ORAL Health

inRELASHINSHIP to
DIABETES MELLITUS
BY NABAA ALI MOHAMMED
SUPERVISOR : DR DALIA ABBAS
DIABETES MELLITUS:
that occurs when your blood glucose, also called blood sugar, is too high.
Blood glucose is your main source of energy and comes from the food you
.eat
?What are the different types of diabetes
T YP E 1 D IA B E TE S M E LL IT U S
T YP E 2 D IA B E TE S M E LL IT U S
G E STATI O N A L D IA B E TES
:O TH E R T YP ES
M O D Y ( M ATU R IT Y- O N SE T D IA B ET ES O F YO U TH )
S EC O N D A RY D IA B ET ES M ELL IT U S
Type 1 DM : results from the body's failure to produce insulin, and
currently requires the person to inject insulin.
This form was previously referred to as "insulin-dependent diabetes
.mellitus" (IDDM) or "juvenile diabetes“the cause is unknow
.
Type 2 DM : results from insulin resistance, a condition in which cells fail to use
insulin properly, sometimes combined with an absolute insulin deficiency.This form was
previously referred to as non-insulin-dependent diabetes mellitus (NIDDM) or "adult-onset
."diabetes
Gestational diabetes : in some women when they are pregnant. Most
.of the time, this type of diabetes goes away after the baby is born
HbA1c :It is a test that allows healthcare providers to see how
diabetics have managed their blood glucose level over the last 2-3
.…months
:Critera for diagnosis DM
Symptoms of diabetes + casual plasma glucose level less than or equal
to 200 mg/dL
OR
•Fasting plasma glucose higher than or equal to
126 mg/dL
OR
•2-hour postload glucose level higher than or equal to 200 mg/dL during
an oral glucose tolerance test
•Impaired glucose tolerance (IGT)
◦FPG <110 mg/dL: normal fasting glucose
◦FPG ≥110 mg/dL but <126 mg/dL: impaired fasting glucose (IFG)
◦FPG ≥126 mg/dL: provisional diagnosis of diabetes mellitus
People who have diabetes know the disease can harm the eyes,
nerves, kidneys, heart and other important systems in the body.
?Did you know diabetes can also cause problems in your mouth
Oral complication of poorly
contorollrd of DM:

1.Dental caris.
2.Salivary dysfunction(dry mouth).
3.Oral mucosa disease and other oral
infection.
4.Taste and neurosensory disorder.
5.Gingivitis.
6.periodotitis.
7.Burnning sensation.
8.Periapical abcesses.
Dental caris: The relationship between dental caries and diabetes mellitus is complex. Children with
type 1 diabetes often are given diets that restrict their intake of carbohydrate-rich, cariogenic foods, whereas children
and adults with type 2 diabetes which often is associated with obesity and intake of high-calorie and carbohydrate-
rich food can be expected to have a greater exposure to cariogenic foods. Furthermore, a reduction in salivary flow
has been reported in people with diabetes who have neuropathy, and diminished salivary flow is a risk factor for
.diabetes
Salivary dysfunction :One of the most common
symptoms of diabetes is dry mouth, or xerostomia.
Dry mouth is a common symptom in both type 1 and
type 2 diabetes. Not everyone with diabetes will
experience it, though. You can also have dry mouth
if you don’t have diabetes. If you have dry mouth
and suspect you might have diabetes, you should
.talk to your primary care doctor
Oral mucosal diseases and other oral
:infections
◦ Fungal infection: Candida albicans is a
fungus that normally lives inside the
mouth without causing any problems.
But when you have diabetes, deficient
saliva in your mouth and extra sugar in
your saliva allow the fungus to cause an
infection called candidiasis (thrush),
which appears as sore white or red
areas in your mouth.
Taste and other neurosensory
disorders:

