Advances in medical management of diabetes have resulted in intensification of treatment regimens, with a resulting decrease in long-term complications of the eyes, kidneys, and nervous system. This intensified treatment may place the diabetic patient at increased risk of hypoglycemic emergencies during dental appointments.
Full Answer
How to treat a patient with diabetes at the dentist?
In the dental treatment of patients with diabetes, the most important is to have good communication with the patient. Before treatment, the dentist needs to know which therapy is the patient taking, is the disease under control and whether there are complications on vital organs.
How does diabetes affect dental health?
In patients with poorly controlled diabetes, wound healing is difficult and risk of infection is increased. Regular dental checkups and cleanings of soft and hard teeth deposits are recommended every three months, and more often if necessary.
How common is diabetes in dentists?
Because diabetes is a relatively common condition, practicing dentists are likely to encounter it frequently. Type 1 diabetes is a chronic autoimmune disease in which the beta cells in the pancreas create little to no insulin, and accounts for 5% to 10% of all diabetes cases.
Does type 2 diabetes affect oral health and quality of life?
Type 2 diabetics have had improvement in care provision through the development of shorter acting sulphonylureas and the potential for GLP1 injections. The impact of diabetes on both oral health and quality of life is discussed.
How can diabetes affect dental treatment?
Periodontitis tends to be more severe among people who have diabetes because diabetes lowers the ability to resist infection and slows healing. An infection such as periodontitis may also cause your blood sugar level to rise, which in turn makes your diabetes more difficult to control.
How does type 2 diabetes affect the course of dental treatment?
Because saliva protects your teeth, you're also at a higher risk of cavities. Gums may become inflamed and bleed often (gingivitis). You may have problems tasting food. You may experience delayed wound healing.
Does diabetes affect dental health?
Diabetes affects many parts of your body, including your mouth link. People with diabetes are more likely to have gum disease link, cavities, and other problems with their teeth and gums. And some of these mouth problems can make your diabetes worse.
Do diabetics need dental prophylaxis?
No, not routinely in patients/clients with well controlled diabetes and no evidence of infection. However, patients/clients with diabetes may have compromised immunity, which places them at risk for distant-site infections from dental procedures.
What difficulties can a dentist face when treating a patient with severe diabetes?
Diabetes and Dental Care - Are You at Higher Risk?Dry mouth. Dry mouth is a big problem for diabetics since the condition can decrease the flow of saliva needed to keep the inside of the mouth moist. ... Gum inflammation (gingivitis and periodontitis). ... Poor healing of oral tissues. ... Burning mouth and/or tongue.
What affect does diabetes have on teeth?
She explains that high blood sugar can damage gums and teeth in the same way that it can damage the heart, eyes, and nerves. As a result, people with diabetes are at higher risk for tooth decay, gum inflammation and disease, and periodontitis (a severe gum infection that destroys the bone supporting your teeth).
Why are people with diabetes more likely to develop oral health problems?
If blood sugar is poorly controlled, oral health problems are more likely to develop. This is because uncontrolled diabetes weakens white blood cells, which are the body's main defense against bacterial infections that can occur in the mouth.
Do diabetics need antibiotics for dental work?
For example, antibiotic prophylaxis might be useful for patients undergoing invasive dental procedures, who also have compromised immune systems, due to, for instance, diabetes, rheumatoid arthritis, cancer, chemotherapy and chronic steroid use.
Which of the following is the most acute diabetic problem encountered in the dental office?
The emergency most likely encountered in the dental office is a patient with hypoglycemia or insulin shock. This condition is caused by an excessively high level of insulin due to the patient taking their daily dose of insulin with inadequate intake of carbohydrates.
Why is extraction contraindicated in diabetes?
People with diabetes need to be careful because extractions open the gum to infection. This infection may cause hyperglycaemia and mobilize fatty acids leading to acidosis. All these conditions make control of blood sugar level extremely difficult.
How often should diabetics go to the dentist?
Get your teeth and gums cleaned at least once a year (more often if your doctor recommends), and let your dentist know that you have diabetes. If you're meeting your treatment and blood sugar goals, have this test every 6 months. If you're meeting your treatment goals, visit your doctor every 6 months.
How does diabetes affect dental health?
In addition, some of them such as gingivitis and periodontitis have adverse effect on disease control. Daily implementation of the oral hygiene measures and regular dental checkups will preserve oral health of patients with diabetes and will contribute significantly to the health of the whole organism.
When should diabetes be treated?
The treatment of diabetes should start before the development of complications. Also, if a patient during dental treatment has symptoms of hyperglycemia (red dry skin, rapid breathing, dehydration, acetone breath), he should be immediately treated.
What are the most common oral complications of diabetes?
Oral manifestations of diabetes are gingivitis and periodontitis, dry mouth, increased susceptibility to infections especially fungal, increased susceptibility to caries, burning sensation of oral mucosa and difficult wound healing. Gingivitis and periodontitis are the most common oral complications of diabetes.
