DENTAL MANAGEME

NT OF PATIENT

WITH DIABETES DISEASE

DEFINITION

It is a persistent increase of blood glucose level ,it is a result of absolute or relative deficiency of insulin.

TYPES There are two types of DM:

1\Type 1 :insulin-dependent Young onset (childhood & adolescence).

Pt with normal weight . Decrease blood insulin.

2\Type 2 :

Non-insulin dependent. Adult onset diabetes. Risk factors :age , obesity , alcohol , diet , family history and lack of physical activity.

Normal or increase blood insulin.

MAIN SYMPTOMS Excessive of urination occurs ( polyuria).

Increase fluid loss lead to dehydration and excess thirst.

Increase hunger feeling. Loss of wight.

ORAL MANIFESTATION Gingivitis. Alveolar bone resorption. Xerostomia. Delayed wound healing. Pulpitis in non caries tooth. Burning sensation in tongue. Acetone smell in breath . Increase of infection (Candida). Ulcers.

DIAGNOSIS

A plasma glucose level of 200mg\dl or more with symptoms presented.

Fasting plasma glucose level

126-or more .and normal

(<110mg\dl).

MEDICAL MANAGEMENT

Exercise and diet control. Insulin : rapid , short, intermediate, long acting.

Oral antidiabetic agent .

DENTAL MANAGEMENT

Morning appointment and short . Ensure that the patient has eaten and

taken medication. Blood glucose controlling (measured

before beginning ). Prophylactic antibiotics (established

infection ,major surgery , pre operation contamination wound).

EMERGENCY MANAGEMENT

During treatment there complication of DM are :

hypoglycemia( most

complication). Hyperglycemia.

HYPOGLYCEMIA Signs:

Headache. Confusion. Hunger. Weakness. Sweating. Tachycardia, cool and pale. Consequence in unconsciousness,

hypotension , seizures', coma even death.

Management: Maintain airway . Keep pt supine. 15 grams of fast-acting oral

carbohydrate. Measured blood sugar. Loss of conscious 25-30ml 50%dextrose

solution I.V over 3min period. Glucagon 1mg. Assess vital signs. Call ambulance.

HYPERGLYCEMIA

Signs: nausea.

Vomiting. Abdominal pain . Acetone odor. Management: Need medication intervention

and insulin.

SECOND PART OF LECTURE

DENTAL MANAGEMENT OF PATIENT WITH RENAL, LIVER AND THYROID DISEASE.

RENAL DISEASE Symptoms: Decrease urine out put 70% Edema. Mental changes. Heart failure. Nausea , vomiting. Anemia. Cool, pale, moist skin..

ORAL MANIFESTATION

Taste and smell ammonia. Stomatitis (ulcer). Gingivitis. Decrease salivary flow ( high

caries rate). Parotitis.

MEDICAL MANAGEMENT Dialysis: It diffuse harmful waste out of

body. 3-4 times a week and take 2-4

hours. (machine filters blood and return

it to body).

DENTAL MANAGEMENT Determine dialysis schedule & treat on

the day after dialysis. Consult with the patient physician for

antibiotics prophylaxis. Avoid taking blood pressure

measurement ,injection of medication on the arm with (shunt).

Allow pt to walk or stand during procedures.

Take hepatitis precaution if un able to screen for hepatitis.

Note: The bleeding is the most

commonly affect patient after periodontal or surgery treatment

We can use anti fibrinolytic agent in the form of mouth wash or soaked gauze on bleeding site.

LIVER DISEASE That include:Liver cirrhosis. Jaundice.

POTENTIAL COMPLICATION1) reduced drug detoxication e.g. sedative,

analgesic, general anesthesia.

2) Bleeding disorders due to decrease clotting factors, excess fibrinolysis ,decrease vitamin K absorption.

3) Transmission of viral hepatitis.

Recommendation to dental practitioners: HBV vaccination for all staff. Protocols: hand wash before Tx . Routine use of gloves and protective eyes wear. Using masks & gowns. Heat sterilizing hand pieces between pt. Disposable instrument or individual instrument for

each patient.

DENTAL MANAGEMENT Medical consultation. Avoid drugs metabolized in liver:L.A (lidocaine )& G.A (caused

bleeding).Sedatives (valium).Antibiotics (ampicillin).Analgesics (aspirin).recommended to give pt VIT K

(10 mg/day before surgery).

THYROID DISEASE Thyroid function : produce T3

and T4 which regulate the body metabolic rate and increase protein synthesis.

Types of thyroid disease : 1\hyper thyrodism . 2\hypo thyrodism.

HYPER THYRODISM Symptoms : Nervousness . Anxiety. Heat intolerance. Fatigue. Weight loss. Palpitations. Rapid heart beat. Worm moist skin. Diarrhea. aOpthlmopathy : edema & inflammation of

the extra ocular muscles.

MEDICAL TREATMENT Beta blockers (propranalol). Subtotal \radioactive iodine. Dental management : Recognize signs & symptoms. Patient un treated or

incompletely treated are very sensitive to epinephrine (adrenaline) do not administer.

HYPO HTYRODISM Symptoms: Increase sensitivity to cold. Constipation. over weight. Weakness . Dry hair & skin. Puffy eyelids. Moving & thinking slowly.

MEDICAL TREATMENT

T4 ( thyroxin). Dental treatment :

Recognize signs & symptoms .

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