Dental Management of Diabetic Patient

8/14/2019 Dental Management of Diabetic Patient

1/15

Dental management of

diabetic patient

Presented by: Jamal .Q.

Ahmed


2/15


3/15

Oral Manifestations ofDM

None arepathognomonic

Commonlyassociatedconditions:

xerostomia enlargement of

parotidglands

burning

mouth/tongue altered taste candidias periodontal

disease


4/15

Oral manifestations andcomplications

No specific oral lesions associated with diabetes.

However, there are a number of problems by present of

hyperglycemia.

Periodontal disease Microangiopathy altering antigenic challenge.

Altered cell-mediated immune response andimpairment of neutrophil chemotaxis.

Increased Ca+ and glucose lead to plaque formation.

Increased collagen breakdown.


5/15


Salivary glands Xerostomia is common, but reason is unclear.

Tenderness, pain and burning sensation of tongue.

May secondary enlargement of parotid glands with

sialosis.

Dental caries Increase caries prevalence in adult with diabetes.

(xerostomia, increase saliva glucose)

Hyperglycemia state shown a positive associationwith dental caries.


6/15


Increased risk of infection Reasons unknown, but macrophage metabolism

altered with inhibition of phagocytosis.

Peripheral neuropathy and poor peripheral circulation Immunological deficiency

High sugar medium

Decrease production of Ab

Candical infection are more common and addingeffects with xerostomia


7/15


Delayed healing of wounds Due to microangiopathy and utilisation of protein for

energy, may retard the repair of tissues.

Increase prevalence of dry socket.

Miscellaneous conditions Pulpitis : degeneration of vascular.

Neuropathies : may affect cranial nerves. (facial)

Drug side-effects : lichenoid reaction may be

associated with sulphonylurea. (chlopropamide) Ulcers


8/15

Dental management

considerations To minimize the risk of an intraoperative emergency,clinicians need to consider some issues before initiatingdental tx.

Medical history : take hx and assess glycemic

control at initial appt. Glucose levels

Frequency of hypoglycemic episodes

Medication, dosage and times.

Consultation


9/15

Dental managementconsiderations

Scheduling of visits Morning appt. (endogeneous cortisol) Do not coincide with peak activity.

Diet Ensure that the patient has eaten normally and taken

medications as usual. Blood glucose monitoring

Measured before beginning. (


10/15

Dental managementconsiderations

During treatment The most complication of DM occur is hypoglycemia

episode.

Hyperglycemia

After treatment Infection control

Dietary intake

Medications : salicylates increase insulin secretionand sensitivity avoid aspirin.


11/15

Emergency management

Hypoglycemia

Initial signs : mood changes,decreased spontaneity, hunger and

weakness. Followed by sweating, incoherence,

tachycardia.

Consequenced in unconsiousness,hypotention, hypothermia, coma,even death.


12/15


15 grams of fast-acting oralcarbonhydrate.

Measured blood glucose.

Loss of conscious, 25-30ml 50% dextrosesolution iv. over 3 min period.

Glucagon 1mg.

Emergency call


13/15


Severe hyperglycemia

A prolonged onset

Ketoacidosis may develop with

nausea, vomiting, abdominal painand acetone odor.

Difficult to different hypo- or hyper-.


14/15


Hyperglycemia need medicationintervention and insulin administration.

While emergency, give glucose first !

Small amount is unlikely to causesignificant harm.


15/15

Conclusion

Documents

Dental Management of Diabetic Patient