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Treating Diabetes In Dentistry

Diabetes Mellitus

Diabetes Mellitus

Poorly controlled diabetic patients are at risk for numerous oral complications such as periodontal disease, salivary gland dysfunction, infection, neuropathy, and poor healing. Diabetes mellitus (diabetes) is a common chronic disease of abnormal carbohydrate, fat, and protein metabolism that affects an estimated 20 million people in the United States, of whom about one third are undiagnosed. There are two major forms recognized, type-1 and type-2. Both are characterized by inappropriately high blood sugar levels (hyperglycemia). In type-1 diabetes the patient can not produce the hormone insulin, while in type-2 diabetes the patient produces insulin, but it is not used properly. An estimated 90% of diabetic patients suffer from type-2 disease. The causes of diabetes are multiple and both genetic and environmental factors contribute to its development. The genetic predisposition for type-2 diabetes is very strong and numerous environmental factors such as diet, lack of exercise, and being overweight are known to also increase one’s risk for diabetes. Diabetes is a dangerous disease which affects the entire body and diabetic patients are at increased risk for heart disease, hypertension, stroke, kidney failure, blindness, neuropathy, and infection when compared to nondiabetic patients. Diabetic patients also have impaired healing when compared to healthy individuals. This is in part due to the dysfunction of certain white blood cells that fight infection. The most common test used to diagnose diabetes is the fasting blood glucose. This test measures the glucose levels at a specific moment in time (normal is 80-110 mg/dl). In managing diabetes, the goal is to normalize blood glucose levels. It is generally accepted that by maintaining normalized blood glucose levels, one Continue reading >>

Best Practices For Managing The Diabetic Patient In The Dental Office

Best Practices For Managing The Diabetic Patient In The Dental Office

Brian L. Mealey, DDS, MS; Robert J. Genco, DDS, PhD; and Rachel A. Schallhorn, DDS, MS Abstract With the number of diabetic patients in the United States on the rise and the close association now known to exist between diabetes and periodontal disease, it is critical that oral healthcare providers have an understanding of best practices for treating this growing population. This article examines the relationship between diabetes and periodontal disease and offers practical considerations for dentists treating diabetic patients. According to the most recent (2014) National Diabetes Statistics Report of the Centers for Disease Control and Prevention, some 29.1 million Americans currently have diabetes, including both type 1 and type 2.1 This constitutes 9.3% of the total US population, with an additional 86 million Americans identified as having prediabetes. Both the incidence and prevalence of diabetes have been steadily increasing.2 A chronic inflammatory disorder, diabetes is associated with significant morbidity and mortality and is a leading cause of kidney failure, blindness, limb amputation, myocardial infarction, and stroke. It also is now understood to have a two-way relationship with periodontal disease, with poor glycemic control adversely affecting the periodontium, and inflammatory periodontal diseases associated with potential negative effects on glycemic control.3 Given the growing number of diabetic patients (Table 1) and the close association between diabetes and periodontal disease, it is incumbent on oral healthcare practitioners to be aware of the best practices for treating this population. The aim of this article is to review some of these practices. Background Some understanding of the relationship between diabetes and periodontal disease dates back Continue reading >>

Dentists Management Of The Diabetic Patient: Contrasting Generalists And Specialists

Dentists Management Of The Diabetic Patient: Contrasting Generalists And Specialists

Dentists Management of the Diabetic Patient: Contrasting Generalists and Specialists Carol Kunzel , PhD, Evanthia Lalla , DDS, MS, and Ira Lamster , DDS, MMSc The authors are with the College of Dental Medicine, Columbia University, New York, NY. Carol Kunzel is also with the Mailman School of Public Health, Columbia University, New York. The authors are with the College of Dental Medicine, Columbia University, New York, NY. Carol Kunzel is also with the Mailman School of Public Health, Columbia University, New York. The authors are with the College of Dental Medicine, Columbia University, New York, NY. Carol Kunzel is also with the Mailman School of Public Health, Columbia University, New York. The authors are with the College of Dental Medicine, Columbia University, New York, NY. Carol Kunzel is also with the Mailman School of Public Health, Columbia University, New York. Requests for reprints should be sent to Carol Kunzel, PhD, Division of Community Health, College of Dental Medicine, Columbia University, 630 W 168th St, New York, NY 10032 (e-mail: [email protected] ). Copyright American Journal of Public Health 2007 This article has been cited by other articles in PMC. Objectives. We measured and contrasted general dentists and periodontists involvement in 3 areas of managing diabetic patientsassessment of health status, discussion of pertinent issues, and active management of patientsand identified and contrasted predictors of active management of diabetic patients. Methods. We conducted a cross-sectional mail survey of random samples of general dentists and periodontists in the northeastern United States during fall 2002, using lists from the 2001 American Dental Directory and the 2002 American Academy of Periodontology Directory. Responses were received from 10 Continue reading >>

