importance of oral health in diabetic patients
Diabetes Mellitus is an important disease to watch out for in the field of dentistry. It is a complex metabolic disorder characterized by insulin deficiency and impaired insulin action. Two types of diabetes mellitus are there,
Type-I Diabetes Mellitus (Insulin dependent)
Type-II Diabetes Mellitus (Insulin Independent)
Oral health changes have been found in the patient with diabetes mellitus such as the mucosal burning mouth and decreased salivary greater chance of candida hemolytic and staphylococci infections. Patients with diabetes mellitus are more likely to get dental caries. subjects with controlled diabetes have normal tissue response, defense mechanism, and decreased incidence of caries.
Patients with diabetes mellitus have a great influence on periodontium including gingival polyp, gingival abscess, loosened teeth, and deep rapid frequent periodontal abscesses. And patients with poorly controlled diabetes are more prone to poor wounds and a lack of defense mechanisms.
Children with Type-I diabetes mellitus have more destruction of the gingiva around the first molar and periodontitis starts after the age of 12. After age, the patient may have a greater attachment to increased bleeding on increased tooth delayed post-surgical healing, and glucose content in gingival fluid and blood is higher.
Oral bacterial flora in diabetic patients
Patients with diabetes mellitus and periodontitis reported subgingival flora composed of mainly Capnocytophaga, anaerobic Actinomyces, Porphyromonas gingivalis , Prevotella intermedia, Aggregatibacter actinomycentumcomitans species. Black pigmented species such as P. gingivalis, and C. rectus are prominent in the severe periodontal lesion in those who have Type-II diabetes mellitus.
Impaired polymorphonuclear leukocytes (PMNs)
Patients with diabetes mellitus are more prone to infection because of polymorphonuclear leukocyte (PMN) deficiency that may lead to impaired defective bacterial proliferation may happen.
Altered Collagen Metabolism
Chronic hyperglycemia may cause a decrease in collagen synthesis, and a reduction in alveolar bone height has been It adversely affects the properties of collagen and extracellular AGEs (Accumulated glycation endproducts) obtained when numerous protein and matrix molecule undergoes non-enzymatic reactions thereby producing AGEs.
The AGEs (Accumulation Glycation Endproduct) is produced in normal individuals also, but the excessive formation of AGE in diabetes mellitus affects many molecules such as proteins, and lipids. Collagen is cross-linked to AGEs (Accumulation Glycation Endproduct) which makes the collagen less soluble and reduces its capacity to repair and regenerate that is collagen is not renewed at a normal rate and may also cause a periodontal, Therefore, poor glycemic level with increased AGEs has a major impact
on periodontal destruction.
Investigation before extraction of the tooth
It is important to detect the blood glucose level before dental treatment mainly in the case of surgical procedures, like
1. Urine analysis for sugar and acetone.
2. Oral glucose tolerance test (GTT).
3. Fasting blood glucose.
4. Random plasma glucose.
5. Renal Profile: Blood Urea Nitrogen, Serum creatinine, Serum electrolyte.
6. Blood Pressure.
Management of Diabetic Patients for Dental procedures
1. Postpone the treatment until the diabetes is under control.
2. Give an early morning appointment.
3. Follow stress reduction protocol.
4. If the patient is allowed to eat a normal diet after asking him/her to take a regular diet and regular insulin.
5. In case of any infection, it should be properly treated with antibiotics.
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