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