diabetes prostho management

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Dcharacterized by hyperglycemia due to absolute or relative deficiency of insulin. 1 The two main categories of Diabetes Mellitus include Type I or Insulin dependentDiabetes Mellitus and Type II or Non insulin dependent Diabetes Mellitus. The former is a result of absolute deficiency of insulin with its onset occurring before adulthood.

In contrast, Type II results because of insulin resistance with an insulin secretarydefect with its onset usually occuring in mid or later life although it can occur earlieras well.2

Regarding pathogenesis, Type I Diabetes Mellitus results from immunologicaldestruction of pancreatic beta cells, while Type II results from combination ofimpairment of insulin resistance and defective secretion of insulin by beta cells.ontributing factors include genetics, obesity, physical inactivity and advancingage. 3 Diabetes Mellitus is becoming a common disease of today!s world, in "nited#ingdom one in twenty people over the age of $% has diabetes and this rises to onein five people over the age of &% years. The 'orld (ealth )rganization predicts that

the global prevalence of diabetes will increase from *+% million to + million in--%.4 ven in developing countries li/e 0a/istan, the incidence of diabetes isincreasing rapidly and most of the cases are undiagnosed as well. 0eople mostlyconsult their physician when typical symptoms of diabetes li/e polyuria, polydipsia,polyphagia occur.5 onsidering oral health in diabetic patients, they are more proneto develop caries, periodontitis, 1erostomia, oral ulcers, burning mouth syndrome,candidiasis, loss of resilience of oral mucosa, residual bone resorption, periodontalabscess, gingival overgrowth and poor tolerance to prosthesis especially forcomplete dentures. 6 )ral manifestations are most li/ely due to increase glucoseconcentration in saliva, polyuria, impaired host resistance due to defective function of polymorphonuclear leucocyte 20MN3 and microvasculsar changes.7

Management Considerations: General Dental Considerations

It is better to arrange appointment in the morning and avoiding lengthyappointments. 4ll procedures should be done involving minimal possible trauma andshould be carried in stress free environment. Maintenance of good oral hygiene is aprere5uisite for all dental procedures. In this regard application of topical agents li/echlorhe1idine, fluoride gel is found very useful. The use of prophylactic medication toavoid postoperative infection and pain is recommended in certain cases. 6ormanagement of 1erostomia, diet counseling, medication, artificial salivary substitutes

are helpful. 7efore starting any procedure consultation with patient!s physician orendocrinologist is also beneficial for the diabetic patients. 8

Dentist should also be able to /now about the diagnosis and management ofhypoglycemic shoc/. It is characterized by hunger, nausea, perspiration, pallor, andtachycardia. In severe condition seizure may occur and patient may undergo in stateof unconsciousness

Management depends upon the severity of the shoc/. Initially treatment should bedeferred and to monitor vital signs and administer glucose orally if possible otherwiseintravenous administration of glucose should be done.

Prosthodontics Management Considerations:


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radication of any disease8s that will affect the prognosis of any dental prosthesiswill be the first line of action. Teeth re5uiring restoration must be restored byappropriate restorative procedures li/e filling, endodontic treatment etc. 4spreviously mentioned restoration and the maintenance of good oral hygiene ismandatory before starting any prosthodontic procedures. )n first visit, assessment

of the patient should be done which include proper history and e1amination. Detailsregarding type of prosthesis, duration of treatment, number of appointments must bee1plained to the patient.10

Radiographic evaluation must be carried out. 0atients is advised to bring reports ofrecently done and up to date laboratory investigation regarding blood sugar level.9econdly it is better to note blood sugar level before starting any dental procedurewith the help of glucometer. 0atient must be instructed to consult his or her physicianbefore initiating any procedure, if needed then any alteration regarding patient!smedication must be discussed with the patient!s physician. 11

