- 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.
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:
LICHEN PLANUS & LICHENOID REACTIONS( INFLAMMATORY SKIN DISEASE):
- 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.
INFECTION AND DELAYED WOUND HEALING:
DENTURE - SORE MOUTH & CHANGES IN THE TONGUE(CHRONIIC FISSURED TONGUE):
ALTERED IMMUNE AND INFLAMMATORY RESPONSES:
ORAL NEUROPATHIES:
- 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.
- 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.
- 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
- 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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