of the patient’s medical history, including their diabetes management plan. Understanding their blood sugar levels, medication regimen, and any complications from diabetes is essential for tailoring dental care. Regular communication with the patient’s primary care physician or endocrinologist can help coordinate care effectively.

“Dentists should always document all of this information in their patient’s record. This is always a good risk management protocol,” says Dr. Croley.

2. Create individualized care plans.

   Senior patients with diabetes may have different needs depending on their overall health, level of diabetes control, and mobility. Create individualized care plans that address these specific needs, including more frequent cleanings or targeted treatments for gum disease.

3. Emphasize preventive care. 

   Preventive care is crucial for patients with diabetes. Encourage regular check-ups every three to six months, depending on the severity of their condition. Focus on preventive measures such as professional cleanings, fluoride treatments, and education on proper oral hygiene techniques tailored to seniors.
4. Monitor for signs of gum disease and other complications.

   Be vigilant in monitoring for signs of gum disease, thrush, and other oral health issues commonly associated with diabetes. Early detection and intervention can prevent the progression of these conditions, which can otherwise lead to severe complications.

5. Manage dry mouth.

   Recommend products specifically designed to combat dry mouth, such as saliva substitutes, mouthwashes formulated for xerostomia, and sugar-free gum or lozenges. Educate patients on the importance of staying hydrated and avoiding foods and beverages that can exacerbate dry mouth.

   
   
“Diabetes can decrease salivary flow that can alter the pH levels of the saliva and the mouth, supporting growth of less beneficial bacteria in the mouth.  This can lead to a more acidic oral environment which could facilitate the development of tooth decay,” warns Dr. Croley. 

6. Educate patients on oral hygiene.  

   Many seniors may struggle with manual dexterity due to arthritis or other conditions, making oral hygiene challenging. Recommend adaptive tools such as electric toothbrushes, floss holders, or water flossers to help them maintain their oral hygiene. Emphasize the importance of brushing twice daily with fluoride toothpaste and flossing regularly.

7. Take caution with surgical procedures.  

   For seniors with diabetes, surgical procedures such as extractions or periodontal surgery require special consideration. Ensure that blood sugar levels are well-controlled before proceeding and provide clear instructions for pre- and post-procedure care. Follow up closely to monitor healing and address any complications promptly.

8. Address nutrition and diet. 
   Collaborate with nutritionists or dietitians to help patients understand the impact of their diet on both their oral health and diabetes management. Encourage patients to avoid sugary snacks and drinks, which can harm their teeth and complicate blood sugar control.

9. Support smoking cessation.  

   Smoking greatly increases the risk of gum disease and complications in diabetic patients. Provide resources and support for smoking cessation, emphasizing the dual benefits for both oral and overall health.

Create a comfortable and supportive environment

For many seniors, visiting the dentist can be a source of anxiety, especially if compounded by health concerns like diabetes. Creating a welcoming and supportive environment is essential to making your senior patients more comfortable and receptive to care. 

To help put your patients at ease, offer extra assistance for mobility challenges, ensure appointment times accommodate their needs, and take the time to explain procedures clearly and with compassion. Be sure to reach out to patients who might need more care. Dr. Croley suggests, “With a patient-centric lens, the dentist can advise between visits too—it could be email reminders, a phone call, or whatever—but most people need this kind of additional support.”

Caring for senior patients with diabetes requires a specialized approach that considers their unique needs and challenges. By following best practices tailored to this population, dental providers can play a pivotal role in improving their patients’ oral health and overall quality of life. Through regular preventive care, individualized treatment plans, and a supportive patient-provider relationship, seniors with diabetes can maintain healthy smiles and better manage their condition.