1. Diabetes is a disease that has been associated with
an increased risk for a number of serious, sometimes
life-threatening complications. Some of those risks
include, poor dental health. Studies have shown that
people with diabetes are more likely to have
periodontal disease than people without diabetes
2. A chronic metabolic
disorder caused by
deficiency of insulin,
the primary feature is
increase in blood
glucose level
(hyperglycemia)
8. Capnocytophaga species ,
A. actinomycetumcomitans,
C. rectus, C. species, E.
corrodens, F. nucleatum, P.
gingivalis, and P.
intermedia.
glycemic control and
alterations in microflora
may increase the
susceptibility of diabetics to
periodontal disease.
Bacterial pathogens in diabetes mellitus
9. Polymorphonuclear leukocyte function in diabetes mellitus
Function of polymorphonuclear leukocytes (PMNs) impaired.
polymorphonuclear leukocyte deficiencies resulting in impaired
chemotaxis, defective phagocytosis, or impaired adherence .
collagenase concentration is higher in diabetics and it is
primarily derived from PMNs.
10. Monocytes, macrophages and cytokines in diabetes mellitus
Higher concentration IL, PG, and TNF-α have been detected in
GCF.
The release of these cytokines in response to bacteria by
monocytes is significantly higher.
Dysregulation of macrophages cytokine production results
in,tissue destruction and alveolar bone loss. alter the function of
macrophages and delay the wound healing
11. Altered collagen metabolism in diabetes mellitus
In the hyperglycemic state, numerous proteins and matrix molecules
undergo a nonenzymatic glycosylation, resulting in accumulated
advanced glycation end products (AGEs)
Collagen is cross-linked by AGE formation, making it less soluble and
less likely to be normally repaired or replaced
causing precoagulatory changes, thrombus formation and thickening of
basement membrane of microvasculature
Increase collagenasae activity, decreased collagen synthesis, maturation,
and maintenance of collagen
12. Altered wound healing in diabetes mellitus
The primary reparative cell in the periodontium is the
fibroblast, which does not function properly in high-
glucose environments
The collagen that is produced by these fibroblasts is
susceptible to rapid degradation
Resulting in Gingival microangiopathy, Increased
collagen degradation, and Glycolysation
14. Undiagnosed…
Confirm through;
Randomglucose >= 200 mg/dl
Fasting glucose >= 126 mg/dl
Post prandial bloodglucose >= 200
mg/dl 2 hrs. after Oral glucose tolerance
test
ONLY nonsurgical oral hygiene
procedures until diagnosis
has been established
15. • inquire about the medication, the type, severity
and control of diabetes, the physician treating
the patient and the date of last visit
16. Known diabetic patients
• The dentist should be aware of the
patient’s recent glycated
hemoglobin values.
