Prakash Poudel is a PhD student on a scholarship with the School of Nursing & Midwifery at WSU, based at the Centre for Oral Health Outcomes & Research Translation. He was born and raised in Nepal, coming here 11 years ago. Migrant health is close to his heart. He's been involved in developing a fresh approach to oral-dental hygiene for diabetics and the resulting patient brochure is being much praised. The oral-health research centre is affiliated with WSU and SWSLHD Oral Health Services and is within Ingham Institute for Applied Medical Research.
Why a brochure? People with poorly controlled diabetes have a higher risk of dental problems, often three-fold. Our studies show people with diabetes are less aware of the link between diabetes and dental problems. And GPs and diabetes educators don't often teach good oral hygiene, assess for oral risks or encourage regular dental visits. It's due to limited oral-health knowledge, time constraints and lack of resources. So we developed a Diabetes Oral Health program including a brochure and simple risk-assessment tool. The brochure was developed to be readable, often overlooked. It's endorsed by NSW Health, Diabetes Australia, Australian Dental Association and South-West Sydney Local Health District. It's available for free at health.nsw.gov.au/oralhealth/Pages/diabetes-oral-health.aspx.
Why is oral-healthcare in diabetes overlooked? Care-providers have limited knowledge and training in it and patients are unaware of the role of oral health in general health. And patients may overlook oral health because of other pressing health problems.
What indicates poor oral health? When you don't brush properly and clean between your teeth daily, food will develop into bacteria and plaque. If not cleaned, it forms calculus. People living with diabetes (type 1 or 2) have high levels of glucose in saliva and very dry mouths, increasing the chance of plaque, decay and oral thrush. And plaque and calculus irritate the gums which become red, swollen and start to bleed. Diabetes increases risk of gum disease. A bleeding gum is an early sign. Early gum disease can be treated by effective cleaning. If not treated, it progresses to periodontal disease and destroys the bone and teeth get loose and fall out. People with diabetes also have lower immunity and are more likely to have infections like dental abscesses. Gum disease increases inflammation in the body, making it harder to control diabetes.
People with diabetes are already busy with diet and exercise -- is this why oral health-care is overlooked? Yes, overshadowed by more pressing concerns as people living with diabetes might have a range of health problems. Poorly controlled diabetes can affect eyes, kidneys and feet and your ability to care for your oral health. The mouth is often not considered part of the body, though it's a window for infection. It's important to brush twice a day, floss between teeth daily and see a dentist at least once a year. Patients should be encouraged to discuss their oral health and diabetes with their dentist and diabetes care providers.
Here in the multicultural South-West are there culturally-specific concerns? Generally, culturally and linguistically diverse communities here face extra barriers in terms of accessing health services. Areas of the South-West are disadvantaged and include people with low literacy and those from culturally and linguistically diverse backgrounds who are largely unaware of the importance of oral health.
What did you find in your research? On top of overseas research, we surveyed 200 patients and found more than half (55 per cent) reported having one or more dental problems. Less than half (46 per cent) were aware of oral-health problems associated with diabetes. But very few (13 per cent) got information on oral health from diabetes-care providers. Our research involving a focus group with a diabetes educator and interviews with GPs found there's limited focus on oral health by diabetes-care providers during clinical care, there's a lack of resources for patient education and screening and they have limited oral-health knowledge or training.
Why the need for a brochure? Simply because our findings indicated that care-providers have limited knowledge and time to educate patients. They indicated that they wanted patient-education resources. For example, diabetes educators told us: "We need resources that provide clear and simple messages" and "Patients do like handouts with not too many messages and which are pretty simple." So we came up with the oral-health brochure, with extensive consultation with NSW Centre for Oral Health Strategy, 15 local health districts, Australian Dental Association, Diabetes Australia and so on.
Patient feedback? Very positive. Such as: "It's excellent on all components, especially for the dental component." "It's well structured, provides questions and answers accurately and the images reflect the content." "It looks very professional and it's easy to read and understand."
- Free brochure Diabetes & Oral Health: health.nsw.gov.au/oralhealth/Pages/diabetes-oral-health.aspx.