Managing Oral Health for a Patient with Type 2 Diabetes
1. Case Study
Fabio Valesi
DH 71D
Tuesday, December 4, 2012
2. Health History & Dental History
• 47 year old male
• Vital signs WNL
• Type 2 Diabetes Mellitus/”Controlled by Diet”
• 15 years since last NSPT/No dentist
• “Not nervous about dental treatment”
• Experiencing: sensitive teeth, bad breath, gingival bleeding
• Concerned with yellowing of teeth
• Looks for caries and gingival disease
Tuesday, December 4, 2012
3. EOIO
• Extra Oral: WNL
• Class 1 Occlusion right molar/canine, Class 1 left canine with Class 2 left
molar
• Anterior end to end bite, overjet 2mm
• Intra Oral:
• Bilateral linea alba
• Soft palate lesion: single, red, symmetrical, firm macule.
• Dorsal of tongue: asymmetrical, white, single firm papule.(Fibroma)
• Anterior palate ulceration lingual to #9
Tuesday, December 4, 2012
4. PSE
• Sensitivity to Probing, done by quadrant with local anesthesia.
• Generalized Periodontal abscess with transudate
• Generalized class 2 mobility, localized class 3 mobility
• Generalized recession
• Generalized clinical attachment loss
• Advanced active periodontitis
Tuesday, December 4, 2012
6. Dental Charting
• No evidence of past disease
• Abfraction
• Attrition of anterior dentition
• Tooth brush abrasion of exposed root surfaces
Tuesday, December 4, 2012
7. OHI
• Initially he brushed 2x a day, flossed 1x day.
• Instructions: Brush at a 45 degree angle to the gum line, wrap floss around
teeth in a c-shape to target line angles.
• Patient motivated, on subsequent visits he showed improvements in brushing
with light marginal plaque accumulation, still needs improvement with
flossing technique. Now brushes 3x a day and flosses 1x day.
Tuesday, December 4, 2012
8. Record of Treatment
• 8/27 Assessmnets
• 9/10 NSPT 28-30
• 9/24 NSPT quadrant with ultrasonic scaler completed LR
• 10/1 NSPT LL quadrant, tooth # 24 oraquix and infiltration
• 10/08 NSPT UR quadrant, PSA, AMSA, IO + infiltration over teeth #’s 6,7,8
anesthesia not profound.
• 10/12 NSPT teeth #’s 12-15, 4% septocane PSA, GP, NP, IO + infiltration’s
over teeth #‘s 9,10,11,12 could not finish quadrant. Full mouth irrigation
with chlorhexedine.
• 11/5 NSPT teeth #’s 9-11 IO, NP + 3 infiltrations. Subgingival irrigation
Tuesday, December 4, 2012
9. Type 2 Diabetes Mellitus
• Pancreatic insulin secretion may be low, normal, or even higher than normal,
but the patients exhibits an insulin resistance that impairs the use of insulin
• Patients have insulin resistance with a relative, not absolute, insulin deficiency
• Insulin resistance is the inability of the peripheral tissues to respond to the
insulin that is produced
• Onset typical after 30 years of age, but may occur at any age. Incidence has
increased dramatically in children and adolescents in recent years, possibly
due to increases in sedentary lifestyle and obesity in children.
• Accounts for 90-95% of all patients with diabetes(Wilkins)
Tuesday, December 4, 2012
10. Risk Factors for Type 2 Diabetes
• Obesity
• blood relative has diabetes
• physical inactivity
• High-risk race/ethnicity: African/Asian/Hispanic/Native American, Latino, Pacific Islander
• Had baby weighing more than 9 pounds
• Had gestational diabetes mellitus
• History of polycystic ovary syndrome
• Hypertension >140/90 mm Hg
• Age 45 years or greater
Tuesday, December 4, 2012
11. Oral Findings
• Gingiva: Increased inflammation
• Periodontium: Periodontitis more frequent, severe, longer duration
• Attachment loss: more frequent, more extensive
• Probing debths: more teeth with deep pockets
• Alveolar bone loss: more
• Tooth mobility and migration: increased
• Healing: delayed, increased infection after surgery
• Teeth: increase in caries do to poor diet, xerostomia, endodontic therapy less successful do decreased resistance
to infection
• Saliva: decreased flow, glucose in sulcular fluid, xerostomia, contributes to opportunistic infections such as oral
candidiasis
• Mucosa: Edamatous, red, oral candidiasis, burning mouth syndrome, poor tolerance to removable prosthesis,
delayed healing, may increase prevalence of lichen planus and aphthous stomatitis
• Taste: diminished taste perception
Tuesday, December 4, 2012
13. How can we help?
• Oral findings may indicate undiagonesed or poorly controlled diabetes
• refer to a physician for evaluation
• Stress adequate biofilm control to aid the host response which has a
decreased resistance to bacteria
• Antimicrobial Irrigation of Periodontal pockets with sodium hypochlorite,
chlorhexidine, and hydrogen peroxide to reduce bacterial load
• Arestin-minocycline hydrochloride
Tuesday, December 4, 2012