• HbA1c values of less than 8%
indicate relatively good glycemic
control; greater than 10% indicate
poor control
17. Known diabetic patients
• When the level of control of diabetes is
not known, consult patients physician
and the treatment should be just
limited to palliation
18. Known diabetic patients
• In patients with good glycemic control
before starting any procedure, verify
that the patient has taken medication
and diet as usual
19. Known diabetic patients
• Patients, receiving good medical
management without serious
complications such as renal disease,
hypertension, or coronary
atherosclerotic heart disease, can
receive any indicated dental treatment
20. Known diabetic patients
• Local anesthesia is preferred, but such
patients can even be safely treated in
general anesthesia
21. Known diabetic patients
• Patients with complications require
different treatment plan
• Morning appointments should be
preferred because this is the time of
high glucose and low insulin activity
• This reduces the risk of hypoglycemic
episodes during the dental procedures
22. Known diabetic patients
• Appointments should be of short
duration
• a source of glucose such as an orange
juice must be available in the dental
office to avoid hypoglycemic attacks
23. Known diabetic patients
• Prophylactic antibiotics for patients
taking high doses of insulin to prevent
post-operative infection are
recommended
• It's best to do surgery when blood
sugar levels are within normal range
24. Known diabetic patients
• to avoid hyperglycemia use anxiety
reduction protocol, emotional stresses
and painful conditions increase the
amount of cortisol and epinephrine
secretion which induce hyperglycemia so
– pre-treatment anxiety should be reduced
by sedation
– pain during procedures can be avoided by a
potent anesthesia
25. Known diabetic patients
• If the dental needs are urgent and
blood sugar is poorly controlled,
treatment should be provided in a
hospital or other setting where more
medical professionals can monitor
patient
26. Management of Insulin Shock
• The most common diabetic emergency
which a dentist encounters is
hypoglycemia
• it can lead to life-threatening
consequences
• it occurs when the concentration of
blood glucose drops below 60 mg/dL
27. Management of Insulin Shock
• confusion, sweating, tremors, agitation,
anxiety, dizziness, tingling or numbness,
and tachycardia. Severe hypoglycemia
may result in seizures or loss of
consciousness
28. Management of Insulin Shock
• As soon as such signs or symptoms are
present the dentist should check the
blood glucose with a glucometer,, the
“Golden Rule” is that manage the
patients as if they are hypoglycemic
until proven otherwise
29. Management of Insulin Shock
• Establish adequate airway, breathing &
circulation by loosening dress near the
neck, switching on the fan/air
conditioners, and placing the patient in
the head-low-feet-up position
30. Management of Insulin Shock
• If patient is conscious and able to take
food by mouth, give 15g of oral
carbohydrate in one of the following
forms;
– 4-6 ounce fruit juice or soda,
– 3-4 teaspoon sugar,
– a hard candy.
– Small amount of honey/sweet syrup can also
be placed in the buccal fold
31. Management of Insulin Shock
• In unconscious patients, give 50ml of
dextrose in 50% concentration or 1mg
glucagon intaravenously, or give 1ml
glucagon intramuscularly at almost any
body site.
32. Management of Insulin Shock
• Following treatment, the signs and
symptoms of hypoglycemia should
resolve in 10 to 15 minutes
• The patient should be observed for 30
to 60 minutes after recovery. Normal
blood glucose level is confirmed by a
glucometer before the patient is
allowed to leave
33. Post-operative Period
• Eating the right diet is a critical part of
diabetes therapy, if the patient is
expected to have difficulty in eating
solid food after dental procedure; diet
should be modified to soft solids or
liquids
• Even the use of blender to blend food
before eating is recommended
34. Post-operative Period
• Consult the patient’s physician for post-
operative period diet plan
• It is necessary that the total caloric
content and
proteins/carbohydrates/fats ratio of
the diet remain same
35. Instructions to be given to a
diabetic
• diabetic patients should be strongly
motivated to maintain a good oral
hygiene by
– brushing after every meal
– using floss daily
– keeping their dentures clean
36. Instructions to be given to a
diabetic
• patients should be frequently recalled
for
– dental examinations
– prophylactic measures, such as topical
fluorides should be applied
37. Instructions to be given to a
diabetic
• Cavities should be treated as quickly as
possible. The dryness of mouth can be
relieved by providing salivary
substitutes or asking the patient to
suck sugar-free candy or gums and
frequently drink water
38. Instructions to be given to a
diabetic
• Because their good oral health can help
in maintaining good glycemic control,
they should be taught that if there is a
problem like a bleeding, swollen or
tender gums, continuous bad taste or
white patches, they should immediately
contact a dentist
39. Instructions to be given to a
diabetic
• The patients should be encouraged to
quit smoking as it greatly increases the
risk of periodontal disease in diabetic
patients
40. Instructions to be given to a
diabetic
• Diabetics should be informed that they
are more likely to catch dental diseases
than the normal ones because awareness
and knowledge increases the tendency
to seek preventive dental care, and
improves chances of maintaining healthy
mouth
