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Diabetes and Oral Health: A Two Way Relationship

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Summary

Learn with me! I'm a diabetes specialist nurse with a special interest in understanding the two-way link between diabetes and poor oral health. This interactive session covers topics like common oral health issues (e.g. cavity, gingivitis, periodontal gum disease), how diabetes and poor oral health are linked, and how to recognise and combat these issues. Through this session, medical professionals can gain a better understanding of the connection between diabetes and oral health and learn how to better integrate oral health into their practice.
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Description

Diabetes and Oral Health:

A two way relationship

  • To give healthcare professionals information, so that they understand the importance of providing people with diabetes education regarding their oral health
  • To understand the potential bi-directional relationship between diabetes and poor oral health
  • For health care professionals to undertake and oral assessment as part of the diabetes annual review

Delivered by Diabetes Specialist Nurse Judy Downey RGN BSc(Hons)

A 40-minute live webinar that will be recorded and made available on demand.

Nurses and midwives are in a unique position to raise awareness about the importance of oral health and provide oral health education to individuals, families and communities. Implementing preventive measures early will alleviate individual pain, discomfort and disfigurement and reduce the economic burden of oral diseases on individuals and the health system.

A collaboration between C3 Collaborating for Health, the Commonwealth of Nurses and Midwifery Federation and Learn With Nurses.

Funded by Burdett Trust for Nursing.

Learning objectives

Learning Objectives 1. Understand why there is a strong link between diabetes and poor oral health 2. Name the main oral health issues associated with diabetes 3. Explain why there are barriers to access dental care in the UK 4. Identify the connection between diabetes, periodontal disease, and cardiovascular diseases 5. Explain why it is important to assess and address oral health as part of diabetes care
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

So, hi, everybody. You can all hear me. I hope if you can't let me know. Um, I am going to just about start. So I'm just thrilled that, um, that you've joined me to be, to be honest and, and also that we have people from outside of the UK as well, which is really, really nice. Yeah. So I'm looking at chat one more time. Someone else has just messaged. Yes. Hi, Raisin. Now, I know Raisin. We, we did work together a bit in the past, didn't we? Raisin? So, it's lovely that you've joined us and Jess has, has said she's a practice nurse in Sudbury Suffolk. I've never been there, Jess. So, um, yeah. So why are we all here? And why am I doing this now? I'm a diabetes specialist nurse. Darius. You're from the Philippines and you're a medical student and you're also a nurse. Brilliant. Yes. Go for it. Um, I'm a diabetes specialist nurse. No, I'm not a dentist. All right. But I can tell you when I was preparing these slides. I, I've learned a lot myself to be Frank Maura. Hi. You're Rain Preston. Well, I'm in high Wickham. Anyone heard of High Wickham? And it's going to rain. My God. What a summer we haven't had people who aren't in the UK. You, it's just dreadful. Honestly, the weather is so bad. So I'm going to start now and, um, keep any questions if you don't understand or you just want me to clarify. But I do want to stress. I'm not a dentist, I'm a diabetes specialist nurse, but I am really, really interested in this. And um, Annemarie in Birmingham. Hi, Annemarie. Love you, Birmingham. My husband's from Birmingham. So, um, let's move on. There's me. Ok, that's what, that's uh sort of all my list of things that I do. And this time I've been working to learn with nurses for quite a long time. Now, since the beginning of the pandemic actually, and we're all volunteers to learn with nurses. But more recently, we actually received funding from the Burdett Trust for Nursing and this was actually um, smart health solutions, Briana. Hi. Now I beli I think we have a dentist in, in the audience, don't we? So, and as I just said, Briana, I'm not a dentist. So, um, but I'm very, very interested in this whole thing. Now, anyone who's, who's looked after people with diabetes and I know Roisin will have noticed this often. We notice that our patients do have a lot of teeth missing to be frank, you know, and I often notice this and I didn't really think much of it and we certainly didn't actually ask about people's or oral health or mouth health at all. So we would do annual reviews for diabetes, looking at lots of other things which I'm not going into now. Um And I'm sure you all know what they are, but look asking about people's oral health wasn't one of them. So, um these are the people that are involved in this whole thing, as I say, learn with nurses, Burdett Trust who provided funding, collaborating for Health and Commonwealth Nurses and Midwives Federation. And some of you may have listened to our friend Jill giving a talk about what's it about 10 days ago? I think you might have done and she and she heads up the Common Wealth Nurses and Midwives Federation and she's in Australia, which