Why does diabetes occur?
Diabetes is caused by two reasons: when the pancreas stops completely or partially to produce hormone insulin (Type 1 diabetes) or when the insulin is not effective in the body (Type 2 diabetes). Type 1 diabetes (formerly called insulin dependent type) occurs in 10% of patients, most often in children and adolescents.
How many people have Type 2 diabetes?
Type 2 diabetes (formerly called non-insulin dependent type) occurs in 90% of patients, mainly adults over forty years of age. The disease occurs when the pancreas is not anymore able to produce sufficient amounts of hormone insulin to meet the needs of the organism or when the target cells become resistant to insulin ...
What is the cause of diabetes?
It is believed that this type of diabetes occurs as a result of an autoimmune destruction of insulin-producing beta cells in the pancreas (pancreatic islets, also called islets of Langerhans – tiny clusters of cells scattered throughout the pancreas).
What bacteria are more destructive in diabetics?
In patients with poorly controlled diabetes the number of destructive bacteria (spirochetes and movable rods) is increased than in patients with well-controlled diabetes and non-diabetic individuals.
Abstract
Diabetes mellitus affects approximately seven percent of the American population; thus, patients with diabetes are seen in every dental practice. Advances in medical management of diabetes have resulted in intensification of treatment regimens, with a resulting decrease in long-term complications of the eyes, kidneys, and nervous system.
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Diabetes and dental care: Guide to a healthy mouth
What do brushing and flossing have to do with diabetes? Plenty. If you have diabetes, here’s why dental care matters — and how to do it right.
Cavities, gum disease, and other problems
Whether you have type 1 diabetes or type 2 diabetes, managing your blood sugar level is key. The higher your blood sugar level, the higher your risk of:
Proper dental care
To help prevent damage to your teeth and gums, take diabetes and dental care seriously:
How do dental teams understand diabetes?
In order to understand diabetes, the dental team must learn how carbohydrates are metabolized (Figure 1). 3,4 In a healthy individual, eating initiates a series of events that results in the breakdown of complex carbohydrates into simple sugars (glucose), which are then absorbed across the gastrointestinal lining into the bloodstream.
How to prevent hypoglycemic event in dental office?
The easiest way to prevent a hypoglycemic event in the dental office is to ask patients with diabetes to bring their glucometers to each dental appointment. 16 Prior to the start of treatment, patients should check their blood glucose levels and clinicians should record the results in the treatment notes.
Why is hypoglycemia the highest risk?
Risk of hypoglycemia is highest among patients with well-controlled blood glucose levels and low HbA1c because they have lower average daily blood glucose levels. 16 Symptoms of hypoglycemia generally present when a patient’s blood glucose levels drop below 60 mg/dL to 70 mg/dL, but can also occur at higher levels.
How is diabetes diagnosed?
Diabetes is diagnosed by a physician using various types of blood glucose testing (Table 1). 5,10 Fasting blood glucose, casual blood glucose and post-prandial plasma glucose tests are used to evaluate blood glucose levels at a single point in time. These tests can evaluate only the blood glucose level at the moment the blood is drawn. In the bloodstream, glucose binds to numerous proteins, and, the higher the blood glucose levels, the higher the percentage of total protein that becomes glycated. As glucose circulates in the bloodstream, it attaches irreversibly to part of the oxygen-carrying hemoglobin molecule on red blood cells.
Why do diabetics use glucometers?
It is the patient’s responsibility to use the glucometer readings to maintain control of blood glucose levels, minimize highs and lows, and avoid hypoglycemia.
What are the most common complications of diabetes?
Hypoglycemia is the most common complication of diabetes, particularly among those whose treatment involves insulin therapy. 5 Shakiness, sweating and tachycardia often precede hypoglycemic reactions, but some events occur without warning. Table 3 provides a list of signs and symptoms.
What is the main cause of diabetes?
Type 2 constitutes 90% to 95% of all diabetes cases and is more common in nonwhite populations. Its main cause is insulin resistance. 3–5 Patients with type 2 diabetes can produce insulin, but their muscle cells exhibit insulin resistance.
What is the role of communication and cooperation between medical and dental health care providers?
Communication and cooperation between medical and dental health care providers is key to supporting the health of individuals with diabetes. FIGURE 2. This is a three-dimensional model of an insulin molecule. A hormone generated by the pancreas, insulin enables the body to use the glucose provided by the carbohydrates consumed through food ...
Why do diabetics use glucometers?
It is the patient’s responsibility to use the glucometer readings to maintain control of blood glucose levels, minimize highs and lows, and avoid hypoglycemia.
How long does glucose stay in the blood?
Glucose remains bound to the hemoglobin molecule for the entire lifespan of the red blood cell, which is approximately 120 days. 11 High HbA1c levels indicate that a greater percentage of the hemoglobin on red blood cells has become glycated by the circulating blood glucose.
