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Checklists - Systemic health related care

Systemic health related care checklists are intended to support you in your effort to provide personalised care for patients living with co-morbidities.

Learn more about:

Patients with diabetes

  • Inform about bidirectional link between periodontal disease and diabetes
  • Prevalence of other oral complications is higher in people living with diabetes
  • Gum disease may be a factor in causing blood sugar to rise and may make diabetes harder to control
  • Holistic oral health management: include dry mouth, mucosal lesions (candida infections), oral cancer, taste impairment, and caries 
  • Remind diabetes requires greater attention to oral health

Complete or review patient screener - has something changed?

Consider additional lifestyle and risk factors using screener.

  • Regular use of diabetic medication as prescribed?
  • Implant/prosthetic rehabilitation
  • Stress? Smoking? Nutrition? Obesity? Alcohol?

  • Recommend particularly rigorous oral hygiene: daily toothbrushing, interdental cleaning and mouth rinsing
  • Space permitting, recommend easy-to-use interdental brushes/rubber interdental cleaners as most effective and compliance-promoting method
  • Instruct about detection of early signs of gum disease
  • Discourage smoking
  • Emphasize importance of visit frequency
  • Refer to dentist as needed

Download the guidebook

Patients in menopause/with osteoporosis

  • Lower oestrogen levels affect bone metabolism and affect the oral cavity, causing inflammatory changes in the body that can lead to gingivitis
  • Menopausal women susceptible to bone fractures may also be at higher risk of periodontal disease. Low bone density in the jaw can result in other dental problems as well
  • Older women with osteoporosis may be more likely to have difficulty with loose or ill-fitting dentures and may have less optimal outcomes from oral surgical procedures
  • Available information suggests that hormone therapy and bisphosphonate drugs may help against alveolar bone loss and perhaps slow the progression of periodontal disease. However, bisphosphonates may be associated with oral hygiene risks for certain patients (see next section)

  • According to the USA NIH, women with osteoporosis are three times more likely to experience tooth loss than those who do not have the disease
  • Women with high Fracture Assessment Risk Tool (FRAX) scores may show the strongest signs of periodontal disease
  • Bisphosphonates, a group of medications available for the treatment of osteoporosis, have been linked to the development of osteonecrosis of the jaw (ONJ), which is cause for concern. However, the risk of ONJ has been greatest in patients receiving large doses of intravenous bisphosphonates, mostly to treat cancer. The occurrence of ONJ is rare in individuals taking oral forms of the medication for osteoporosis treatment.

  • Recommend 2-minute brushing twice daily, using a toothbrush with tapered bristles to reach below the gum line and between teeth
  • Explain interdental cleaning helps to clean where a toothbrush cannot; recommend interdental brush or rubber interdental cleaner to clean between each and every tooth daily
  • Maintain regular check-up visits
  • Remind to change toothbrush or toothbrush head at least every 12 weeks and interdental cleaners as recommended on pack

Download the guidebook

Patients with eating disorder/obesity

  • Gently inform patient with eating disorder (ED) associated with vomiting/binge eating behaviours that they may suffer worse oral health and greater dental erosion
  • Recall that in ED patients with longer duration of the disease, dental erosion is significantly more common
  • Gently let ED patient know they can be honest with their treatment team about purging behaviours and remind that this is a great time to strive to have the best oral hygiene
  • For your patient with obesity, gently inform that they are more prone to periodontal disease and more likely to suffer tooth loss
  • For your patient with obesity, encourage meticulous oral health, explaining that foods rich in sugar and carbohydrates (which they may like) increase the chance of periodontitis

  • A poor diet can negatively impact oral health and overall health
  • The link between obesity and a series of diseases has been confirmed, particularly cardiovascular diseases and diabetes
  • Obesity and inactivity are also linked to metabolic syndrome, which increases the risk of diabetes and heart and blood vessel disease – again with a negative impact on oral health

  • Encourage patient to maintain meticulous oral health, noting that people with obesity are less likely to regularly visit their oral care professional
  • To maintain oral care, after purging, patient should immediately rinse their mouth with water or use a sugar-free mouthrinse
  • You may recommend brushing be halted for an hour after vomiting to avoid scrubbing the stomach acids deeper into the tooth enamel
  • Fluoride rinses may be prescribed as well as desensitizing or re-mineralizing agents
  • Recommend 2-minute brushing twice daily, using a toothbrush with tapered bristles to reach below the gum line and between teeth
  • Explain interdental cleaning helps to clean where a toothbrush cannot; recommend interdental brush or rubber interdental cleaner to clean between each and every tooth daily
  • Remind to change toothbrush or toothbrush head at least every 12 weeks and interdental cleaners as recommended on pack
  • Maintain regular check-up visits

Download the guidebook