is why we have the talks very early in the morning in the UK because of the time difference, this medal, you may have used it before. I love it. Actually, it's probably the best um platform. I I've had to use so many different platforms, but I find this one is, is really useful. You will receive emails afterwards for your evaluations, but I'll also pop a link across as well. But if you need to do the evaluations quite frankly to get the slides and the certificate. So um if you don't get chance to do it following on from my little little talk, then um you'll get an email with a link. So don't worry about it anyway, I'm not gonna read all of that out because, you know, it's in some ways it's a bit tedious. But my main mission is to inspire people who look after patients with diabetes, to understand the strong link between poor overall health and actually diabetes. The two things are really linked, which is why over the years I've seen so many patients with, you know, you can just, when they're talking to you, you can see that a lot of teeth are missing, for example, and I never gave it much thought, you know, but now I will do and I think it's important that after, you know, anyone, nurses, doctors, dentists, whatever, you know, that, that we do understand that this bidirectional two way link between diabetes, type one or type two or any type of diabetes and oral health in particular poor oral health. So, um and actually where people are, I guess if, if they're on a path to developing diabetes such as they have prediabetes or, or they have family history, even of type two diabetes, that they are more likely to develop type two diabetes if they have really poor oral health. So, so actually doing something about that at that stage is just brilliant because it could actually prevent progression to type two diabetes. And it would be fantastic and you'll shoot me down in flames, I'm sure. But in the UK, ideally, we would, if we could, we would do an oral health assessment as part of the diabetes annual review. Don't shoot me down in flames because I do understand the time issue involved in this. I do understand that. So we need to think outside the box, we may not be able to even look in people's mouths. But there are things we can ask people and there's educational material we can give to people anyway. I mean, the most common oral health issues. Um, anyone want to put anything in chat? What do you think I'm talking about? Mainly? Of course, there's lots, Briana's probably got lots of ideas. But, um, Roisin, any of you, what are the most common oral mouth, oral or mouth issues that you see in people in all people. It doesn't have to be people who already have diabetes. As I said, it could be in anybody. What, what, what do you see? We don't have time to do a proper poll because I've only got 40 minutes. But, um, who, who, what do you think? I'm going to be talking about? Mainly anyone want to put that into the chat. Go on, be brave. Put it into the chat, oral health issues. What am I gonna be talking about? Mainly I could, I could talk for Raisin knows what I'm like. I could talk for England. That's what we say. Talk for England. Oh my God. Maura. Maura, thank you. I mean, yeah, in the UK. I don't know about the Philippines, Briana. You were in India, but there is a real problem for our patients to access dentists. And so part of me is a little bit um you know, we, we, we say give all this advice about seeing dentists, etcetera, but pre aca healing in oral cavities compromise in diabetic cases, correct. It, it, it is um all healing is where people have high blood sugars, high HBA one C. It does affect all healing and Darius Periodontal gum disease to be exact. Thank you. Yes, that's what I'm going to be mainly um talking about although everything's important. Yeah. And pre aa says high rates of cavities. Yeah. Um but you know the thing about lack of um ok, those of you who don't live in the UK, you know, the National Health Service, it's just so difficult for, for a patient to see any a dentist on the National Health Service, isn't it? It really, really is. And many of our patients who do have real problems with their oral health actually also are often from more deprived areas. They're may be unemployed. They don't have much money and to go and see a dentist privately is costs so much money. So this is a real problem we have. So, yeah, so let's, let's there. They are. Look, um we've already said um cavities or carries, you know, holes in your teeth. Then we have gingivitis, which is a precursor to periodontitis, which is the main thing I'm talking about, which would lead on eventually to loss of teeth and, and, and the, um you know, the, the uh word for it, which I didn't know before, before I researched for this is edentulous, which is why I was saying I often often saw patients who had a lot of teeth missing. And I'm sure before that they did started off with gingivitis, they probably had dental cavities as well that led on to periodontitis and then they start to lose the teeth. So this is the sort of three things mainly, of course, we do have oral cancers. Of course, people can get injured. And Briana has said um same problem regarding dentists in India. Really, I'm not surprised. So, so, yeah, injuries obviously. And of course, oh my God, I hope I never get one. Some of you may have had a tooth abscess, painful and that's a dental emergency. So those are some of the more common