Diabetes Mellitus & periodontal disease
l History
l Definition
l Diagnosis
l Classification
l Oral manifestation of DM
l Factors pontentiate the development of periodontal dental disease
l Dental management of diabetic patient
l Periodontal treatment of diabetic patient
l Management of medical emergencies
History of diabetes
l Named for urinary symptoms
l Diabetes Greek origin for excessive urination
l Mellitus Latin origin for sweet taste of urine
Definition of D.M
D.M comprises heterogonous group of metabolic disease that are characterized by chronic hyperglycemia and disturbance in carbohydrate , lipid & protein metabolism . These disease result from defect in insulin secretion , insulin action or both
Diagnosis
l Patient with type I
• Polydispsia
• Polyuria
• Weight loss
• Less frequency polyphgia
• Blurred vision
• Pruritus
l Patient with type II
• Less acute than in type I
• Companied by lethargy and fatigue
• Generally older population
Important tests for diabetic patient
l Glycated hemoglobin test
1- hemoglobin A1 test (Hb1)
Normal values about 8%
2-hemoglobin A1C
Normal values less than 6-6.5%
l Glycated fructosamine
Normal range 2-2.8%mmol\L
Oral manifestation of DM
1-diminishes salivary flow.
2-burning sensation of mouth or tongue.
3-enlargment of parotid glands.
4-increase glucose in GCF may alter plaque micro-flora and influence periodontitis and dental caries.
5-increase tendency to multiple abscess formation ,enlarged swollen and gingival papillae that bleed profusely.
6-xerostomia ;conductive infection by opportunistic MO such as C.Albicans candidiosis
Factors pontentiate the development of periodontal disease
1- PMN cell function
Numerous studies have identified a clear role for the PMN cells in the maintenance of gingival and periodontal health.
Reduced PMN cell function in diabetic patient.
-Bissada et al (1982) show that the severity of periodontitis has been correlated with defective chemotaxis ,compared to those with mild periodontitis or non diabetic patient with sever or mild periodontitis.
-Nicoll et al (1982) in animal study,in rats,abnormalities of PMN function can be correlated by insulin therapy.
2- collagen metabolism and advanced glycation end products AGEs
-El Kishky (1986)
-Glub M et al (1978)
-Sorsa T. et al (1992)
*In Hyperglycemia Environment .
Protein (including collagen) by non-enzymatic glycosylation process -advanced glycation end products (AGE)
l -AGEs play a central role in diabetic complication. AGEs accumulation with chronic hyperglycemia;
l 1-Alters the function 0f numerous extracellular matrix component.
2-modifies matrix-matrix and cell-matrix interaction.
3-AGE formation on collagen cross linking solubility and turn over rate.
-Mono.R +AGE
-Macro.R+AGE increase IL_1,insulin like growth factor, TNF.
-Endothelial.R+AGE processing change leading to focal thrombosis and vasoconstriction.
-Salvi GE et al (1997)
-Schmidt AM et al (1996)
*Impaired host defense mechanism.
*Vascular change.
In hyperglycemic environment
BM protein ---became glycoslation
---Thickening
---changing in physical properties
-G.capillaries in D.patient have ;
--Thickening of BM
--Disruption of BM,collagen fiber within the BM
--Swelling of the endothelium
These change can hypothesize to impede:
-O2 diffusion
-Metabolic waste elimination
-PMN migration
-Diffusion of serum factors including antibodies
l *Insulin resistance
These three factors will also affect the
-Wound healing
-Decrease in collagen synthesis by fibroblast
l –Increase collagenase production in D. patient
Dental Management of diabetic patient
l Control of the acute infection and communication with the patient physician.
l For routine dental need
diabetic patient = non diabetic
l The procedure should be as short as possible ,atrumatic & stress free .
l Patient should be instructed to take his medication .
l Early morning appointments.
l Normal breakfast before appointment to prevent hypoglycemia .
l Periodontist must be aware of the risk of hypoglycemia during dental appointment and be ready to manage such occurrence .
Periodontal treatment of diabetic patient
l Trevonen (1997)
l Christaqu et al (1998)
l Rocha et al (2001)
Type 2 diabetic patient , two groups
• First group treated by alendronate (6month bone resorption ).
• Second group by placebo for 6month.
** the results : is the periodontal parameters is improved in both group , however alveolar bone loss increase in placebo , but decrease in alendronate group .
Management of medical emergencies
l Hypoglycemia or insulin shock :-
• Signs & symptoms
1- mental confusion
2- lethargy
3- nausea
4- hunger
5- huger bizarre behavior
6- mood changes
7- tachycardia
8- Cold clammy skin
9- cold gastric motility
10- hypotension
11- Loss of consciousness if the condition is not treated
Treatment of Hypoglycemia
l 15 g oral carbohydrate
l 10-20 ml of IV dextrose
• The signs & symptoms do not usually occur until blood glucose level fall below 60 mg\dL .
• patient after treatment respond within 5-10 min.
• If not transport to hospital emergency room .
Management of medical emergencies
l Hyperglycemia or diabetic crisis :-
• Signs & symptoms
1- disorientation.
2- rapid & deep breathing.
3- hot dry skin.
4- acetone breath.
5- loss of consciousness will develop without proper treatment .
• Treatment
I – airway maintenance + 100% oxygen.
II – IV fluid to prevent vascular collapse .
* Hyperglycemia may develop when blood glucose over 200 mg\dL .
المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .