Dental management of a diabetic patient

1. DENTAL MANAGEMENT OF A
DIABETIC PATIENT
DR: MAMOON MARWAT
SARDAR BEGUM DENTAL COLLEGE PESHAWAR

2. CONTENTS  DIABETES
 TYPES
 Pathophysiology
 LOCAL AND GENERAL COMPLICATIONS
 Lab findings
 DENTAL MANAGEMENT

3. Diabetes
 Diabetes Mellitius is characterized by
hyperglycemia resulting from defects in
insulin secreation,insulin action or both

4. TYPES OF DIABETES MELITUS
 TYPE 1(insulin secretion)
 TYPE 2(insulin resistance)

5. 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

6. 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

7. 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

8. PATIENT WITH CARDINAL SIGNS OF
DIABETES
 Polydipsia
 Polyurea
 Polyphagia
 Weightloss
 Poor wound healing
 Severe infections
 Obesity
 Weakness

9. 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

10. Diabetic gangrene of the feet.

11. Oral complications of poorly controlled
diabetes mellitus
 XEROSTOMIA
 BURNING SENSATION
 Gingivitis and periodontitis
 DENTAL CARIES
 bacterial, viral, and fungal infections
 Periapical abscesses

12. SEVERE PROGRESSIVE PERIODONTIS

13. Oral moniliasis in a patient
with diabetes(Multiple white
lesions)

14. Mucocormycosis (a serious
fungal infection )

15. Criteria for the Diagnosis of Diabetes Mellitus
 S y m pt o m s o f diabet es plu s cas u al plas m a glu co s e level
o f 200 m g/dL o r great er
 F ast in g plasma glu cose of 126 mg/dL or greater

16.  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

17.  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.

18. treatment
TYPE 1 DIABETES
 Diet and physical activity
 Insulin
 Pancreatic transplant
TYPE 2 DIABETES
 Diet and physical activity
 Insulin
 Oral hypoglycemic agents

19. DENTAL MANAGEMENT

20. 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.

21. 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

22. 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

23. 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

24. 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

25. 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

26.  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

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

28. 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

29. 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.

30. 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

31. DENTAL MANAGEMENT OF A
DIABETIC PATIENT
 Sign and symptoms
 Confusion
 Restlessness
 Tremors
 Sweating
 tachycardia

32. 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

33. 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.

34. 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.

35. 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.

36. THANK You