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Dental management of a diabetic patient

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Dental management of a diabetic patient

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Dental management of a diabetic patient

  1. 1. DENTAL MANAGEMENT OF A DIABETIC PATIENT DR: MAMOON MARWAT SARDAR BEGUM DENTAL COLLEGE PESHAWAR
  2. 2. CONTENTS  DIABETES  TYPES  Pathophysiology  LOCAL AND GENERAL COMPLICATIONS  Lab findings  DENTAL MANAGEMENT
  3. 3. Diabetes  Diabetes Mellitius is characterized by hyperglycemia resulting from defects in insulin secreation,insulin action or both
  4. 4. TYPES OF DIABETES MELITUS  TYPE 1(insulin secretion)  TYPE 2(insulin resistance)
  5. 5. TYPE 1(insulin secretion)  It results from the pancreas' failure to produce enough insulin.  This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes".  The cause is unknown
  6. 6. Type 2 DM  It begins with insulin resistance, a condition in which cells fail to respond to insulin properly.  The primary cause is excessive body weight and not enough exercise
  7. 7. Pathophysiology Insulin uptakes of glucose from the blood into the cell Pancrease (beta cells found in islets of in response to rising level of blood glucose langherhans ) IF the amount of insulin available is insufficient or cells responds poorly to the effect of insulin Net effect will be high level of blood glucose
  8. 8. PATIENT WITH CARDINAL SIGNS OF DIABETES  Polydipsia  Polyurea  Polyphagia  Weightloss  Poor wound healing  Severe infections  Obesity  Weakness
  9. 9. General complications  Ketoacidosis  Hyperosmolar nonketotic coma (type 2 diabetes)  Diabetic retinopathy/blindness  Diabetic nephropathy/renal failure  Accelerated atherosclerosis (coronary heart disease )  Ulceration and gangrene of feet  Diabetic neuropathy  Infections
  10. 10. Diabetic gangrene of the feet.
  11. 11. Oral complications of poorly controlled diabetes mellitus  XEROSTOMIA  BURNING SENSATION  Gingivitis and periodontitis  DENTAL CARIES  bacterial, viral, and fungal infections  Periapical abscesses
  12. 12. SEVERE PROGRESSIVE PERIODONTIS
  13. 13. Oral moniliasis in a patient with diabetes(Multiple white lesions)
  14. 14. Mucocormycosis (a serious fungal infection )
  15. 15. Criteria for the Diagnosis of Diabetes Mellitus  S y m pt o m s o f diabet es plu s cas u al plas m a glu co s e level o f 200 m g/dL o r great er  F ast in g plasma glu cose of 126 mg/dL or greater
  16. 16.  2-hour plasma glucose level of 200 mg/dL or greater during an oral glucose tolerance test The test should be performed using a glucose load containing the equivalent of 75 g of anhydrous glucose dissolved in water; this test is not recommended for routine clinical use
  17. 17.  Glycohemoglobin. Measurement of HbA1c levels is of value in the detection and evaluation of patients HbA1c is an electrophoretically fast-moving hemoglobin component found in normal persons; it increases in the presence of hyperglycemia and may reflect glucose levels in the blood over the 6 to 12 weeks preceding administration of the test.  Normally, patients should have 6% to 8% HbA1c.
  18. 18. treatment TYPE 1 DIABETES  Diet and physical activity  Insulin  Pancreatic transplant TYPE 2 DIABETES  Diet and physical activity  Insulin  Oral hypoglycemic agents
  19. 19. DENTAL MANAGEMENT
  20. 20. MEDICAL CONSIDERATIONS  Any dental patient whose condition remains undiagnosed but who has the cardinal symptoms of diabetes Should be refered to physician  Patients with findings that may suggest diabetes should be referred to a clinical laboratory or a physician for screening tests.
  21. 21. MEDICAL CONSIDERATIONS  Known diabetic patient  All patients with diagnosed diabetes must be identified by history, and the type of medical treatment they are receiving must be established.  The type of diabetes (type 1, type 2, or other types of diabetes) should be determined, and the presence of complications noted.  This provides the dentist with information regarding the severity of diabetes and the level of control that has been attained
