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Diabetes m.
1. betes mellitus and its dental managem
Produced by :
Howida abubredaa
Hajer fidan
Amani Alamary
2. 2
Diabetes mellitus:
It is metabolic disorders characterized
by dysregulation in carbohydrates ,
protein & fat metabolism due to
decrease insulin secretion or function
resulting in hyperglycemia affecting all
tissues of body.
3. 3
classification:
1-Type 1 : insulin dependent
2-Type 2 : non-insulin dependent.
3-other specific types:
a- genetic defect of cell function of
pancreas.
b- genetic defects of insulin action
c- disease of pancreas :pancreatitis ,
neoplasm in pancreas.
d- endocrinal disorder : Cushing syndrome
, phaeochromcytoma.
4. 4
e- drug induced : glucocortcoids
(cortisone) ,thyroid hormone.
4-gestational diabetes : occurs during
pregnancy.
5. Type I(IDDM):or juvenile-onset DM
-comprises 5-10% of diabetics.
-autoimmune destruction of the insulin-
producing beta cells of pancreas, leading to
complete absence of insulin.
-it is partly inherited with multiple genes, the
onset of diabetes can be triggered by one or
more environment factors such as a viral
infection or diet .
-it affects childhood and adolescence below
the age of 25 years.
7. Type II(NIDDM):or maturity-onset DM
-It forms 90-95% of diabetics.
-result from impaired insulin function
(insulin resistance) which may be
combined with reduced insulin secretion.
-It affects individuals who are typically in
middle and old age (mainly 40 years) and
over weight.
.
8. Risk factors : obesity , sedentary lifestyle
and high fat and cholesterol level.
Treatment : diet or hypoglycemic drugs or
even insulin.
9.
10. 4-gestational diabetes :
-appears usually in second or third
trimester of pregnancy
-Affects up to 5% of pregnant women
-Placental hormones interfere with
insulin.
After delivery it either :
a- disappear(patient still liable to
diabetes later on).
b-persist treated as diabetic patient.
11. Pathophysiology:
-healthy people blood glucose level
maintained within 70 to 110 mg/dl by
balance between insulin and glucagon as
well as some other hormones.
-insulin synthesized in beta cells of
pancreas and secreted rapidly into blood
in response to elevation in blood sugar.
12. 12
-insulin binds to receptors on cell
facilitate
1-glucose uptake by the cell and its
storage as glycogen.
2-fatty acid and amino acids converted
to triglyceride and protein stores.
13. -lack of insulin or insulin resistance
hyperglycemia.
-blood sugar glycosuria osmotic
pressure of the urine polyuria fluid
loss polydipsia
-cells send signals to brain to express
their need to glucose polyphagia
-body try to compensate the need of
cells to energy in the cells break
down of fats & protein ketoacidosis
14. Symptoms and signs of undiagnosed or
poorly treated DM:
Polydipsia ,polyphagia ,polyurea ,loss
of weight ,blurred vision , kussmaul
(deep) breathing , smell of acetone ,
poor wound healing , recurrent skin
infection and oral manifestation.
15.
16.
17. Oral manifestation:
1-dry mouth
2-burning sensation of the tongue.
3-atrophy of tongue coating.
4-periodontal disease
5-increase rate of dental caries
6- odontalgia
7- Candida infection
8- lichenoid reaction
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Diabetic patient are more susceptible to
infection:
a-effect of ketoacidosis: chemo taxis
and phagocytic function of neutrophils.
b-effect of hyperglycemia : the
phagocytic function of neutrophils
c-peripheral neuropathy and poor
peripheral circulation
d- glucose concentration in the
saliva and GCF
23. Diagnosis:
1-two fasting blood glucose level
A- the patient should be fasting
completely 6 hours before test.
B- fasting blood glucose level < 110 mg/
dl rule out diagnosis of diabetes.
C-fasting blood glucose > 126 mg / dl
suggest diabetes mellitus.
D- impaired fasting glucose from 110 <
126 mg/dl.
(Normal 70 -110 mg/dl)
24. 2-two random blood glucose level
( normal < 200 mg / dl )
A-random blood glucose level >
200 mg / dl suggest diabetes
mellitus
B-associated with clinical
manifestation of DM
25. 3-glucose tolerance test:
a - fasting blood sample is taken.
b- 75 gm sugar given orally.
c- blood samples are taken at half
hour intervals for 2-3 hours.