things. Obviously, there's more than that. Um this is periodontitis. So it does, it's, it's inflammation basically. And the you, you probably know most of you that diabetes type two diabetes and type one to some extent are now seen uh as a partly inflammatory process. So you, you do get inflammation throughout the body. So, um I think we know that there's we've known for a long time that there's a link between periodontitis, which is the extension of gingivitis. So it's inflammation of the gums leading, which can eventually lead to tooth loss. But we have known for quite a while that there's a link between that and cardiovascular disease, haven't we? We have known that for quite a while and we now know there's a big link between periodontitis and the development of type two diabetes. And there are people that say type two diabetes is a cardio in some respects, is, is a cardiovascular disease. Have you heard that? So the things are terribly linked. Um, it has been researched for many years and of course, if someone's got high blood sugars, which people with type two diabetes do, then that's going to actually um basically speed things up. So they will develop periodontal disease more quickly as someone's already mentioned healing of in the mouth and all over the body in effect, it is, is much more difficult if you have high blood sugars. And you need to remember that, that, that people have higher blood sugars than normal for quite a few years before they actually get a diagnosis of type two diabetes. So this is going to affect the healing in their mouth and, and also they are more likely to get infections. Darius has come on up. You can see me peering. It's the sixth leading complication of type two diabetes since the 19 nineties. Yeah. And that's why I'm quite sad to say Darius and all of you that we haven't up until recently. Well, I hadn't, um, pay, paid much attention to this. So we talk about all the other complications of diabetes, don't we? Um, such as, uh, cardiovascular disease, eyes, kidneys, neuropathy. Um, and we talk about those all the time, but we didn't actually talk about oral health or periodontitis as a complication. So that's really interesting that you said that Darius the sixth leading complication of type two diabetes since the nineties. And yet we're, we are starting to properly address it now. Um And of course, if you do have chronic periodontitis, of course, any infection is going to affect your blood sugars, they tend to be higher. So it goes both ways. If you've got high blood sugars, you're more likely to get periodontitis. But if you do have periodontitis, it gets worse much more quickly because of your high blood sugars and this will aggravate the other complications as well. So, so the whole, everything's linked, it's all, all holistic, isn't it? We can't just look at the overall health and not, you know, not realize that it's going to affect cardiovascular and other complications. That's just, and I've given you references at the end, I've got this off on a public domain website. Um And yeah, you know, it sort of backs up what Dari has just said that apparently, um, diabetes mellitus in the world sounds, it's sort of almost you can't get your head round. It. Can you 415 million people. But we all know that type two diabetes prevalence is rising. Everybody knows that. But in the western countries, more than 50% of people have periodontitis. Yeah. And in the whole world, if we want to think on a global thing, more than that means more than 750 million people have the severe forms. So we're not talking about gin gingivitis, which is like the pre precursor periodontitis or even where you have periodontitis, which hasn't got severe. We're talking about the severe form. So God knows how many have got um less severe forms. And we have just said this, that if you have periodontitis, you're more likely to develop diabetes. Mellis in particular type two diabetes. Um I per I, I, I'll tell you, I personally don't know if, if there is a link to developing type one diabetes, it's less likely mainly because um people with type one diabetes are often much, much younger people. Um, but we do know that type one diabetes is also on the increase. So yeah, then if there isn't studies going on to, to see the link between periodontitis and type one diabetes, then I'm sure there will be. So, um, so I'm just picking my screen up so I can read it. So it's, it's, it's a periodontitis is a common chronic inflammatory disease and, and basically, it means there's damage to the tooth supporting structures caused by this inflammation and eventually the teeth teeth fall out. As I told you, I've seen many people. Um, and of course, you've all heard of plaque, haven't you? That's why we clean our teeth so carefully to remove the plaque. Hopefully, we, we use interdental um, floss or, or these TP sticks to clear the plaque from between the teeth as well. Uh The, the, the, the, um, the film that you develop before you get plaque. The idea is that you remove this film when you clean your teeth and between your teeth so that you don't develop plaque because when you do develop plaque, you, you need to go to the dentist to have it removed. So, so yeah, we've, we've seen that people with periodontitis are more likely to develop diabetes, but people with type two diabetes do show a high prevalence of periodontitis but also people who are not yet diagnosed. So, um, move on. So, you know, you're gonna get all