The Diabetic Patient And Dental Treatment: An Update

The Diabetic Patient And Dental Treatment: An Update

The diabetic patient and dental treatment: an update BDJ volume 211, pages 209215 (10 September 2011) This paper has been written to both refresh and update clinicians' knowledge of diabetes. Treatment for patients with diabetes continues to develop with the majority of Type 1 diabetics now using multiple daily injections and an increasing minority using insulin pumps. Blood glucose monitoring and patient education programmes have resulted in more patient involvement in controlling this condition. Type 2 diabetics have had improvement in care provision through the development of shorter acting sulphonylureas and the potential for GLP1 injections. The impact of diabetes on both oral health and quality of life is discussed. Practical suggestions are made regarding the dental treatment of diabetic patients using both local anaesthetic and under sedation. Diabetes continues to be a fickle master for those affected by this condition. The paper is written from the perspective of the 'expert patient'. It is hoped that a greater understanding of this chronic condition will improve both access to, and safety of, dental care for those patients with diabetes. Provides an update on the current management of Type 1 and Type 2 diabetes. Outlines the oral health implications of having diabetes. Advises on the safe dental treatment of the diabetic patient including under sedation. Discusses the possible effects of dental treatment on diabetic control. As Martin Silink, past-president of the International Diabetes Foundation (2003-2006), expressed, 'diabetes is understood by few and ignored by many'. 1 With the current global epidemic of this condition it is important that clinicians should have background knowledge of diabetes and its implications for dental care so that barriers to t Continue reading >>

Diabetes And Dental Care

Diabetes And Dental Care

Diabetes can affect your whole body, including your mouth. So you’ll want to take special care of your teeth and gums. It’s also important to manage your blood sugar. Over time, increased levels of blood glucose can put you at risk for oral health problems. Watch out for: Dry mouth, which can lead to soreness, ulcers, infections, and tooth decay. Inflammation in your gums. Thrush. People with diabetes who often take antibiotics to fight infections are more likely to get this fungal infection of the mouth and tongue. The fungus thrives on the high levels of sugar in the saliva of people with uncontrolled diabetes. It can give your mouth and tongue a burning feeling. You can do a lot to avoid these problems, starting with the basics of taking good care of your mouth, teeth, and gums. Keep your blood sugar as close to normal as possible. If you have dry mouth, try a mouthwash without alcohol. Brush your teeth after every meal. Wait at least 30 minutes after eating before brushing to protect any tooth enamel that's been softened by acid in the food. Use a toothbrush with soft bristles. Floss at least once a day. Rinse daily with an antiseptic mouthwash. If you wear dentures, remove them and clean them daily. Do not sleep in them. If you smoke, talk to your doctor about ways to quit. Tell your dentist that you have diabetes and what medicines you take. Let her know if your blood sugar level is off-track, and if you take insulin, tell her when you took your most recent dose. Get your teeth and gums cleaned and checked by your dentist twice a year. Your dentist may recommend that you do it more often, depending upon your condition. Continue reading >>