If patient is provided removable partial denture 2R0D3, then restoration andmaintenance of good oral hygiene by any restorative procedures or root planningand scaling must be accomplished first. (ealth of abutment teeth is very importantand will be achieved by various means for better prognosis of R0D treatment. 12 4llcomponents of R0D must be tissue friendly by ma/ing appropriate design of theprosthesis. 4s diabetic patients are more prone to develop periodontal diseases,therefore in certain cases splinting of periodontalally compromised teeth is also agood option. 9ome times periodontal surgery may be indicated.13 9election ofparticular type of R0D is also very important, in Diabetic patients. If an acrylicdenture is a preferred option then the design should incorporate the principles of:very Denture! with wider self cleansing interdental spaces and embrasures areas,uncovered marginal gingiva, point contact between denture and natural abutmentteeth, free gliding occlusion, ma1imum retention following complete denture ma/ingprinciples. These all factors are beneficial for the diabetic patients if they need R0D. 14

'hen complete denture is fabricated for diabetic patients then always use tissuefriendly material and techni5ue, impression ma/ing will be done by mucostatictechni5ue. )cclusal vertical dimension should be appropriate

4lways use an occlusal scheme that has narrow bucco;lingual dimension andshortened mesiodistal length. This approach will decrease the stress on the

underlying tissue to retard bone resorption, concept of neutral zone can also beemployed. Denture flanges should be smooth and polished. There should be nowor/ing or non;wor/ing occlusal interference between opposing teeth.15

It is also mandatory for the dentist to fully educate and motivate the patient to theimportance of maintaining good oral hygiene and towards the importance of regularfollow;up visits to the dentist.

This will ensure the long term heath of the oral tissues by preventing chronicinfection states such as denture related stomatitis and denture hyperplasia that couldlead to more serious conditions. Diabetic patients are more susceptible to infections

which in severe cases may lead to e1cessive oral tissue destructions, such patients


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may need obturators. 6abrication of obturator re5uire special care in every patientand especially in diabetic patient.16

6or patients re5uiring a fi1ed prosthesis li/e crown or fi1ed partial denture 260D3, thefinish;line of the preparation should be placed supragingival and to provide chamfer

finish;line on the facial aspect of prepared tooth as it is better than shoulder becauseshoulder can concentrate stresses on wea/ened tooth8 teeth. 4nte!s law should beobeyed< minimal preparation li/e three 5uarter crown can be done on teeth li/e premolar.

4 narrow occlusal table, group function or mutually protected occlusal scheme isbetter choice for periodontally compromised teeth.17. In certain cases procedures li/ecrown lengthening, periodontal surgery and orthodontic e1trusion of tooth will furtherimprove the 5uality of fi1ed prosthesis in diabetic patients.18 Implant supportedprosthesis are not advised for patients whose blood sugar level remainsuncontrollable but if conditions are favorable , then this type of prosthesis can be

planned. =i/e any other dental surgical procedure, implant placement must beaccomplished with least trauma under stress free environment.19

0roper medication must be provided before and after implant placement. ompletehistory and e1amination along with radiographic evaluation must be carried out forselection of type of dental implant, number of dental implants, site of implantplacement, type of artificial prosthesis and occlusal scheme.

4ll these considerations will ensure better performance of implants supportedprosthesis.20 21

Concl!sion

Diabetes Mellitus is a comple1 disorder having many oral and systemic problems.Multi disciplinary approach is needed for the management of diabetes mellitus.6abrication of dental prosthesis would only be started after complete evaluation ofdiabetic patients through history, e1amination and ma/ing diagnostic cast. 7eforeembar/ing any procedure for dental prosthesis, oral hygiene of the diabetic patientsmust be evaluated and should be improved through different surgical and non;surgical periodontal therapies and restorative techni5ues. 4part from conventionalremovable or fi1ed dental prosthesis, introduction of dental implants helps to improve

the 5uality of life of the patients by better masticatory ability of the dental prosthesis.In this article along with oral complications of Diabetes Mellitus, various0rosthodontics treatment options available for diabetic patients are discussedManagement of diabetic patients in 0rosthodontics should be done carefully. 7eforeembar/ing dental treatment it is better to consult patient!s physician. >ood oral anddenture hygiene maintenance is a pre re5uisite for ensuring the long term successful0rosthodontics treatment. 'ith an increasing incidence and prevalence of DiabetesMellitus, the role of oral health care provider becomes very important