these sides, don't you? So don't worry, don't take notes. We've already ascertained that periodontal disease does have a relationship by directional two way with diabetes. That's one of the people, Casa Nova. I always think of the, um, the film CAA Nova, but it wasn't the same person CAA Nova at all. 2014. So if you've got periodontitis, it can influence the pre, pre presentation of type two diabetes and vice versa. Bidirectional. So you optimal management and treatment of one disease may influence presentation and response to treatment in the other, in both directions. Simpson L 2015. That makes sense now, doesn't it? This is um that you probably anyone who listened to Jill, um 10 days ago, I, I'm not going to, to dwell on this because I'm conscious of the time and I do go on a bit but th this isn't an ideal world what's going on with, with, with your teeth and I'm sure you all know that. But the, the, the thing is the, the, in a healthy mouth, I don't know if you can see that arrow but the gums, um, you know, are not red, they're not inflamed, they don't bleed, um, you can floss around them, it doesn't cause any bleeding. Um, and, um, you don't, you know, that's in an I deal. So when the teeth have just come through in a, in a, in a nine year old child, that's what, that's what you see and that's what you want to keep. Really, don't you? So, and in fact, if you have severe periodontitis, a lot of that is affected and you, if you see your patient, um, in, in hospital or in a, in, um, a clinic or you're a dentist, obviously, you know, all of this stuff. I mean, a lot of us do occasionally get bleeding gums. It is true. Um, and that's sort of a bit of a warning sign. You need to be really, really really careful with cleaning your teeth and flossing and using the TP, you know, the little plastic TP sticks that you can push between your teeth to get the, get the, um, beginnings of plaque out. And of course, you can get bad breath. Of course you can get bad breath with this. These are the sort of things you can ask the patient, even if you haven't got time to look in their mouth and some of you might be thinking, well, what do I know? I'm sort of thinking that a bit, you know, I'm a diabetes specialist nurse, but I certainly could ask these questions. Have they got any loose teeth of the, is there any change in the position of the teeth or gaps that didn't used to be there? Is there any pain even have? Well, obviously if they've got abscesses that's dreadfully painful. And the screening tools that I would like to think if they could see a dentist. And I'm, I, I'm not, I'm not amused by this, but who's had this done? I certainly have where they were, where they, um, where they, where they actually use a, a tiny little, I don't know what it's called to, to see if there's any, it, there's pictures coming up basically to see if there's any signs of periodontitis. And here's the, here's the picture. Um, so on the left hand side, to me, it's the lefthand side. Anyway, the, the health, healthy, healthy where it says healthy. Yeah, and I've had this done to me. Have you guys had this done to you? Because I certainly have loads of times. I'm just trying to um, there we go. Yeah, I can see that better now. Move it over there we go. Yeah. So, so you, what you, what they're looking for is these pockets that form between the tooth and the gum and, and um by measuring using, using this little little contraption someone has put something in on. Yeah, but pre aca thank you. Yeah. Yeah, I mean, I've had this done to me loads of times. I'm sure most of you have if you go to the dentist, it's a, it's um, you know, fairly, let me get that smaller. There we go. Yeah. And I said Periodontal probe. Thank you, Brianca. See, I told you I wasn't a dentist but it's, it is a probe really that and, and, and measurements are taken and basically the more severe your periodontitis is the further down it goes between the tooth and then the tooth root because in the first one, it's not even got as far as the in a healthy mouth. It's not even got as far as the root has it. You get early periodontitis, it goes down further moderate periodontitis, it goes down even further and in severe periodontitis look and of course, that is affecting the root. The gum is, is, is actually lowering as well. So you start to see, you can almost see part of the, the root when you look at your teeth, it, you know, and as we get older, that tends to happen a bit anyway. But um if you have severe moderate periodontitis, it's a lot of inflammation and this is going to affect this is this, by the way, I I is a patient in information leaflet, but I think this is quite useful myself to, to, to, to ask them questions and then to give them this information leaflet. Um Even if you don't have time to actually have a proper look, I'm so conscious of the the time thing guys, I really am. But certainly this to me, this is a problem for me as well. Have you got red, red or swollen gums? Do your teeth look longer? Are there bigger spaces between your teeth? Is there bleeding from your gums when you brush your teeth? Got bad breath? Have you got the Tartu? So that's calculus. So that's where you, you know about that when you go to the hygienist and they have to, you know, remove it, um which is not very nice, but it, it needs to be done if you got a bad taste in your mouth, obviously, have you lost teeth and some people feel they've got a dry or burning mouth. These