Management Of A Diabetic Patient In Dental Office

Management Of A Diabetic Patient In Dental Office

1. MANAGEMENT OF A DIABETIC PATIENT IN DENTAL OFFICE KAMRAN MASOOD MIRZA 2. Diabetes Mellitus • A chronic metabolic disorder caused by deficiency of insulin,the primary feature is increase in blood glucose level (hyperglycemia) 3. Global Prevalence • 171 million (people having diabetes, worldwide) in the year 2000 is expected to increase to at least 366 million in 2030 4. Patient with cardinal features of diabetes • polydipsia, polyuria, polyphagia, weight loss, poor wound healing, weakness, frequent and severe infections, obesity and having family history of diabetes 5. Patient with cardinal features of diabetes • oral conditions includes xerostomia, burning sensations, overgrowth of gum tissue, tooth decay, periodontal disease, and fungal infections, fruity (acetone) breath, dry mouth, thickness of saliva 6. Patient with cardinal features of diabetes • Such patients are more prone to diabetes so should be referred to a physician for diagnosis of diabetes 7. Known diabetic patients • inquire about the medication, the type, severity and control of diabetes, the physician treating the patient and the date of last visit 8. Known diabetic patients • The dentist should be aware of the patient’s recent glycated hemoglobin values. HbA1c values of less than 8% indicate relatively good glycemic control; greater than 10% indicate poor control 9. Known diabetic patients • When the level of control of diabetes is not known, consult patients physician and the treatment should be just limited to palliation 10. Known diabetic patients • In patients with good glycemic control before starting any procedure, verify that the patient has taken medication and diet as usual 11. Known diabetic patients • Patients, receiving good medical management without serious compli Continue reading >>

Dental Management Of Patients With Diabetes

Dental Management Of Patients With Diabetes

Diabetes mellitus (DM) is a disease of glucose, fat, and protein metabolism resulting from impaired insulin secretion, varying degrees of insulin resistance, or both. Hyperglycemia is the most clinically important metabolic aberration in DM and the basis for its diagnosis. Apart from the obvious impact of impaired glucose metabolism, DM and chronic hyperglycemia are associated with important ophthalmic, renal, cardiovascular, cerebrovascular, and peripheral neurological disorders. Management of the diabetic dental patient must take into consideration the impacts of diabetes on dental disease and dental treatment, as well as a clear appreciation for the comorbidities that accompany long-standing DM. To access this article, please choose from the options below Continue reading >>

Dental Management In The Medically Compromised Patient

Dental Management In The Medically Compromised Patient

Dental Management in the Medically Compromised Patient Author: Jeff Burgess, DDS, MSD; Chief Editor: Arlen D Meyers, MD, MBA more... As of November 1, 2011 the world's population is estimated to be 7 billion. Within this mass of humanity is a substantial number of people that are elderly; the graying of the world's population is predicted to produce millions of individuals with systemic medical conditions that can affect oral health and dental treatment. The dental management of these medically compromised patients can be problematic in terms of oral complications, dental therapy, and emergency care. This review focuses on a number of medical problems that dentists might encounter in daily practice that necessitate extra knowledge and care to prevent potential complications causing otherwise unnecessary morbidity and mortality. These include diabetes, multiple drug interactions, cardiac abnormalities, and infectious disease. The first step in managing the patient with medical problems is acquiring a thorough health history; the second step is for the clinician to fully understand the significance of the disease that may be endorsed by the patient. Each identified condition can affect dental care in a unique manner. For example, medication prescribed for a medical condition might produce a problem during the administration of a local anesthetic, or it could interact with pain medication prescribed post intervention. The dental clinician needs to understand the potential complications that can occur as a consequence of dental treatment of a medically compromised patient and when pretreatment or post-treatment medication or emergency care is indicated. [ 1 ] Certain medically compromised patients should only be treated in a hospital setting where emergency issues, should Continue reading >>

My Next Patient Is Diabetic: What Are The Implications For The Dental Treatment I Provide?

My Next Patient Is Diabetic: What Are The Implications For The Dental Treatment I Provide?

