Diabetes Mellitus and Oral Health

Diabetes mellitus is a metabolic disorder which affects the uptake and use of glucose by the human body. As a result, the glucose level in the blood rises beyond normal which has an overall impact on the general health and oral cavity.

Types Of Diabetes

1. Insulin-dependent diabetes mellitus: It occurs due to deficiency of insulin hormone from the pancreatic cells. As a result, the glucose level in the blood rises which is not taken up by the liver cells.
2. Non-insulin dependent diabetes mellitus: It occurs due to resistance to the action of insulin which can be due to various factors including obesity. As a result, glucose is not taken up by the cells to be utilized as fuel by the body.

Common Symptoms

1. Polydipsia: Patient feels thirsty.
2. Polyphagia: Patient feels hungry all the time.
3. Polyuria: Frequent urination.

Oral Manifestations

There are several oral manifestations of diabetes mellitus. These are:

• Gingival inflammation or gingivitis.
• Peridontitis.
• Dryness of mouth or xerostomia from polyuria.
• Loss of taste sensations or alteration in taste from neuropathy.
• Poor oral hygiene from frequent calculus and plaque formation from rising glucose levels in saliva.
• Salivary gland enlargement from hypertrophy.
• Bone loss and tooth mobility from periodontitis and gingivitis.
• Certain lesions like lichenoid reactions from the use of drugs to control diabetes.
• Burning mouth.

Complications During Dental Surgery and Tooth Extraction

• Dry socket from susceptibility to infections and poor healing.
• Delay in wound healing.
• Septicemia or blood infection as these patients have lots of plaque and calculus which are safe haven for bacteria.
• Hypoglycemic shock due to a sudden fall of blood glucose level and patient collapses. It is the most serious complication.
• Hypotension due to a fall in blood pressure which occurs due to autonomous neuropathy among diabetic patients.

Management of Diabetic Patient with Oral Problems

• Maintain good oral hygiene by brushing twice daily.
• Mandatory scaling every three to six months to avoid calculus formation.
• Always try to do an atraumatic extraction.
• Suturing the wound or extraction site.
• Cleaning the extraction site with saline.
• Avoid leaving bony spicule at the extraction site which can cause dry socket.
• Always try morning extraction and ask the patient to come after eating food to avoid a hypoglycemic attack.
• Give antibiotic prophylaxis if needed before extraction to avoid infection transmission.
• Ask the patient to always come with an attendant.

When Should One Do Extraction

First, ask the patient for fresh tests like fasting blood glucose level and postprandial level.

Ask the patient for CBC (complete blood count) and CTBT (clotting time and bleeding time) to avoid complications from bleeding.

Before a major surgery, ask the patient to take the consent of an endocrinologist as well.

If these tests are normal, then go for extraction and if these are not normal, send the patient to the endocrinologist for management till investigations return to normal.

Ideally, the dentist should ask the patient to bring fasting blood glucose report and monitor postprandial level before extraction. After extraction, the postprandial test should be repeated after two hours. It is always better to keep the patient on monitoring for two hours after surgery or extraction.

Ideally, it is better and safer to do an extraction after the patient has taken food because one can compromise with hyperglycemia but not with hypoglycemia.

Between fasting glucose level of 110 to 125 mg/dl, one can do the extraction and less than 140 mg/dl after measuring postprandial levels.

If the patient has well-controlled diabetes, oral hypoglycemic drugs can be stopped for 24 hours prior to extraction or minor surgery. But glucose levels need to be monitored pre and postoperatively for two hours until the patient eats again and medication is to be started again.

However, if the disease is poorly controlled, the patient may require insulin before surgery. For such cases, the consent of an endocrinologist must be taken.

As a final note, if you find any diabetic patient, always explain to him/her the preventive measures to maintain good oral health. If you have sufficient technical and manpower support, then go for extraction. But, if you have problems of poor infrastructure, it is always wise to send the patient to an established government or private hospital. If the patient has poor diabetic control, never hesitate in referring the patient to an endocrinologist.

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