are questions you could ask and you could also give out a leaflet like this. Um This is from the same previous website. But then you've got the link at the end again, the same thing. And it's already been mentioned that if you have periodontitis and also diabetes, it's like a vicious circle. It goes round and round and round, doesn't it? And this will actually increase your risk also of getting these other complications of diabetes. Sadly, so that's why it's so crucial for us to pay more attention to this than I know I wasn't doing. Um, you know, and it's still not officially part of an annual review. And the other thing is if you work in general practice, um that I, I dread to say this, but if you work in general practice in the UK, we have this thing called qua quality outcomes framework. In other words, it's, it's a form of payment for the, for the surgery for the practice for doing, trying to reach certain targets. And I'm afraid at the moment doing an oral check isn't one of them? I hope that changes because that obviously will make a difference. But also your practice manager, anyone who's a, who is a practice nurse on here, um You know, that, that they often want are, are only interested in you doing things for the cough payment, aren't they? Sadly, there's the leaflet again. Um You'll get this in your handouts. You can also have a look on their website. You've got references to that. So if you wanted to print these um and give them out to your patients. That's a jolly good start, isn't it? I think so. Anyway, but obviously what, what advice are we supposed to give? And um, yeah, you know who one of you said attend the dentist regularly for screening for early signs of gum disease? No, you know, call, call me um call me cynical, but that is a huge issue. So, um isn't it? It's a huge issue. So I'm fiddling around with my screen now. Just give me a minute. I've done something silly. Just give me a minute. There we go and put, get me, get me chat on. There we go. Yeah. Um, that is a huge problem in the UK and Bianka was saying it, it also is in, in, in India. I don't know about the Philippines because, um, obviously some of the people that I saw that had teeth missing. I doubt whether they ever went to the dentist. Yeah, Briana, she said screening is difficult as most people do. They, they just what I said, you know, and the thing is they probably never have in their whole adult life even yet until there's a problem. And then you've got this huge thing about you. Do you know, I've heard of people this has been in the media that have actually pulled their own teeth out. Has anyone heard that they've done it themselves? I know you can actually get kits now because they cannot afford to go to the dent. Can you imagine pulling out your own teeth? It's how desperate people must be obviously brushing your teeth twice a day using the fluoride toothpaste. And, and, um, uh, to me, I've learned that you, you know, normally you rinse your mouth. Well, apparently it's best not to rinse your mouth that to leave the fluoride toothpaste on your, on your teeth. Um, so that's something I learned, you know, follow a healthy lifestyle. Ok. What's a healthy lifestyle? That's a whole other topic. And it's one of my favorites about diet, but we're not talking about that today. Try to maintain good glucose levels. And yes, we've already covered, um, that, that, um, if, if you have periodontal disease you, you can slow down or even prevent progression to type two diabetes. So. 00, that's so interesting, isn't it, Briana? Yeah. Most rural areas in India they do that. That's pulling their own teeth out. Well, yeah, I mean, in the, even in the, in the UK, before dentists, pe, uh, I don't know. You know, I've seen, you have to go to someone who wasn't, obviously a qualified dentist who just yanked your teeth and I do believe that people used to sell their teeth as well. I know that's, it's amazing. Really, isn't it? That's very small. But again, it's talking about what we could do. Obviously, this education said about that cleaning between the teeth really important. Um, obviously tell them that, that if they have periodontitis, you know, and they don't already have type two diabetes, particularly where we know their HBA one C is starting to rise. So it may not even be as high as 42 which is, which is officially prediabetes, isn't it 42 to 47? So it may, it, it, it, it may be, um, 38. But you do, you know, do you know what, even 38 is quite a lot higher than normal? So that's the time to really if you can get in there to try and prevent progression to type two diabetes. And even if we don't have time to other than to give out an education sheet to them, we can ask, we can ask and we can record, have they had a prior diagnosis of periodontal disease, we can do that and we can advise going to the dentist, etcetera. And obviously we can ask about signs and symptoms. And ideally it should be part of the diabetes annual review. So I'm finding it tricky to keep a straight face because I actually know, um, that, that it's very hard to, to actually get in the stuff we have to do already for a diabetes annual review. Um, but notwithstanding, if you guys go away with anything, after listening to me going on, you, you'll realize how important it is to even if you only take one minute to just quickly go through these things and I ideally they'd go to the, the dentist. Um, and of course, where people have high blood