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Diabetes m.


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Diabetes m.

  1. 1. betes mellitus and its dental managem Produced by : Howida abubredaa Hajer fidan Amani Alamary
  2. 2. 2 Diabetes mellitus: It is metabolic disorders characterized by dysregulation in carbohydrates , protein & fat metabolism due to decrease insulin secretion or function resulting in hyperglycemia affecting all tissues of body.
  3. 3. 3 classification: 1-Type 1 : insulin dependent 2-Type 2 : non-insulin dependent. 3-other specific types: a- genetic defect of cell function of pancreas. b- genetic defects of insulin action c- disease of pancreas :pancreatitis , neoplasm in pancreas. d- endocrinal disorder : Cushing syndrome , phaeochromcytoma.
  4. 4. 4 e- drug induced : glucocortcoids (cortisone) ,thyroid hormone. 4-gestational diabetes : occurs during pregnancy.
  5. 5. Type I(IDDM):or juvenile-onset DM -comprises 5-10% of diabetics. -autoimmune destruction of the insulin- producing beta cells of pancreas, leading to complete absence of insulin. -it is partly inherited with multiple genes, the onset of diabetes can be triggered by one or more environment factors such as a viral infection or diet . -it affects childhood and adolescence below the age of 25 years.
  6. 6. Treatment :insulin + diet control
  7. 7. Type II(NIDDM):or maturity-onset DM -It forms 90-95% of diabetics. -result from impaired insulin function (insulin resistance) which may be combined with reduced insulin secretion. -It affects individuals who are typically in middle and old age (mainly 40 years) and over weight. .
  8. 8. Risk factors : obesity , sedentary lifestyle and high fat and cholesterol level. Treatment : diet or hypoglycemic drugs or even insulin.
  9. 9. 4-gestational diabetes : -appears usually in second or third trimester of pregnancy -Affects up to 5% of pregnant women -Placental hormones interfere with insulin. After delivery it either : a- disappear(patient still liable to diabetes later on). b-persist treated as diabetic patient.
  10. 10. Pathophysiology: -healthy people blood glucose level maintained within 70 to 110 mg/dl by balance between insulin and glucagon as well as some other hormones. -insulin synthesized in beta cells of pancreas and secreted rapidly into blood in response to elevation in blood sugar.
  11. 11. 12 -insulin binds to receptors on cell facilitate 1-glucose uptake by the cell and its storage as glycogen. 2-fatty acid and amino acids converted to triglyceride and protein stores.
  12. 12. -lack of insulin or insulin resistance hyperglycemia. -blood sugar  glycosuria osmotic pressure of the urine  polyuria fluid loss  polydipsia -cells send signals to brain to express their need to glucose polyphagia -body try to compensate the need of cells to energy in the cells   break down of fats & protein  ketoacidosis
  13. 13. Symptoms and signs of undiagnosed or poorly treated DM: Polydipsia ,polyphagia ,polyurea ,loss of weight ,blurred vision , kussmaul (deep) breathing , smell of acetone , poor wound healing , recurrent skin infection and oral manifestation.
  14. 14. Oral manifestation: 1-dry mouth 2-burning sensation of the tongue. 3-atrophy of tongue coating. 4-periodontal disease 5-increase rate of dental caries 6- odontalgia 7- Candida infection 8- lichenoid reaction
  15. 15. Gingivitis in uncontrolled diabetic patient
  16. 16. 19 Pseudomembranous candidiasis
  17. 17. 20 Lichen planus
  18. 18. 21 Periodontal abscess
  19. 19. 22 Diabetic patient are more susceptible to infection: a-effect of ketoacidosis:  chemo taxis and phagocytic function of neutrophils. b-effect of hyperglycemia :  the phagocytic function of neutrophils c-peripheral neuropathy and poor peripheral circulation d- glucose concentration in the saliva and GCF
  20. 20. Diagnosis: 1-two fasting blood glucose level A- the patient should be fasting completely 6 hours before test. B- fasting blood glucose level < 110 mg/ dl rule out diagnosis of diabetes. C-fasting blood glucose > 126 mg / dl suggest diabetes mellitus. D- impaired fasting glucose from 110 < 126 mg/dl. (Normal 70 -110 mg/dl)
  21. 21. 2-two random blood glucose level ( normal < 200 mg / dl ) A-random blood glucose level > 200 mg / dl suggest diabetes mellitus B-associated with clinical manifestation of DM
  22. 22. 3-glucose tolerance test: a - fasting blood sample is taken. b- 75 gm sugar given orally. c- blood samples are taken at half hour intervals for 2-3 hours. Normal blood glucose should be less than 180 mg/dl after 1 hour and return to normal level after 2 hours.