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6rier 7M, Truswel 49, 9hepherd ?, ?ung R. Diabetes mellitus nutritional andmetabolic disorders. Davidson!s 0rinciples and 0ractice of Medicine. *&th ed. "#@hurchill =iving stone -*< AB*;%A-.

-. Rhodus N=, Cibeto 7M, (amamoto DT. >lycemic control in patients with diabetesmellitus upon admission to a dental clinic@ onsiderations for dental management.uintessance Int -%< +$@ ABA;A&-.+. >hom 4>. Te1t boo/ of )ral Medicine. *st ed. India@ ?aypee 7rothers -%< B$A;B&*.A. 6is/e ?. Diabetes Mellitus and )ral are. Dent "pdate -A< +*@ *E;&.%. 7asit 4, (ydrie MFI, 4hmed #, (a/eem R. 0revalence of diabetes, impairedfasting glucose and associated ris/ factors in a rural area of 7alochistan provinceacoording to new 4D4 criteria. ? 0a/ Med 4ssoc --< %-@ +%B;+$.$. 9oell M, (assan M, Miliaus/aite 4, (ai/el G, 9elimovic/ D The oral cavity ofelderly patients in diabetes. Diabetes Metab -B< ++ 9uppl *@ *;*&.

B. =ima D, Na/ata >, 7alducci I, 4lmeida ?I. )ral manifestations of DiabetesMellitus in complete denture wearers. ? 0rosthet Dent -&< EE@ $;$%.&. Miley DD, Terezhalmy >T. The patients with Diabetes Mellitus@ tiology,epidemiology, principles of medical management, oral disease burden and principlesof dental management. uintessance Int -%< +$@ BBE;BE%.E. (upp ?R. 0revention and management of medicalemergencies. Ath ed. "94@Mosby -< --*;-A*.*. 7ric/er 9=, =anglais R0, Miller 9. )ral Diagnosis, )ralMedicine and Treatment 0lanning. -nd ed. anada@ 7 Dec/er Inc --< A-*;AB.

**. (abib 99, 4lmas #. Management of Diabetic patients in dental practice. ? 0a/Dent 4ssoc --< **@ **;*$.

*-. arr 47, Mc>ivney >0, 7rown DT. Mcrac/en!s Removable 0artial0rosthodontics. **th ed. India@ lsevier -%< *A%;*$-.

*+. 9tewart #=, Rudd #D, #ueb/er '4. linical Removable 0artial 0rosthodontics.-nd ed. India@ 4I0D -%< EB;**$.

*A. 'almsley 4D. 4crylic 0artial Dentures. Dent "pdate -+< +@ A-A;E.

*%. Farb >4, 7olender =. 0rosthodonticc Treatment for dentulous 0atients. *-thed. "94@ Mosby -A< -E&;+-&.

*$. 9y/es =M, 9u/ha 4. 0otential ris/ of serious oral infections in the diabeticpatient@ 4 clinical report. ? 0rosthet Dent -*< &$@ %$E;%B+.

*B. 9hillingberg (T, (obo 9, 'hitsett =D, ?acobi R, 7rac/ett 9. 6undamentals of6i1ed 0rosthodontics. +rd ed. India@ uintessence --< -**;--A.

*&. Fiada (, Irwin , Mullaly 7, 7yrne 0?, 4llen . 0eriodontics@ 9urgical rown=engthening. Dent "pdate -B< +A@ A$-;&.


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diabetes prostho management

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