sugars, they're more likely to get all fungal infections, aren't they? Just as, they are more likely to get any sort of fungal infections? Yeah, of course, oral screening should be part of the diabetes and review. And we're hoping by running this series of events, um, and we are, we are going to try, we're not going to try. We are doing round table events where we're bringing in, in interested. Well, I hope they're interested such as the Royal College of Nurses saying diabetes, UK, you know what I mean, other people. So what we can do, it's mainly we're talking about nurses, but actually it's not just nurses is it, it's GPS, it's health care. Often the health care assistants. I don't know if I've got one listening, but the health care assistants are in a brilliant position to actually talk about oral health and, and to give education. So um it's, it's the whole of the health care team and of course dentists and dental nurses. So um everyone really to raise our awareness and to raise our patients awareness. Now, I just wanted um, Dari was just saying oral Candia isis. I probably said that wrong, didn't I we probably rule out other immune related problems aside from having type two history taking is crucial too to all dental professions. Absolutely. Now, I just put this in because this came up actually on my Twitter the other day. And I just wanted just to quickly talk about this is literally very relevant. Actually, how we talk to people, how we talk to people, how we make them feel, language matters. And this, this was a, a real person with type one diabetes, a young person who was with a dental hygienist. You could say she's lucky she can afford to go, but she wasn't happy because while she was having her teeth, um scaled and polished, these are the things that hygienist actually said to her. And this is a true story. We don't say things like this. Ok. We don't make assumptions. So she, she said that hygiene is you're on insulin. Are you a type two? What what she could be a type two, couldn't she? Because quite a lot of type two patients do use insulin therapy. But you don't wanna hear that when you're a person with type one diabetes where your life depends on insulin. And then, and then another silly thing she said was knowing that the girl, she was only a young woman had in its in pump. She said, are you also on injections? Of course not because the whole point of an insulin pump is you don't need to use injection. And then she asked her if her diabetes was controlled, which is a bit rude. And then she asked her if she ate a lot of sugar and carbs. And then when she found out she was a vegetarian, she said, do you think you could be deficient in B 12? And then she started on about herself. Diabetes runs in my family. So I'm trying to avoid getting it. Well, you don't talk about your own family or anything do you with? No, no, no, no. And then she started talking about horror stories of dental patients she'd seen who had uncontrolled diabetes. Now this was actually post on Twitter. This person was so upset about it. Just want to remind us all what to be careful what we say cause you know where you've had type one diabetes, insulin pump, you probably had it since you were a kid. You don't need all this sort of stuff. Um So anyway, this is just a repeat. Um, hyperglycemia is associated with increased risk and severity of periodontitis. The higher the blood sugars though the greater the amount of periodontal destruction. So you remember in that slide with the, with the, um, you know, with, with the severe periodontitis, you could see, couldn't you that the, the tissue was being lost? And in fact, in the end, the bone is affected, the that and it's one of the reasons the teeth get loose and then fall out. So the higher the blood sugars and the longer they're high, the greater the amount of periodontal destruction. If you've got diabetes, you're up to three times more likely to get periodontitis mean that that's particularly if you've got high blood sugars and high HBA one C. But of course, conversely, if you've got periodontitis, then it makes it more difficult to control your blood sugar. So again, the old two way thing. Um, so Darius, um it is, it must be therapeutic by all means the manner of how, yeah, we're talking about the words, the manner of how the words are being conveyed and delivered to that is sometimes the big issue in all health care institutions here in the Philippines and in the UK, I mean, we in particular, Dari and all of you, there has been Roisin will know this. There's been a lot of discussion around how we talk to people with diabetes. Um not only regarding oral health but everything else because you know, to have to live with diabetes, take drugs. Although there is ways of reversing diabetes. But that's another of my subjects which I shall have to put a put one on medal for you guys. If you're interested in reversal, remission of diabetes, how it could be done. Um Even when one's had type two diabetes for 10 years or more, then you, you might want to watch out because I I'm going to actually put one on. Um, of course, if you could reverse your diabetes, put your diabetes into remission, your your, if you have periodontitis, it's going to be immeasurably reduced if not completely resolved. So, um So, if they, if a person has good glycemic control, so they, it could have been our young lady that we talked about just now, then, then she, she, she probably has brilliant