dental management of a diabetic patient

DENTAL MANAGEMENT OF A DIABETIC PATIENTDR: MAMOON MARWATSARDAR BEGUM DENTAL COLLEGE PESHAWAR

CONTENTS DIABETES

TYPES Pathophysiology LOCAL AND GENERAL

COMPLICATIONS Lab findings DENTAL MANAGEMENT

Diabetes

Diabetes Mell i t ius is characterized by hyperglycemia result ing from defects in insul in secreation,insul in action or both

TYPES OF DIABETES MELITUS

TYPE 1(insulin secretion) TYPE 2(insulin resistance)

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

Type 2 DM

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

Pathophysiology

Insulin uptakes of glucose from the blood into the cell

Pancrease (beta cells found in islets of in response to rising level of blood glucose langherhans )

IF the amount of insulin available is insufficient or cells responds poorly to the effect of insulin Net effect will be high level of blood glucose

PATIENT WITH CARDINAL SIGNS OF DIABETES

Polydipsia Polyurea Polyphagia Weightloss Poor wound healing Severe infections Obesity Weakness

General complications

Ketoacidosis Hyperosmolar nonketotic coma (type 2 diabetes) Diabetic retinopathy/blindness Diabetic nephropathy/renal failure Accelerated atherosclerosis (coronary heart disease ) Ulceration and gangrene of feet Diabetic neuropathy Infections

Diabetic gangrene of the feet.

Oral complications of poorly controlled diabetes mellitus

XEROSTOMIA BURNING SENSATION Gingivitis and periodontitis DENTAL CARIES bacterial, viral, and fungal infections Periapical abscesses

SEVERE PROGRESSIVE PERIODONTIS

Oral moniliasis in a patient with

diabetes(Multiple white lesions)

Mucocormycosis (a serious fungal infection )

Criteria for the Diagnosis of Diabetes Mellitus

Symptoms o f d i abe tes p lus casua l p lasma g lucose l eve l o f 200 mg/dL o r g rea te r

Fas t ing p lasma g lucose o f 126 mg/dL o r g rea te r

2-hour plasma glucose level of 200 mg/dL or greater during an oral glucose tolerance test

The test should be performed using a glucose load containing the equivalent of 75 g of anhydrous glucose dissolved in water; this test is not recommended for routine clinical use

Glycohemoglobin.Measurement of HbA1c levels is of value in the detection and evaluation of patients

HbA1c is an electrophoretically fast-moving hemoglobin 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.

treatment

TYPE 1 DIABETES Diet and physical activity Insulin Pancreatic transplant

TYPE 2 DIABETES Diet and physical activity Insulin Oral hypoglycemic agents

DENTAL MANAGEMENT

MEDICAL CONSIDERATIONS

Any dental patient whose condition remains undiagnosed but who has the cardinal symptoms of diabetes Should be refered to physician

Patients with findings that may suggest diabetes should be referred to a clinical laboratory or a physician for screening tests.

MEDICAL CONSIDERATIONS

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

Medical considerations

Vital 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

Dental management of patient with diabetes

If diabetes is well-controlled, all dental procedures can performed without special precautions before starting the procedure ,verify that the patient have taken medication and diet as usual

Dental management of patient with diabetes

IF Diabetes is poorly controlled I.e fasting blood glucose <70 mg/dL or >200 mg/dL and ANY complications [post MI, renal disease, congestive heart failure, symptomatic angina, old age, cardiac and blood pressure ≥180/110 mm Hg ,All elective dental procedures should be postponed.

Provide Only emergency care, Consult patient physician Critical setting: hospital Patient preparation: ECG,PULSE,B,P,RESPIRATION MONITERING

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

Patient 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

Infection should be treated with the use of standard methods Warm intraoral rinses Incision and drainage Pulpotomy, pulpectomy,extractions antibiotics

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 Patient should come with normal breakfast taken and normal

regular dose of insulin taken

DENTAL MANAGEMENT OF A DIABETIC PATIENT

AT CLINIC Immediate treatment should be provided A source of glucose such as orange juice should be present in the

dental office to avoid hypoglycemic 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.

DENTAL MANAGEMENT OF A DIABETIC PATIENT

A major goal in dental management of diabetes is to prevent insulin shock MANAGEMENT OF INSLUN SHOCK WHEN OCCUR.

Most common diabetic emergency which dentist encounter is hypoglycemia

Leads to life threatening consequences It occurs when concentration of blood glucose drops below 60

mg/dl

DENTAL MANAGEMENT OF A DIABETIC PATIENT

Sign and symptoms Confusion Restlessness Tremors Sweating tachycardia

DENTAL MANAGEMENT OF A DIABETIC PATIENT

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

DENTAL MANAGEMENT OF A DIABETIC PATIENT

If the patient is conscious and she is able to take her food by mouth so give 15 g of the carbohydrate in the following form

orange juice 3-4tablespoon 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.

DENTAL MANAGEMENT OF A DIABETIC PATIENT

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.

DENTAL MANAGEMENT OF A DIABETIC PATIENT

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 necessary that the total content of the calorie

protein/carbohydrate/fats etc remains the same. Antibiotics should be given after surgery.

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