(Peer-reviewed content that will appear in the JCDA OASIS “point of care” searchable database at www.jcdaoasis.ca – which will be introduced at the beginning of 2013. Diabetes Mellitus Diabetes mellitus (DM) is a disease of glucose, fat, and protein metabolism characterized by hyperglycemia, which results from impaired insulin secretion or varying degrees of insulin resistance, or both. • Types: Type 1 DM, Type 2 DM, Gestational DM Local Anesthetic Precautions Use vasoconstrictors with caution: Routine use of local anesthetic with 1:100,000 epinephrine is generally well tolerated. However, epinephrine has a pharmacologic effect that is opposite to that of insulin, so blood glucose could rise with the use of epinephrine. In diabetic patients with hypertension, post-myocardial infarction, or cardiac arrhythmia caution may be indicated with epinephrine. RECOMMENDATION: Guidelines for diabetic patients are similar to those for patients with cardiovascular conditions: Consider limiting epinephrine to 0.04 mg (2 cartridges of 1:100,000 or 4 cartridges of 1:200,000 epinephrine) and levonordefrin to 0.2 mg. AVOID 1:50,000 concentrations of epinephrine in dental anesthetic and epinephrine-impregnated retraction cord. Drug Interactions Prescribe with caution. Adverse interactions likely: NSAIDs, corticosteroids with: Insulin-dependent DM or noninsulin-dependent DM Concurrent use may increase blood sugar. Chlorpropamide (sulphonylureas) Avoid large doses and long-term use as they raise blood sugar levels and have antagonistic effects (steroids, chlorpropamide). Repaglinide (meglitinides) Concurrent use increases risk of hypoglycemia. Significant interaction – monitor closely: Prednisone will decrease the level or effect of repaglinide by affecting hepatic / intestinal en Continue reading >>

Turkish Diabetes Foundation - Turkish Dental Association

Turkish Diabetes Foundation - Turkish Dental Association

NATIONAL DIABETES CONSENSUS GROUP AND TURKISH DENTAL ASSOCIATION COMMISSION FOR THE DEVELOPMENT OF COLLABORATION IN THE FIELD OF GENERAL HEALTH AND ORAL HEALTH 2015 Guidelines in Clinical Dentistry for Diabetes 3 INTRODUCTION The World Health Organization (WHO) and the World Dental Federation (FDI) report that nearly 36 million people die of chronic diseases each year. It is known that non-communicable diseases such as diabetes, cardiovascular diseases or cancer, as well as tooth-decay and gingivitis, pose similar risks. Diabetes is the most serious of all chronic diseases. The Ministry of Health of the Republic of Turkey estimates that there are 7.2 million people with diabetes in Turkey. Diabetes is a lifelong disease that can surface at any stage of life. Critical organ damage may occur in a short period of time if diabetic patients are left untreated or if their blood sugar is not regulated. Diabetes is the number one cause of high blood pressure, obesity, coronary heart disease, stroke (paralysis), chronic kidney failure, blindness over the age of 20 years and leg amputations with the exception of traffic accidents. Clinical studies reveal oral and dental health problems in 80-100% of people with type 2 diabetes and in a significant number of people with type 1 diabetes. Oral health problems are one of the most crucial obstacles preventing blood glucose regulation in diabetic patients. Thus, it is not possible to treat diabetes without first ensuring the oral and dental health of people with the disease. Dentists thus play a critical role in controlling diabetes and improving the quality of life of patients with the disease. In light of the FDI’s Istanbul Declaration, the Turkish Dental Association argues that dentists can have a large impact on the health o Continue reading >>

Dental Management Of A Diabetic Patient

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 SENS Continue reading >>

Diabetes And Dental Health

Diabetes And Dental Health

Tweet Problems with teeth and gums can be more common for people with diabetes, so good dental health is important to prevent dental complications developing. Looking after your teeth and gums is an essential part of learning to live with both type 1 diabetes and type 2 diabetes. You should inform your dentist if you have either new-onset or long-standing diabetes as this might affect your dental treatment and how often they must review your teeth and gums. Diabetes and dental hygiene People with diabetes who have poor control of their blood glucose levels are more likely to develop dental health problems. Therefore keeping your blood sugar within a normal range will reduce this risk. Eating a balanced diet, getting regular exercise and giving up smoking is also advised to lessen the risk of oral health problems. Making sure that you visit a dentist every six months ensures that any infection will be treated as early as possible. Minor dental problems can quickly escalate, and a routine visit to the dentist will pick up on these. In the UK, although people with diabetes are more prone to dental problems, they do not receive any extra financial help for dental treatment. What are the symptoms of dental health problems? Sore or swollen gums Bleeding gums Receding gums Loose teeth Bad breath You should visit your dentist if you experience any of these symptoms; urgent treatment might be required to prevent a problem from worsening. Diabetes and gum diseases Having prolonged high blood glucose levels can increase the risk of oral health problems, such as gum disease. Gum disease, also known as periodontitis, is the sixth most common disease in the world. It occurs when bacteria within the mouth begins to form into a sticky plaque which sits on the surface of the tooth. Gum Continue reading >>