glycemic control. She has a pump and, and therefore she doesn't have any more risk of periodontitis than, than a person without diabetes. Yeah. Yeah, Briana was saying, um, it, it really is difficult to get the message across, isn't it? Um, but ii, I think if we, if we, even if we just print off that, that, um, patient guide, you know, make sure that we give it to the patient, our health care assistant gives it to the patient. Um, our GP, our D dentist and dental nurse, um, you know, and we do, sometimes run pop up health care events and that could be something actually that could, I've done a few, um, you know, and actually we haven't covered this in our pop up event, you know, with the general public can just turn up and have a chat. You know, we check their BP, usually sometimes they do a blood sugar if they want us to, but we could actually give out leaflets about oral health there, couldn't we rather, you know, because some of the people who have these issues actually don't actually what we've said. They don't go to the dentist but they often don't turn up to their annual reviews as well, do they? Which is one of the reasons these healthcare events can be really useful because people may just turn up to that and learn something and that's another way of doing it. So again, and we're near the end now that we know that if someone has periodontitis, they've got a higher chance of developing diabetes, especially, of course, if they're obese overweight and they have a family history and if you have poor glycemic control, so your HB and C, um, and higher that means you've got high blood glucose levels and you're more like you, you're more like to get periodontitis. But, you know, it goes without saying, you know, if you know about, um, insulin resistance, which people who develop type type two diabetes often have 10 years or more actually of, of increasing, um, insulin resistance before they even get a diagnosis. Yeah, you probably know that. So, um, if you have, um, periodontitis it, it's actually going to affect your levels of insulin resistance as well. So that's another reason why you're more likely to get type two diabetes. Yeah. C, yeah, it is a good, I haven't thought about that. We're talking about pop up things. I mean, I do them with an amazing GP, um, in South London who, I don't know how she finds time to do them. But, um, we basically, I haven't been very often. We're all volunteers but we're basically there at some event in, in the local area that, that anyone can come to and, and, you know, we have been thinking about prevention of diabetes and also BP as well, high BP. But we could, couldn't, we so easily just draw people's attention to this at, at these pop up clinics or at any, or even leave leaflets in libraries and things like that, couldn't we? Because there's got to be more than we can do than just rely on an annual review when a lot of people don't actually turn up for their annual reviews. Um, and we've, we've mentioned that it does lead, but of course, if you've got periodontitis, it's an inflammatory process, the whole of diabetes in, in, in some effects, it is an inflammatory process. Um, and it's going to actually affect your risk of developing other complications as well in particular cardiovascular complications. And that's another, that's, we've actually almost at the end now. But that's another, um, thing from this, this, I don't know if you've, you've seen this, I, I hadn't seen this before. I've been researching, I've learned a lot myself and it's made me quite passionate about actually doing something about this and, and raising awareness. Um, but, but, um, any, any of you can look at this website and look at this information, but again, it's saying the same things really take care of your gums, control your diabetes. So it's a simpler one than the previous one I showed you. So, yeah. Um, before we have a few questions if we didn't already know. And I think a lot of you did know that there is a bidirectional link between diabetes and poor oral health. And that periodontitis obviously is an inflammatory process that we know now that poor oral health increases your chances of developing type two diabetes. Not the only thing, obviously, but it certainly isn't helping. And that if you have poor oral health, it it raises your your incidence of other complications as well. We should do a yearly oral examination as part of the diabetes annual review. And obviously, we refer to dental services, which is a moot point because it isn't it. Um, do you know what? I think some of the patients I've seen that had a, a lot of teeth missing. Never go, never, never go to dentists. They don't, um, they often have other issues going on in their lives, not only their diabetes, but, you know, often, you know, sometimes drinking too much or sleeping rough. Even. What about our people that sleep rough on the streets? You know, but we can certainly, um, go through with our patients. Have they got any signs and symptoms and we can give them education with those written guidelines that I showed. You. Can't, we, we could do that. That would only take a couple of minutes. So that's a start. These are the references and there's a few, quite a few websites there, um, as well as you know, official references. But these are websites you, you can click on to, to see a lot even more than the stuff I've shown you, right? Ok. So perfect timing. So any que any more questions or do you feel