diabetus mellitus in complete denture wearers/ oral surgery courses

INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

Statement of problem
The oral mucosa has been reported to have a variety
of changes in subjects with diabetes mellitus

DIABETES MELLITUS
Diabetes mellitus is a chronic metabolic disease
characterised by hyperglycaemia, associated with
irregularities in the metabolism of carbohydrates,
lipids, and proteins, and susceptibility to the
development of specific form of renal , occular,
neurological, cardiovascular diseases.

TYPE I:
This is common before 40yrs of age.
It is insulin dependent
Not related to obesity
Due to destruction of islets of langerhans
If it is from child hood – JUVENILE DIABETUS

Type II: also called non insulin dependent
It is the 5th
most common condition and ,6th
most
common cause leading cause of mortality.
This type occurs only after 40yrs
And the prevalence increases with age
Their cause is more genetic and it is not associated
with and auto immune diseases
The predisposing factors are: obesity and sedenterism

Patients with D.M present a higher susceptibility of
infections due to a deficiency of polymorph nuclear
leucocytes, as a result of vascular alterations and
neuropathies .
D.M increases the susceptibility to erosion and
ulceration of the mucosa where it comes in contact
with the base of the complete denture

Cardinal signs of D.M
1) polydypsia
2) polyphagia
3) polyurea

Purpose of the study
The purpose was to compare diabetic and non-
diabetic subjects wearing complete dentures with
regard to salivary flow, salivary buffering capacity,
denture retention and oral mucosal lesions

Materials and methods
This sample consisted of 60 individuals in which 60
were denture wearers 30 were suffering from type II
D. M and the other 30 were controls with matching
age, sex and race.

Stimulated salivary flow was classified as:
1) normal: 1-2ml/min
2) hypo: 0.7 ml/ min
3) xerostomic: 0.1 ml/ min

Buffering capacity was classified as:
1) low: 4.5 pH
2) medium: 4.5-5.5 pH
3) high: >5.5 pH

Each subject was evaluated regarding denture
retention and was asked for a self report of comfort,
efficiency, and occlusion of the complete denture.
Retention for considered to be present when the
subject did not complain about moment or
displacement of complete denture during mastication
, talking , breathing, smiling, or even at rest.

Prosthodontic point
Subjects commonly report
1) dry mouth
2) loss of taste
3) speech difficulty
4) lack of adaptation of the dentures
5) burning sensation of the mouth
6) difficulty in mastication

What we observe
1) loss of tissue resiliency
2) high degree of inflammatory response.
3) ketonic breath {striking feature}
4) a high frequency of periodontal disease
5) gingival displacement
6) residual bone resorption
7) periodontal abscess,
8) gingival over growth
9) vascular alterations

10) candidasis
11) blood coagulation,
12) tissue regeneration above normal times and
13) xerostomia

Sennerby etal in his study concluded that lose of
stability in dentures was because of lose of resiliency
of underlying tissues and that was because of
osteoclastic activity
Berghal and berghal showed that psychological
factors accentuate for xerostomia
And he even concluded that drugs like anti
depressants, anti hypertensive's will play role in
xerostomia in diabetics

Results
Comparison of two groups revealed no difference in
salivary flow
A significant difference in mean buffering capacity
was observed between case and control groups
And blood glucose also showed a mean diff between
the two groups

DISCUSSION
Skyes etal observed that subjects with D.M are more
susceptiable to infections as a result of vascular
alterations and neuropathies.
Astro etal reported an increased risk of infections in
the presence of reduced flow, low buffering capacity
and inadequate hygiene of complete dentures.
With in the scope of investigation statical analysis
failed to reveal a diff in salivary flow rate between the
groups

The buffering capacity of saliva is responsible for the
maintenance of the oral pH in order to guarantee the
tooth integrity and to inhibit acid production by
bacterial plaque.

Dry mouth is an uncomfortable and potentially harm
full oral symptom which is usually caused by a
decrease in the salivary secretion rate.
This condition is more prevalent in the elderly
population primarily because of the increased use of
drugs and susceptibility to disease in this age group

Prosthodontic considerations
SHORT APPOINMENTS- only in mornings
NO STRESS
ALGINATE- thin mix
FULL SPACER
MONOPLANE TEETH
TISSUE SIDE SHOULD BE SMOOTH
FREQUENT RECALLS
RELINING AND REBASING
TISSUE CONDITIONERS

REFERENCES
1. Daniell Cristina de lima, DDS, etal ORAL
MANIFESTATIONS OF DIABETES MELIITUS IN COMPLETE DENTURE
WARERS Journal of Prosthetic Dentistry 2008; 64-69
2. Leanne m,sykes , Bsc,Bds, Mdent etal POTENTIAL RISK
OF SERIOUS ORAL INFECTIONS IN THE DIABETIC PATIENT A CLINICAL
REPORT : Journal of Prosthetic Dentistry 2001; 569-573
3. Macedo Firoozamand l, etal STUDY OF DENTURE
INDUCED FIBROUS HYPERPLASIA CASES DIAGNOSED FROM 1979-
2001: QUINTESSENCE INT 2005; 36: 825-829

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