  23. 23. 4-glycosylated hemoglobin (reflects blood sugar level in the last three months) A- 4 -6% it is normal , patient is not diabetic. B-<7 % patient is controlled C->7 % patient is uncontrolled
  24. 24. medical management: -objective : maintain blood glucose levels as close to normal as possible A-exercise and diet control Meals should be at regular intervals , with a high fiber and relatively high carbohydrate content but avoiding sugar.
  25. 25. B-oral antidiabetic drugs used in type 2 DM: a-Biguanides : 1-cell sensitivity to insulin 2- gluconeogenesis in the liver. b- sulphonylurea :  pancreas insulin secretion
  26. 26. C-insulin: used in type 1 DM and some patients with type 2 DM if can not controlled by diet and oral hypoglycemic drugs Insulin are classified as long- , intermediate- , short- , or rapid-acting.
  27. 27. Dental Management considerations : To minimize the risk of an intra operative emergency we should manage pt according to: 1-Uncontroled pt( FBG > 200 MG /DL), should referred to the physician before dental procedure. 2-Controlled pt(FBG <200 mg/dl), 1.morning appt even not coincide with peak activity. 2.Ensure that the pt has eaten normally and taken medication as usual.
  28. 28. 31 5.Avoid excessive trauma during surgical procedure 6.Rapid ttt of infections to avoid hyperglycemia 7.Avoid long appointment 8.The drugs should be sugar-free ,avoid that raise Bl.glucose and that raise insulin function. (Amoxicillin is the antibiotic of choice and paracetamol is the analgesic of choice). 9.Slowly raise dental chair as ortho static hypotension may occur b/c autonomic
  29. 29. 32 12. From preventive point of view ,the pt should instruct to maintain meticulous oral hygiene as DM makes him more prone to oral infections. 10.Hospitalization is done in: a-multiple extraction. b-Massive infection. 11.Antibiotic cover post massive oral infections and in extensive surgeries.
  30. 30. 33 COMPLICATIONS : Divided into acute and chronic Acute:1-hypoglycemia 2- hyperglycemia Chronic :micro vascular and macrovascular
  31. 31. 34 Chronic complication of diabetes : 1-cardiovascular→atherosclerosis leading to ischemic heart disease , cerebrovascular disease and peripheral gangrene 2-renal →renal damage and failure 3-ocular→retinopathy and cataract 4-neuropathies→ peripheral polyneuropathy , autonomic neuropathy 5-infection →candidosis , and staphylococcal infection
  32. 32. 35 Chronic complication :
  33. 33. 36 HYOPGLYCAEMIA -Also called insulin shock. -hypoglycemic coma is the main acute complication of DM, it occur due to imbalance between food intake and insulin therapy leading to reduce blood glucose to a level dl./<70mg
  34. 34. Signs and symptoms : it resemble fainting with rapid onset , 1- due to adrenalin release there will be palpitation ,tachycardia , sweaty skin . 2-due to cerebral hypoglycemia anxiety ,irritability ,headache , and disorientation ,before consciousness is lost this called “neuroglycopnia”
  35. 35. Management : must be quickly corrected with glucose before brain damage result , It is done according to the patient condition If pt is conscious ,give glucose solution immediately orally . but if is not conscious ,give 10-20ml of 20-50% sterile dextrose IV or if the vein can not readily be found ,glucagon 1mg IM On arousal pt should be given glucose orally in the form of long acting.
  36. 36. diabetic ketoacidoses it is a state of uncontrolled lipid catabolism associated with insulin deficiency it occur in cases of: 1.undiagnose diabetes 2.interruption of insulin 3.infection Hyperglycemia coma
  37. 37. 41 1- Acidosis leading to vomiting , hyperventilation and acetone breath 2- osmotic diuresis and polyuria lead to dehydration , hypotension , tachycardia , dry mouth and skin Management : after ensuring that the coma is due to hyperglycemia: give IV fluid for rehydration and to correct electrolytic and insulin. Signs and symptoms:.
  38. 38. Thank you