Having diabetes may raise your risk of a taste

disorder, too. Studies show that people who are
newly diagnosed with Type 2 are more likely to
have trouble tasting sweet foods.
Diabetic Retinopathy Viewed as a Neurosensory
Disorder. Diabetic retinopathy is usually
considered to be a disease of the retinal blood
vessels, capable of causing visual deficits from
macular edema, vitreous hemorrhage, and
vitreoretinal tractional complications.
Gingivitis: begins with bacteria build up
on and around your teeth that extends
into the gums. There is no difference
between the bacteria in the mouth of
someone with diabetes compared to
someone without diabetes. The reason
gum disease is worse if you have
diabetes is because you have a greater
inflammatory response
to this bacteria.
Periodontal disease :may make it more
difficult for you to control your blood
sugar. Your body's reaction to
periodontal disease can increase your
blood sugar level. Consequently, it is
important for patients with diabetes to
treat and eliminate periodontal infection
for optimal diabetes control. Periodontal
treatment combined with antibiotics has
been shown to improve blood sugar
levels in patients with diabetes,
suggesting that treating periodontal
disease could decrease insulin
requirements
:Dental Manengment of DM
:Each visit should begin with several questions and actions
1 What medications did you take today? Did you take the same amount of
those medica- tions that you would normally take?
2 What did you eat most recently? Was that the same type of food and
same amount of food you normally eat at this time of day?
3 What is the baseline glucose level a determined by the patient’s glucoif
you have diabetes
4 if you have trouble keeping your blood sugar levels under control
5 if you notice changes in your mouth, such as patches of whitish-
coloured skin
6 if there have been other changes in your medical history
7 the names of any medications (prescription as well as over-the-counter
drugs) you are taking.meter immediately prior to the dental procedure?
If diabetes is well-controlled, all •
dental procedures can be
performed without special
precautions.
• Morning appointments are usually
best.
• Patient advised to take usual
insulin dosage and normal meals
on day of dental appointment;
information confirmed when
patient comes for appointment.
• Advise patient to inform dentist or
staff if symptoms of insulin
.reaction occur during dental visit
If not well-controlled(i.e.,: fast blood glucose <70
mg/dL or
>200 mg/dL and ANY complications [post Ml, renal
disease, congestive heart failure, symptomatic
angina, old age, cardiac dysrrhythmia,
cerebrovascular accident], and blood
pressure>_180/110 mm Hg, or functional capacity < 4
metabolic equivalents):
• Provide appropriate emergency care only.
• Request referral for medical evaluation,
management, and risk factor modification
• If symptomatic ,seek immediate referral.
Tooth extractions for DM :
DRY SOCKET is the main complication which might occur after tooth
..extraction. Delayed healing is the underlying cause of this condition
People with diabetes need to be careful because extractions
open the gum to infection. This infection may cause
hyperglycaemia and mobilize fatty acids leading to acidosis.
All these conditions make control of blood sugar level
extremely difficult.
The major threat posed to diabetic patients with raised
glucose levels for tooth extraction is not during actual
extraction. The worry is how the healing will take place.
The healing can be delayed, the socket may get dried and
also a possibility of osteomyellitis. And if the diabetes is
accompanied by hypertension, the result would be affected
. severely. Complications can arise after the extraction
Timing of dental appointments :
Appointment timing for patients with diabetes is important.
Many older texts recommended treating patients with
significant medical conditions in the early morning hours.
That may or may not be appropriate for people with
diabetes, depending primarily on the patient’s medication
regimen. The medications taken by the patient are the
primary factor in deciding what time of day to treat the
.patient
How you can improve your oral health in
:DM SCMA UOSKEI DN GB Y- SPMOOOKR EBRLSOHOAV E HIGHER LEVELS OF GUM DISEASE, -1
D C I R C U L AT I O N I N T H E T I S S U E S A R O U N D T H E I R
T E E T H . P E O P L E W I T H D I A B E T E S W H O S M O K E H AV E A N E V E N G R E AT E R
C H A N C E O F H AV I N G S E V E R E G U M P R O B L E M S T H A N N O N - S M O K E R S A N D
.N O N - D I A B E T I C S
.L O O K F O R E A R LY S I G N S O F G U M D I S E A S E - 2
K E E P T O Y O U R H E A LT H Y E AT I N G P L A N A N D TA K E P R E S C R I B E D - 3
.M E D I C AT I O N S A S Y O U R D O C T O R D I R E C T S
B R U S H T W I C E A D AY D W I T H F L U O R I D E T O O T H PA S T E A N D A S O F T - 4
B R U S H . TA K E C A R E T O R E M O V E A L L P L A Q U E O N A N D B E T W E E N Y O U R
.T E E T H , A N D N E X T T O T H E G U M L I N E
I F Y O U H AV E D E N T U R E R E M O V R T H E M O V E R N I G H T A N D C L E A N - 5
.T H E M D A I LY
V I S I T Y O U R D E N T I S T O R O T H E R O R A L H E A LT H P R O F E S S I O N A L - 6
.R E G U L A R LY
BOOK YOUR APPOINTMENTS FOR THE MORNING WHEN YOUR -7
.I N S U L I N L E V E L I S M O R E S TA B L E
TRY TO CON T ROL Y OUR BLOO D SU GA R LE V EL. THOS E W I TH HIGH -8
B L O O D S U G A R L E V E L S A R E M O R E L I K E LY T O H AV E M O R E S E V E R E G U M
P R O B L E M S . I F Y O U H AV E G O O D C O N T R O L O F Y O U R B L O O D S U G A R
L E V E L A N D G O O D O R A L C A R E , Y O U S H O U L D H AV E M I N I M A L P R O B L E M S
.W I T H Y O U R O R A L H E A LT H
advised to avoid dental appoint-
ments when the patient:
• Has not had meds or eaten
• Has cold, or flu, or tiredness
• Has not recently seen their
physician
• Has levels <70 mg/dl or >150 mg/
dl