2. Diabetes
”Overview”
Diabetes mellitus is of great importance to dentists
Detect new case of diabetes
Render dental care to diabetic patients without
endangering their well being
Recognize the level of severity and glycemic
control and the presence of complications from
diabetes to consequently manage the patient
accordingly.
3. Current Classification of Diabetes
Type l: Beta-cell destruction or defect in beta-cell
function which lead to absolute insulin deficiency.
Immune mediated: Presence of insulin or islet
cells antibodies.
Idiopathic: No evidence of antibodies.
Type 2: Insulin resistance with relative insulin
deficiency.
4. Current Classification of Diabetes
(Cont.)
Other specific type: Genetic defects of beta-cell
function or insulin action, pancreatic diseases,
endocrinopathies, malnutrition, or drug or
chemical-induced diabetes.
Impaired fasting glucose.
Gestational diabetes: Any degree of abnormal
glucose tolerance during pregnancy.
5. Diabetes
Incidence & Prevalence
A dental practice serving an adult
population of 2000 can expect to
encounter about 120 persons with
diabetes.
50% of these patients are unaware of
their condition.
6. Diabetes
Etiology
The genetic role in type 2 diabetes is much
greater than type 1.
Obesity plays an important part in the cause of
type 2.
Type 1 has a sudden onset mainly found under
age 40.
Type 2 generally occurs after age 40 in obese
individuals.
7. Diabetes
Signs & Symptoms
*Polydypsia *Marked irritability
*Polyuria *Recurrence of bed wetting
*Polyphagia *Drowsiness
*Loss of weight *Malaise
*Loss of strength
Type 1: the onset of symptoms is sudden
Type 2: The onset of symptoms is slow & the cardinal
signs are less commonly seen.
8. Diabetes
Medical Management
Type 1
Diet & physical activity
Insulin (Conventional Multiple injections,
Continuous infusion, Pancreatic transplantation).
Type 2
Diet & physical activities
Oral hypoglycemic agents
Insulin plus hypoglycemic agents
Insulin
9. Diabetes
Dental Management
Any dental patient who has the cardinal
symptoms of diabetes should be referred to a
physician for diagnosis & treatment.
Pts with findings that may suggest diabetes:
Headache, dry mouth, marked irritability,
repeated skin infection, blurred vision,
paraesthesia, periodontal abscesses, loss of
sensation.
13. Adrenal Insufficiency
Incidence & Prevalence
A dental practice serving 2000 adults can
expect to encounter 50 patients who use
steroids or have potential adrenal
abnormalities (Chronically use corticosteroids
and thus are at risk for secondary
adrenocortical insufficiency).
14. Adrenal Insufficiency
Signs & Symptoms
Hypoadrenalism
Primary adrenal insufficiency: (Addison’s
disease): Weakness, fatigue, abnormal
pigmentation of the skin & mucous membrane.
In addition, hypotension & weight less.
Secondary adrenal insufficiency: (chronic
corticosteroid administration). Usually does not
produce symptoms unless the patient is
significantly stressed.
16. Adrenal Insufficiency
Signs & Symptoms
Hyperadrenalism:
Pts. Who have been receiving long term high-
dose corticosteroid therapy can develop signs &
symptoms of Cushing’s syndrome:
Weight gain, round or moon shaped facies, a
buffalo hump on the back, abdominal striae
and acne.
Other symptoms can include hypotension,
heart failure, osteoporosis and bone
fractures, diabetes mellitus, impaired
healing, mental depression & psychosis.
17. Adrenal Insufficiency
Medical Management
Management of the adrenal disease
Elimination of infection
Malignant disease
Hormonal replacement
Correcting ACTH
Balancing the beneficial effects of steroids
with unwanted side effects.
18. Adrenal Insufficiency
Dental Management
Dental treatment of a patient with
undiagnosed adrenal insufficiency should
be delayed until the patient is medically
stabilized
No treatment modifications are required for
medically stable adrenal disorders
19. Thyroid Disease
A patient of thyroid disease is of concern to the
dentist
The dentist may detect early signs and
symptoms (disease or tumor).
Pt. with untreated thyrotoxicosis may be in
danger if the dentist performs surgical or
operative procedures.
20. Thyroid Disease
Incidence & Prevalence
The most common thyroid disorder is
iodine deficiency (diet related) goiter.
In US the prevalence of goiter ranges from
0.5 to 7%.
21. Thyroid Disease
Signs & Symptoms
Hyperthyroidism
Nervousness
Fatigue
A rapid heart beat & palpitations
Heat intolerance
Weight loss
Soft & friable hair and soften nails
Graves’ ophthalmopathy (edema &
inflammation).
22. Thyroid Disease
Oral Manifestations
Hyperthyroidism
Osteoporosis that may involve the alveolar
bone
dental caries
Periodontal disease
Teeth that may develop rapidly
Premature loss of deciduous teeth.