Diabetes mellitus is a metabolic disorder characterized by hyperglycemia caused by absolute relative deficiency of insulin.
- Diabetes is a predominant health problem today.
- Diabetes can hit at any age
- If not checked, it may be very dangerous
- Consult a specialist & get it treated immediately.
- Type 1 - less common -10% - usually younger than 30 yrs
- Type 2 - most common - 90% - usually obese and older
- Gestational : which occur in 5-7% of all pregnancies and results in loss of fetus.
DIABETES ALSO CAUSES:
- Heart disease
- Nerve damage
- Kidney diseases
- Eye damage
- Oral health complications
DIABETES DIAGNOSIS IN DENTAL HOSPITAL:
- Most common type of diabetes is type 2
- Dentist should be able to recognize diabetic symptoms and interpret screening tests.
- However, referral to physician for definitive diagnosis and treatment is important.
DIABETES AND ORAL HEALTH PROBLEMS:
TOOTH DECAY :
- The high levels of sugar in your saliva caused by type 2 diabetes also can increase your risk of cavities.
- If you ate candy all day, you are at greater risk for tooth decay.
- A lack of saliva due to diabetes also raise your risk of tooth decay.
- When you have high blood sugar from diabetes, your saliva around your gums has more sugars in it.
- This helps harmful germs and plaque grow. plaque irritates your gums and can lead to gum disease.
- Gum disease make your gums bleed.
- As diseased gums pull away from the teeth, the cementum layer on the roots is readily worn away, leaving the underlying dentin exposed, and sensitive teeth result.
Recession of gums:
- Diabetes that is not controlled well leads to higher blood sugar levels in the mouth fluids.
- This promotes the growth of bacteria that can cause gum recession.
Bad breath ( Halitosis ):
- High blood sugar levels provides food for bacteria in the mouth and leads to the build up of dental plaque.
- If plaque is not removed effectively which also causes halitosis.
- Diabetes reduces your ability to fight bacteria. If you don't remove plaque with regular brushing and flossing, it will harden under your gum line into a substance called dental calculus.
- The longer plaque and calculus remain on your teeth, the more they irritate the part of your gums around the base of your teeth, called gingiva.
- In time, your gums become swollen leading to GINGIVITIS.
- If left untreated, gingivitis can lead to a more serious infection called periodontitis, which destroys the soft tissue and bone that support your teeth.
- Periodontitis causes your gums and jawbone to pull away from your teeth, which in turn causes your teeth to loosen and possibly fall out.
SALIVARY GLAND DYSFUNCTION (DRY MOUTH):
- Dry mouth or xerostomia, occurs when a person's salivary glands produce enough saliva to keep the mouth moist.
- Dry mouth can be a symptom of diabetes and also a side effect of the medication that treats diabetes.
- It is caused by an overgrowth of the yeast, Candida albicans, which occur naturally in the mouth.
- Some conditions caused by diabetes such as high glucose in saliva, poor resistance to infection and dry mouth (low saliva levels) can contribute to oral thrush.
LICHEN PLANUS & LICHENOID REACTIONS( INFLAMMATORY SKIN DISEASE):
INFECTION AND DELAYED WOUND HEALING:
- Many people who have diabetes also have problems with immune system activation.
- The number of immune fighter cells sent to heal wounds, and their ability to take action, is often reduced.
- If your immune system can't function properly, wound healing is slower and your risk of infection is higher.
- People with uncontrolled diabetes may develop poor circulation .
- As circulation slows down, blood moves more slowly, which makes it more difficult for the body to deliver nutrients to wounds.
- As a result, the injuries heal slowly, or may not heal at all.
DENTURE - SORE MOUTH & CHANGES IN THE TONGUE(CHRONIIC FISSURED TONGUE):
- The fungus thrives on the high glucose levels in the saliva of people with uncontrolled diabetes.
- Wearing dentures (especially that worn constantly) can also lead to fungal infections.
- Oral candidiasis in the form of candida associated denture stomatitis, is a common disease in a large percentage of denture wearers.
ALTERED IMMUNE AND INFLAMMATORY RESPONSES:
- As type 2 diabetes starts to develop, the body becomes less sensitive to insulin and the resulting insulin resistance also leads to inflammation.
- A vicious cycle can result, with more inflammation causing more insulin resistance and vice versa.
Burning mouth syndrome:
Burning mouth syndrome has been attributed secondarily to diabetes, poor glycemic control and diabetic neuropathy.
Temperomandibular joint dysfunction:
- Diabetes has an inflammatory response which can make the impact of gum disease much stronger.
- As inflammation persists and worsens with the onslaught of these conditions, the TMJs can be affected.
Depapillation of the tongue:
- Complete or patchy atrophy of the tongue papilla, resulting in the appearance of a ''bald'' tongue, is also more common in diabetic patients.
- Generalized atrophy of the papilla of the tongue has been attributed to nutritional deficiencies.
DENTIST INSTRUCTIONS PRIOR TO DENTAL VISIT:
- Patient should eat normal meals before appointment and take their medication.
- Take a morning appointment.
- Inform the dentist about any insulin reaction when they first occur.
- After dental appointment patient should keep his / her eating routine and medications.
- They should keep good oral hygiene and restrict to dentist's instruction to prevent infection and impaired wound healing, dry socket, and osteomyelitis from happening.
IN CASE OF ACUTE INFECTION:
- Antibiotic prophylaxis for patient after dental procedure is not required unless patient suffer from infection and / or systemic symptoms of infection( lymphadenopathy, fever).
- In case of patient with infection , patient's insulin dosage should be altered with consultation, and infection is treated locally.
Insulin dosage guidelines:
- Oral hypoglycemic controlled patients: may require insulin, consult with physician.
- Insulin controlled patients: may need increase insulin dosage, consult with physician
- culture is taken from infected area for antibiotic sensitivity.
- culture is sent to testing, and antibiotic therapy is initiated with penicillin or its alternatives in case of allergies.
- if patient condition did not response to medication, antibiotic is selected from test result and therapy is initiated.
In all cases, infection should be treated locally with:
- Incision and drainage
- Root canal treatment or extraction
- Analgesia: avoid aspirin and NSAIDs in patient taking sulfonylureas, because it can worsen the hypoglycemia.
- Antibiotics: antibiotic prophylaxis is not required unless there is an infection or brittle diabetes.
- Anesthesia: usual dose. however, in patient with cardiac symptoms, limit dose to 2 cartridge containing 1:100,000 epinephrine.
- Blood pressure : monitor blood pressure, because diabetes is associated with hypertension.
If you have ''DENTAL PROBLEMS'' contact us @
GUMS AND TEETH LASER AND DENTAL IMPLANT CENTER @
Perumbakkam Main Road,
Medavakkam, chennai- 100
Land mark: Behind MSM food court
Mail Id: firstname.lastname@example.org
Also check us out at :www.gumsand teeth.in