Diabetes mellitus, often referred to simply as diabetes, is a chronic metabolic disorder characterized by elevated levels of blood glucose (sugar). It occurs when the body either cannot produce enough insulin (a hormone that regulates blood sugar) or cannot effectively use the insulin it produces. This leads to hyperglycemia, which can result in various health complications over time. Diabetes is typically categorized into two main types: Type 1, an autoimmune condition usually diagnosed in childhood, and Type 2, often associated with lifestyle factors and more common in adults. Proper management of diabetes through medication, diet, exercise, and monitoring is essential to prevent complications and maintain overall health.

1. Diabetes mellitus
PRESENTED BY:
Allsun Sweetline.M.S
III year BDS

3. Introduction
01 02 03
04 05 06
Table of contents
Physiology Classification
Oral
manifestations
Dental
considerations and
management
Conclusion

4. 01
Introduction

5. DEFINITION
Heterogeneous metabolic disorder characterized by common
feature of chronic hyperglycemia with disturbance of
carbohydrate, fat and protein metabolism
-WHO

7. Epidemiology
•About 20% adults older than 65 years old have
Diabetes mellitus
•A dental practice serving an adult population
of 2000 can expect to encounter 40-80 patients
with diabetes
•About half of whom will be unaware of their
condition.

8. 02
Physiology

11. INSULIN
FUNCTION

12. 03
Classification

19. Methods of
diagnosis

25. 75 grams of glucose dissolved in
300 ml of water
(To check the ability of the body to utilize glucose)

28. HbA1c - Glycosylated hemoglobin
Long term assessment of degree of
glycemic control over 3 – 4 months.
Normal value : 4-6%

33. ACUTE COMPLICATIONS

35. 04
Oral manifestations

36. Ahmad P, Akhtar U, Chaudhry A, Rahid U, Saif S, Asif JA.
Repercussions of diabetes mellitus on the oral cavity. Eur J Gen
Dent 2019;8:55-62.

37. Increased levels of fatty acid and methyl
nitrate in blood cause oxidative stress

40. • Assessment of risk of disease progression
• Periodic reviews
• Dietary advice
• Periodontal therapy
Treatment and prevention

41. As a result of gingival
resorption and
decreased salivary flow
Root caries

42. • Use of fluoridated toothpastes
• Restorative treatment
• Optimal glycemic control prevents
progression
Treatment and prevention

43. Polyuria and
dehydration
Ahmad P, Akhtar U, Chaudhry A, Rahid U, Saif S, Asif JA.
Repercussions of diabetes mellitus on the oral cavity. Eur J Gen
Dent 2019;8:55-62.
Xerostomia

44. • Maintenance of adequate oral hydration (water, ice
chips, saliva substitutes, sugarless gum)
• Restriction of caffeine and alcohol intake
Treatment and prevention

45. Salivary dysfunction, hyperglycemia and impaired
immune system

47. Ischemic tissue damage
related to pulp own
vascular damage
Root caries

48. • Endodontic treatment
• Control of diabetes
Treatment and prevention

49. Poor
wound
healing
Growth factor production
Hypoxia
Impaired angiogenesis and
neovascularization
Reactive oxygen and
nitrogen species
Reduced immune host
response

50. • Frequent dental visits to assess plaque control and
to identify risk factors for periodontal disease,
caries and oral candidiasis
• Postoperative antibiotic therapy if warranted
• Avoidance of smoking
Treatment and prevention

51. 05
Dental considerations
and management

52. Clinical detection
of patients with
diabetes

53. Dental therapy considerations
ASA PHYSICAL STATUS TREATMENT CONSIDERATIONS
II
(A patient with mild systemic
disease without limitation of daily
activities)
• Eat normal breakfast and take usual
insulin dose in the morning
• Avoid missing meals before and after
surgery
• If missing meal is unavoidable, consult
physician or ↓ insulin dose by half
III
(A patient with severe systemic
disease that limits activity but is
not incapacitating.)
• Monitor blood glucose levels more
frequently for several days following
surgery and modify insulin accordingly
• Consider medical consultation
IV
(A patient with incapacitating
systemic disease that is a
constant threat to life.)
• Consult physician before treatment

59. Dental
Management of
Patients With
Diabetes and
Acute Oral
Infections

60. Diabetic patients on insulin or oral hypoglycemic
medications are at risk of experiencing hypoglycemia
during or after dental procedures.

61. Hypoglycemia in an
unconscious patient

62. Hypoglycemia in conscious
patient

63. Hyperglycemia in an
unconscious patient

64. Q/A

65. What is the value of random blood glucose level?
RANDOM VALUE:
200 mg/dl (11.1 mmol/L) or more
in a symptomatic patient
Harsh Mohan. Pathology. New Delhi, Jaypee Bros.
Medical Publishers (P) Ltd, 2010

66. What are the reasons for diabetic foot?
1) Increased glucose in the tissues precipitates
infections
2) Diabetic microangiopathy, which affects
microcirculation.
3) Increased glycosylated hemoglobin and tissue
protein decreases the oxygen dissociation.
4) Diabetic neuropathy involving all sensory, motor
and autonomous components.
5) Associated arthrosclerosis.
Bhat, Sriram M. SRB’s Surgery for Dental
Students. JP Medical Ltd, 20 Oct. 2014.

69. What is the cause for periodontitis in diabetic patient?
1) Enhanced inflammatory responses,
2) Depressed wound healing,
3) Small blood vessel changes
that contribute to an increased risk for periodontitis.
Kumar, Vinay, et al. Robbins Basic Pathology. 10th ed.,
Philadelphia, Pennsylvania Elsevier, 2018.

70. 06
Conclusion

71. Oral complications in patients with DM are considered
major complications of the disease.
Chronic and persistent oral complications in these
patients adversely affect blood glucose control.
Thus, prevention and management of oral
complications due to diabetes are considerable.

72. References

73. Kumar, Vinay, et al. Robbins Basic Pathology. 10th ed., Philadelphia, Pennsylvania
Elsevier, 2018.
Harsh Mohan. Pathology. New Delhi, Jaypee Bros. Medical Publishers (P) Ltd, 2010
Lamster, Ira B. Diabetes Mellitus and Oral Health. John Wiley & Sons, 26 Mar. 2014.
Malamed, Stanley F. Medical Emergencies in the Dental Office. St. Louis, Mo., Mosby,
Cop, 2015.
Little, James W, et al. Dental Management of the Medically Compromised Patient. 9th ed.,
St. Louis, Mosby, 2018.
Dr. Nitin Saroch. Periobasics: A Text Book of Periodontics and Implantology- Second
Edition. Sushrut Publications Private Limited, 17 Dec. 2019.