  22. 22. Medical considerations  Vital signs also serve as a guide to the control and management of disease in the diabetic patient  Patients with complications or treated with insulin or who are not under good medical management may need to be managed in a special way
  23. 23. Dental management of patient with diabetes  If diabetes is well-controlled, all dental procedures can performed without special precautions before starting the procedure ,verify that the patient have taken medication and diet as usual
  24. 24. Dental management of patient with diabetes  IF Diabetes is poorly controlled I.e fasting blood glucose <70 mg/dL or >200 mg/dL and ANY complications [post MI, renal disease, congestive heart failure, symptomatic angina, old age, cardiac and blood pressure ≥180/110 mm Hg ,All elective dental procedures should be postponed.  Provide Only emergency care,  Consult patient physician  Critical setting: hospital  Patient preparation: ECG,PULSE,B,P,RESPIRATION MONITERING
  25. 25. Dental Management of the Patient With Diabetes and Acute Oral Infection  Non–insulin-controlled patients may require insulin; consultation with physician required  Insulin-controlled patients usually require increased dosage of insulin; consultation with physician required
  26. 26.  Patient with brittle diabetes or receiving high insulin dosage should have culture(s) taken from the infected area for antibiotic sensitivity testing a. Culture sent for testing b. Antibiotic therapy initiated
  27. 27.  Infection should be treated with the use of standard methods  Warm intraoral rinses  Incision and drainage  Pulpotomy, pulpectomy,extractions  antibiotics
  28. 28. DENTAL MANAGEMENT OF A DIABETIC PATIENT  In well controlled diabetes patient: PRE OPERATIVELY:  Use anxiety reduction protocol, but avoid deep sedation  Morning appointment should be given  Patient should come with normal breakfast taken and normal regular dose of insulin taken
  29. 29. DENTAL MANAGEMENT OF A DIABETIC PATIENT  AT CLINIC  Immediate treatment should be provided  A source of glucose such as orange juice should be present in the dental office to avoid hypoglycemic attack  Maintain verbal contact with the patient during surgery  Atraumatic extraction  Advise patient to inform dentist or staff if symptoms of insulin reaction occur during dental visit.
  30. 30. DENTAL MANAGEMENT OF A DIABETIC PATIENT  A major goal in dental management of diabetes is to prevent insulin shock MANAGEMENT OF INSLUN SHOCK WHEN OCCUR.  Most common diabetic emergency which dentist encounter is hypoglycemia  Leads to life threatening consequences  It occurs when concentration of blood glucose drops below 60 mg/dl
  31. 31. DENTAL MANAGEMENT OF A DIABETIC PATIENT  Sign and symptoms  Confusion  Restlessness  Tremors  Sweating  tachycardia
  32. 32. DENTAL MANAGEMENT OF A DIABETIC PATIENT  As soon as such signs or symptoms are present the dentist should check the glucose by the glucometer .  Establishing airway,breathing,and circulation  Turn on the fans, conditioner,  Place the patient in the supine position
  33. 33. DENTAL MANAGEMENT OF A DIABETIC PATIENT  If the patient is conscious and she is able to take her food by mouth so give 15 g of the carbohydrate in the following form  orange juice  3-4tablespoon of sugar  A small amount of sweet/honey it can be placed in buccal fold  In unconscious patient take 50ml of the dextrose in 50% of the concentration or 1mg of the glucagon I/V Or 1mg of the glucagon intramuscularly.
  34. 34. DENTAL MANAGEMENT OF A DIABETIC PATIENT  The signs and symptoms of hypoglycemia should be resolved in 10 to 15 mins.  The patient should be observed for 30 to 60 min after the recovery. The normal blood glucose level is confirmed by the glucometer before the patient leaves.
  35. 35. DENTAL MANAGEMENT OF A DIABETIC PATIENT  Post operative period  if the patient is not able to eat after the dental procedure so he is recommended to eat the soft food and liquids  Consult the patients physician for the post operative diet plan.  It is necessary that the total content of the calorie protein/carbohydrate/fats etc remains the same.  Antibiotics should be given after surgery.
  36. 36. THANK You

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