What is the function of insulin in the body?
Insulin allows entry of glucose into target cells, where it is used for energy. Without insulin, glucose cannot enter most cells. As glucose moves into the tissues, blood glucose levels decrease, causing reduced insulin secretion until the next meal.
Why is hypoglycemia the highest risk?
Risk of hypoglycemia is highest among patients with well-controlled blood glucose levels and low HbA1c because they have lower average daily blood glucose levels. 16 Symptoms of hypoglycemia generally present when a patient’s blood glucose levels drop below 60 mg/dL to 70 mg/dL but can also occur at higher levels.
What are the most common complications of diabetes?
Hypoglycemia is the most common complication of diabetes, particularly among those whose treatment involves insulin therapy. 5 Shakiness, sweating, and tachycardia often precede many hypoglycemic reactions, but some events occur without warning. Table 3 provides a list of signs and symptoms.
How is diabetes diagnosed?
Diabetes is diagnosed by a physician using different types of blood glucose testing (Table 1). 5,10 Fasting blood glucose, casual blood glucose, and post-prandial plasma glucose tests are used to evaluate blood glucose levels at a single point in time. These tests can evaluate only the blood glucose level at the exact moment the blood is drawn. In the bloodstream, glucose binds to numerous proteins, and the higher the blood glucose levels, the higher the percentage of total protein that becomes glycated. As glucose circulates in the bloodstream, it attaches irreversibly to part of the oxygen-carrying hemoglobin molecule on red blood cells.
How does dental treatment affect blood sugar?
By a similar mechanism antibiotics may also affect the blood sugar and in fact may also cause a further reduction in BS as a consequence of increasing the rate of transit of food in the digestive tract. This in turn reduces the amount of carbohydrates being absorbed. Alerting the patient to these possible consequences of treatment and advice to carefully monitor BS may well prevent problems.
How many people in the UK have Type 2 diabetes?
3 There are estimated to be over 500,000 undiagnosed Type 2 diabetics in the UK, 5 and often diagnosis only occurs following presentation with one of the complications.
How much time does a Type 1 diabetic spend on blood glucose?
Unfortunately the average Type 1 diabetic will only spend about 30% of the 24 hour cycle with blood glucose levels within this normal range. Fortunately, the body has the capacity to tolerate abnormal blood glucose levels, however, patients may still be aware that they 'don't feel quite right'.
Why is insulin important for the brain?
The brain is particularly affected by any reduction in blood glucose supply due to its lack of capacity for glucose storage.
How does diabetes affect the pancreas?
In Type 1 diabetes the beta cells in the pancreas undergo a chronic autoimmune destruction process which results in a long-term lack of endogenous insulin. Scientists and researchers remain unsure as to the exact cause of Type 1 diabetes but it is thought that a viral or other infection may trigger the autoimmune destruction. 4 The resultant lack of insulin must be replaced via injection, or via an insulin pump. This should be combined with knowledge of dietary carbohydrate (CHO) values such that injected insulin can be adjusted to carbohydrate consumed to avoid large fluctuations in blood glucose levels.
What causes Type 1 diabetes?
Scientists and researchers remain unsure as to the exact cause of Type 1 diabetes but it is thought that a viral or other infection may trigger the autoimmune destruction. 4 The resultant lack of insulin must be replaced via injection, or via an insulin pump.
What is the key to achieving good blood sugar control?
Blood sugar. Monitoring is the key to achieving good blood sugar (BS) control. Today, the blood sugar level is recorded using a blood glucose meter. There are many different types of blood glucose meter but the same basic principles of use apply.
ABSTRACT
Dentists play a major role as part of an allied health team in providing oral care to patients with diabetes. As such, they may detect undiagnosed cases of diabetes and refer patients to physicians for further evaluation.
GLYCEMIC CONTROL REVISITED
Blood glucose or glycemic control is fundamental to the medical management of diabetes; prolonged and severe hyperglycemia is associated with systemic and oral complications. Thus, a management plan is needed.
ORAL COMPLICATIONS OF DIABETES
The oral complications of uncontrolled diabetes mellitus are devastating.
GENERAL MANAGEMENT CONSIDERATIONS
The dentist plays a major role in referral of patients with diabetes to physicians for additional evaluation.
MANAGEMENT OF THE ORAL COMPLICATIONS OF DIABETES
The comprehensive management of oral infections in patients with diabetes is beyond the scope of this article. Other sources are available that provide advice and examples of detailed therapeutic regimens.
CONCLUSION
The dentist plays a major role with allied members of the health team in helping a patient maintain glycemic control by properly treating oral infections, and by instructing the patient with diabetes to maintain rigorous oral hygiene and a proper diet.
Article Info
The author thanks Dr. Jonathan Ship for coordinating this special edition to JADA on diabetes mellitus