inspired even? And I'm just seeing how many we got here. How many we got? 15 people? Well, I'm so pleased that you all came. Thank you. I, I if, if it does some of you may already be doing this. I, I'd like to think so. But if not, can you pass the message on to your health care assistant? Your GP SS even C can, can we do that? You know, maybe even. Thank you Dari. So, you know, maybe even give a little talk who's in general, you could give a little talk yourself. You know, you've got, you've got the slides, you know, try and raise awareness among other healthcare professionals as well, actually. Yeah. And actually, you know, I'm, I'm a great believer in, in, in general practice if we have a practice meeting, having some receptionist there as well because often they're in a good position to just not, not to give advice but um you know, to give out a leaflet even. Oh Jess, thank you. Yeah, pass o if you can pass on to your teams, that would um be wonderful. Really would, you know, um because I've, I it's inspired me. I don't mind saying, you know, II I um I am now thinking of other ways to get the message out other than just thinking, it's part of an annual review because actually that's not going to do it. Is it, you know, there's got to be other ways. So get your thinking caps on about how you can get this message out. Do do any of you ever go to um you know, local events or anything like that? Healthcare events, Jess, you, you, you are going to um let me, let me just um you will get an email. Let me just um fi I'm popping, oh the feedback. There's a feedback thing. Come on now. So I I'm popping it on. There you go. Got it. And um but you will get an email because I, I know that's for a fact because I've attended other people's sessions because you know, I find them so interesting and you almost immediately get an email with, with, with also a link for your evaluation. Yeah. Um You obviously you're going to do the evaluation and once you've done the evaluation, you then get the slides and you also get certificate Maura, I'm so glad you're going to take it forward to the practice. Yeah. Yeah. So what you'll get sent the slides. Don't worry, Jess, you'll get sent them. Everyone has in the past. So just not immediately, just give it, give it slightly longer, but you will get them, I promise you. So um so yeah, you will and also this is being recorded. So actually this you can, if you go onto the med all website, you can actually see it again. Yeah. There it is. So, so, um your feedback is important to us and there Roisin. Thank you. Yeah. Yeah, because as I've been talking to you guys, it's made me think, you know, about other ways we, we sort of concentrate on, oh, the person comes into clinic? Oh, and they have an annual review. Well, what if they don't come in? We all know that lots of people who have real serious health care issues and complications are the ones unfortunately that don't actually attend for their annual reviews and things. We all know that, you know. And, um, so, so it's thinking outside the box really, isn't it? What other ways can we do it? You know? Um, obviously if, if the person does go to their dentist, the dentist, dentist and the, or the dental nurse or, or, or have leaflets in the reception of the dentist to, you know, with the information, you know, there's, um, I don't know, it's making me think so. Um, lovely to see you all. Um, and I know to have a, to have ad, a dentist tent. I'm very pleased and to have a Roisin is an ex, very experienced diabetes nurse, aren't you? So, thank you for attending. But, but I can, I, I can say, um, that I by doing this, this, um, webinar I thought God, you know, I'm, I'm only a diabetes. I'm not a dentist, but it's, as I said earlier, all of us have got a role to play, haven't we? In raising awareness? So, and, and as one of you pointed out it's really, really, really hard to get a dentist appointment on the NHS. So that actually, in a way you sort of shoot yourself in the foot straight away because you think it's all very well saying go to the dentist but you can't, they can't afford to pay privately and apparently the waiting list for NHS, if you can get an NHS, dentist is ridiculously long. So, um, mm, makes you think, doesn't it? I don't know where, what we're gonna do to resolve it. Has anyone got anything else to say before I go? So, yeah, I, I'm doing an in conversation, um, thingy. Um, I can't remember the 15th of August. So, so if you can come along to that, that's different because we don't have slides and we have a, you know, just chatting through and again, you guys, you know, will have had a chance to think about it and you may have come up with some ideas, um, by then, which would be nice, you know, because, you know, it takes more than it takes lots of us to come up with good ideas that are doable that we, that, that will be hopefully successful. So, all right, everybody, hopefully, see, you on the 15th and look out for, um, on med all. I'm going to do a session on remission of diabetes. How do we do it? Ok. If we, if, if we can re reverse diabetes, we, we can never cure it. We can't say it's cured. But if we can help someone or give advice, so someone puts their diabetes into remission, then a lot of these problems go away or, or get a lot better. So look out on med, all remember to have a look at it, their website and you'll see this. This is, this is recorded and you can watch it again. All right. Take care. Bye.