Thursday, 29 April 2021

IS THERE A CONNECTION BETWEEN DIABETES AND ORAL HEALTH???



         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.

TYPES:
  •   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.



PERIODONTAL DISEASES LIKE:                                                                                                         
   Bleeding gums:
  • 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.

             

   Tooth sensitivity:
  •   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.




  Swollen gums:
  •   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.




                                                                                                                        
   Loose teeth:  
  •  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.




FUNGAL INFECTIONS:
  •   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.

ORAL NEUROPATHIES:

 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
         Patient with brittle diabetes (fluctuating, too high and too low) and patient receiving high dose of insulin:  
  •          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
  • Antibiotics

DENTAL MANAGEMENT:
  • 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
                         Perumbakkam.

                         Mail Id: care@gumsandteeth.in

Also check us out at :www.gumsand teeth.in











                 

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