Normal blood glucose should be less
than 180 mg/dl after 1 hour and
return to normal level after 2 hours.
26. 4-glycosylated hemoglobin
(reflects blood sugar level in the last
three months)
A- 4 -6% it is normal , patient is not
diabetic.
B-<7 % patient is controlled
C->7 % patient is uncontrolled
27. medical management:
-objective : maintain blood glucose levels
as close to normal as possible
A-exercise and diet control
Meals should be at regular intervals , with
a high fiber and relatively high
carbohydrate content but avoiding sugar.
28. B-oral antidiabetic drugs used in type 2
DM:
a-Biguanides : 1-cell sensitivity to
insulin
2- gluconeogenesis in the liver.
b- sulphonylurea : pancreas insulin
secretion
29. C-insulin:
used in type 1 DM and some patients with
type 2 DM if can not controlled by diet and
oral hypoglycemic drugs
Insulin are classified as long- ,
intermediate- , short- , or rapid-acting.
30. Dental Management considerations :
To minimize the risk of an intra operative
emergency we should manage pt according
to:
1-Uncontroled pt( FBG > 200 MG /DL), should
referred to the physician before dental
procedure.
2-Controlled pt(FBG <200 mg/dl),
1.morning appt even not coincide with peak
activity.
2.Ensure that the pt has eaten normally and
taken medication as usual.
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5.Avoid excessive trauma during surgical
procedure
6.Rapid ttt of infections to avoid
hyperglycemia
7.Avoid long appointment
8.The drugs should be sugar-free ,avoid that
raise Bl.glucose and that raise insulin function.
(Amoxicillin is the antibiotic of choice and
paracetamol is the analgesic of choice).
9.Slowly raise dental chair as ortho static
hypotension may occur b/c autonomic
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12. From preventive point of view ,the
pt should instruct to maintain
meticulous oral hygiene as DM makes
him more prone to oral infections.
10.Hospitalization is done in:
a-multiple extraction.
b-Massive infection.
11.Antibiotic cover post op.in massive
oral infections and in extensive
surgeries.
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COMPLICATIONS :
Divided into acute and chronic
Acute:1-hypoglycemia 2- hyperglycemia
Chronic :micro vascular and
macrovascular
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Chronic complication of diabetes :
1-cardiovascular→atherosclerosis
leading to ischemic heart disease ,
cerebrovascular disease and
peripheral gangrene
2-renal →renal damage and failure
3-ocular→retinopathy and cataract
4-neuropathies→ peripheral
polyneuropathy , autonomic
neuropathy
5-infection →candidosis , and
staphylococcal infection
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HYOPGLYCAEMIA
-Also called insulin shock.
-hypoglycemic coma is the main acute
complication of DM, it occur due to imbalance
between food intake and insulin therapy
leading to reduce blood glucose to a level
dl./<70mg
37. Signs and symptoms : it resemble fainting
with rapid onset ,
1- due to adrenalin release there will be
palpitation ,tachycardia , sweaty skin .
2-due to cerebral hypoglycemia anxiety
,irritability ,headache , and disorientation
,before consciousness is lost this called
“neuroglycopnia”
38.
39. Management : must be quickly corrected with
glucose before brain damage result , It is done
according to the patient condition
If pt is conscious ,give glucose solution
immediately orally .
but if is not conscious ,give 10-20ml of 20-50%
sterile dextrose IV or if the vein can not readily
be found ,glucagon 1mg IM
On arousal pt should be given glucose orally in
the form of long acting.
40. diabetic ketoacidoses
it is a state of uncontrolled lipid
catabolism associated with insulin
deficiency
it occur in cases of:
1.undiagnose diabetes
2.interruption of insulin
3.infection
Hyperglycemia coma
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1- Acidosis leading to vomiting ,
hyperventilation and acetone breath
2- osmotic diuresis and polyuria lead to
dehydration , hypotension , tachycardia ,
dry mouth and skin
Management :
after ensuring that the coma is due to
hyperglycemia:
give IV fluid for rehydration and to correct
electrolytic and insulin.
Signs and symptoms:.
