DENTISTRY

1. DENTAL MANAGEMENT
OF A DIABETIC PATIENT
SUBMITTED BY : VIBHOR TYAGI
6085093

2. CONTENTS DIABETES
 TYPES
 Pathophysiology
 LOCAL AND GENERAL COMPLICATIONS
 Lab findings
 DENTAL MANAGEMENT

3. DIABETES
 Diabetes Mellitus is characterized by hyperglycemia resulting
from defects in insulin secretion,insulin action or both.

4. TYPES OF DIABETES MELLITUS
 TYPE 1(insulin secretion)
 TYPE 2(insulin resistance)

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. TYPE 2(insulin resistance)
 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.

8. PATIENTS WITH CARDINAL SIGNS OF
DIABETES
 Polydipsia
 Polyurea
 Polyphagia
 Weightloss
 Poor wound healing
 Severe infections
 Obesity
 Weakness

9. GENERAL COMPLICATIONS
 Ketoacidosis
 Hyperosmolar nonketotic coma(type2 diabetes)
 Diabetic retinopathy/blindness
 Diabetic nephropathy/renal failure
 Accelerated atherosclerosis(coronary heart disease)
 Ulceration and gangrene of foot
 Diabetic neuropathy
 Infections

10. DIABETIC GANGRENE OF THE FEET

11. Oral complications of poorly controlled diabetes
mellitus
 XEROSTOMIA
 BURNING SENSATION
 Gingivitis and periodontitis
 DENTAL CARIES
 Bacterial,viral, and fungal infections
 Periapical abscesses

12. Severe Progressive Periodontis

13. Oral moniliasis in a patient with
diabetes(multiple white lesions)

14. Criteria for the Diagnosis of Diabetes
Mellitus
 Symptoms of diabetes plus casual plasma glucose level o
f200mg/dl or greater.
 Fasting plasma glucose of 126mg/dl or greater

15. • 2-hour plasma glucose level of 200mg/dl or greater
during an oral glucose tolerance test.
The test should be performed using a glucose load
containing the equivalent
of 75g of anhydrous glucose dissolved in water, this test
is not recommended for routine clinical use.

16. Glycohaemoglobin.
Measurement of HbA1c levels is of value in the
detection and evalution patients.
HbA1c is an electrophoretically fast-moving
haemoglobin 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

17. TREATMENT
 Diet and physical activity
 Insulin
 Pancreatic transplant
 Diet and physical activity
 Insulin
 Oral hypoglycaemia agents
TYPE 1 DIABETES TYPE 2 DIABETES

18. DENTAL
MANAGEMENT

19. MEDICAL CONSIDERATIONS
 Any dental patient whose condition remains undiagnosed but
who has the cardinal symptoms of diabetes should be referred
to a physician.
 Patients with findings that may suggest diabetes should be
referred to a clinical laboratory or a physician for screening
tests.

20. MEDICAL CONSIDERATIONS
o 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.

21. MEDICAL CONSIDERATIONS
 Viral 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.

22. Dental management of patients with
diabetes
 If diabetes is well controlled, all dental procedures can be
performed without special precautions before starting the
procedure, verify that the patient have taken medication and
diet as usual.

23. Dental management of patients with
diabetes
 If diabetes is poorly controlled i.e., fasting blood glucose
<70mg/dl or >200mg/dl and ANY complications [post MI, renal
disease, congestive heart failure, symptomatic angina, old
age, cardiac and blood pressure ≥180/110mm Hg], all
elective dental procedures should be postponed.
 Provide only emergency care,
 Consult patient’s physician
 Critical setting: hospital
 Patient preparation: ECG, PULSE, BP, RESPIRATION
MONITORING

24. 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.

25.  Patients 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

26.  Infection should be treated with the use of standard methods :
> Warm intraoral rinses
> Incision and drainage
> Pulpotomy , pulpectomy , extractions
> Antibiotics

27. 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
 Patients should come with normal breakfast taken and
normal regular dose of insulin taken.

28.  AT CLINIC :
 Immediate treatment should be provided
 A source of glucose such as orange juice should be present in the
dental office to avoid hypoglycaemia 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.

29.  A major goal in dental management of diabetes is to prevent
insulin shock
MANAGEMENT OF INSULIN SHOCK WHEN OCCUR.
*Most common diabetic emergency which dentist encounter is
hypoglycaemia.
*Leads to life threatening consequences
*It occurs when concentration of blood glucose drops below
60mg/dl

30.  Signs and symptoms
 Confusion
 Restlessness
 Tremors
 Sweating
 Tachycardia

31. DENTAL MANAGEMENT OF A
DIABETIC PATENT
 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.

32.  If the patient is conscious and she is able to take her food by
mouth so give 15g of the carbohydrate in the following form
 Orange juice
 3-4 tablespoon 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.

33.  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.

34.  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 a necessary that the total content of the calorie
protein/carbohydrate/fats etc remains the same.
 Antibiotics should be given after surgery.

35. THANK YOU