3. INTRODUCTION
It is a group of disease marked by high level of blood glucose
resulting
from defects in insulin production , insulin action or both
Approximately 135 million individuals worldwide have diabetes
mellitus
The prevalence of diabetes in man over age 20 years slightly
greater than women
Diabetes was the sixth leading cause of death in US in 2002
Diabetes is associated with significant complications
Diabetes is the most common endocrine disease
It increases risk of cardiac ,peripheral vascular disease
4. Epidemiology
Almost 20% of adult older than 65 years have Diabetes
Mellitus.
A dental practitioner serving an adult population of 2000
can expect 40-80 persons with diabetes, about half of
them will be unaware of their condition.
5.
6. CLASSIFICATION OF DIABETES
*Diabetes is defined as-
*A casual blood glucose level of 200 mg/dl or greater
*A fasting glucose of 126 mg/dl or greater
*A 2-hour postprandial glucose level greater than 200 mg/dl
*Until recently diabetes classified as <adult and juvenile onset>
and <insulin and non insulin dependent>
*But they are no longer considered criteria for classification
*Instead in 1979 the National Diabetes Data Group recommended a
Therapeutic classification
*4 major types are:-
+Type 1 DM
+Type 2 DM
+Gestational DM
+Impaired glucose tolerance
7.
8. PREDISPOSING FACTORS
TYPE 1-
a. Genetic factors
b. Environmental factors such as diet and toxins
c. Autoimmune factors
TYPE 2-
a. Genetic factors
b. Insulin secretion
c. Insulin resistance
d. Obesity
e. Adipocyte-derived hormones and cytokines
9.
10. ACUTE COMPLICATIONS
it include
*hypoglycemia
*diabetic ketoacidosis
*Hyperglycemic hyperosmolar nonketotic coma
Hypoglycemia may be present in diabetic and non diabetic individuals
Signs and symptoms become evident within minutes,leading rapidly to
loss of consciousness
Hyperglycemia may also result in loss of consciousness
11. CHRONIC COMPLICATIONS
Long –term complications include disorders of microvasculature ,CVS ,
Eyes ,kidneys ,and nerves.
3 major categories are large blood vessel disease ,small blood vessel
disease and increased susceptibility to infection
Large blood vessel disease such as arteriosclerosis frequently occur in
non diabetic individuals and its clinical manifestations are angina, MI,
glomerulosclerosis , gangrene etc.
Small blood vessel disease occur only in diabetic patients and its
manifestations are diabetic retinopathy,nephrosclerosis etc
Diabetic patients are more prone to infections than persons without
diabetes
12.
13. MANAGEMENT OF TYPE 1 DIABETES MELLITUS
2 approaches are commonly employed:
1. In classic approach, prescribe very regular lifestyles in the form of
restrictive meal plans as well as fixed insulin doses to match that lifestyle
2. Currently an approach whereby patients can make fairly unrestricted
lifestyle choices adjusting insulin doses to match those choices by using
a multiple daily injection technique
*Multiple daily injection regimens & insulin pump are generally appropriate
*Patients use at-home self-monitoring of blood glucose
*Typical glucose meters used to test blood glucose
*Minimally invasive glucose monitors are developed to avoid fingersticks
15. MANAGEMENT OF TYPE 2 DIABETES MELLITUS
*Managed by maintaining control over diet and physical activity and
administering antidiabetic drugs and insulin
*Sulfonylurea agents are prescribed widely
*Glyburide and glipizide are 100 fold potent than tolbutamide
*Metformin – biguanide drug is insulin sparing that not cause weight gain
*Sometimes insulin therapy also needed
*Use of continuous subcutaneous infusion with portable insulin pumps
*Insulin doses are basal rates, bolus dose, and supplemental doses
*Insulin pump lead to weight gain and diabetic ketoacidosis
18. DENTAL CONSIDERATIONS
Oral complications include xerostomia, infection, poor healing, Caries,
candidiasis, gingivitis, periodontal disease, periapical abscess and burning
mouth syndrome
Patient with type 2 diabetes are less prone to acute fluctuation in blood
glucose level and can tolerate all form of dental treatment including local
Anesthesia, general anesthesia, parenteral sedation
Basic dental treatment modification considered with type 1 diabetic patient
Through use of stress reduction protocol
Patient should also advised to try to maintain normal diet by taking usual
insulin dose and eating normal breakfast before dental appointment
Scheduling appointments in earlier in the day minimize hypoglycemia
Use of local anesthetics minimize post-treatment eating impairment
Medical consultation should be considered for type 1 diabetic patient who
require large doses of insulin
19. The dentist should encourage patient to bring their glucose meter with
them to appointment
If blood level are low, a fast acting carbohydrate administered prior to
start of treatment
After extensive dental procedures, patient with type 1 diabetes should be
instructed to check blood glucose level more frequently for next few days
If glucose level elevated, patient should change insulin dose and contact
primary care physician
Antibiotic coverage in postsurgical period is appropriate if there is
significant infection, pain, stress