Diabetes And Dental Treatment: What You Should Know

Diabetes And Dental Treatment: What You Should Know

Taking care of your teeth and mouth is especially important if you have diabetes, because the condition results in a greater risk of oral infection and often slows the healing process. Seeing a dentist is a slightly different experience for diabetics, and it's important to learn as much as you can about handling your diabetes and dental treatment so you can work with your dentist to avoid complications and maintain your oral health. Diabetes and Oral Health Issues Gum disease and diabetes have an interesting connection. According to the National Diabetes Information Clearinghouse (NDIC), diabetes raises your risk of gum disease. Having gum disease then raises your risk of diabetes complications since gum disease makes it more difficult for a diabetic to keep his or her blood sugar levels under control. The higher your blood sugar levels, the more likely you are to have plaque buildup on your teeth, as explained by the NDIC. When your blood sugar levels are high, the amount of sugar in your saliva is also high, which creates an ideal environment for plaque to grow. Excess plaque not only increases your risk of infection and gum disease; it also raises your risk of cavities and decay. Being proactive about treating your condition and caring for your mouth can help you avoid additional dental work beyond regular cleanings in the future. Tooth- and gum-related problems aren't the only oral health issues that you might face if you don't treat your diabetes or see a dentist regularly. According to the American Diabetes Association, diabetics are more likely to suffer from dry mouth or to develop a fungal infection in their mouths. Dry mouth can occur when your diabetes is uncontrolled or as a side effect of the medication you're taking to control the condition. Having dry mou Continue reading >>

Diabetes

Diabetes

Diabetes mellitus is a group of metabolic diseases that lead to high levels of blood glucose (hyperglycemia), which is caused when the body does not make any or enough insulin, or does not use insulin well. Because diabetes is a relatively common condition, practicing dentists are likely to encounter it frequently. Type 1 diabetes is a chronic autoimmune disease in which the beta cells in the pancreas create little to no insulin, and accounts for 5% to 10% of all diabetes cases. In contrast, Type 2 diabetes accounts for 85% to 90% or more of diabetes cases and is one of the commonest chronic diseases, characterized by decreased response of target tissues to insulin, dysregulation of insulin production, or a combination of both. As with any patient, the dentist should review the patients medical history, take vital signs, and evaluate for oral signs and symptoms of inadequately controlled diabetes, which may be common. Oral manifestations of uncontrolled diabetes can include: xerostomia; burning sensation in the mouth; impaired/delayed wound healing; increased incidence and severity of infections; secondary infection with candidiasis; parotid salivary gland enlargement; gingivitis; and/or periodontitis. Although patients with diabetes usually recognize signs and symptoms of hypoglycemia and self-intervene before changes in or loss of consciousness occurs, staff should be trained to recognize the signs and treat patients who have hypoglycemia. In such cases, a glucometer should be used to test patient blood glucose levels, and every dental office should have a protocol for managing hypoglycemia in both conscious and unconscious patients. Diabetes mellitus is a group of metabolic diseases that leads to high levels of blood glucose and is caused when the body does not make Continue reading >>

Dental Management Of The Diabetic Patient

Dental Management Of The Diabetic Patient

- Brian L. Mealey, DDS, MS General Dental Treatment Overall, diabetic patients respond to most dental treatments similarly to the way nondiabetic patients respond. Responses to therapy depend on many factors that are specific to each individual, including oral hygiene, diet, habits such as tobacco use, proper dental care and follow-up, overall oral health, and metabolic control of diabetes. For example, the diabetic patient with poor oral hygiene, a history of smoking, infrequent dental visits, and a high fermentable-carbohydrate intake is more likely to experience oral diseases such as caries and periodontitis and to respond poorly to dental treatment than a diabetic patient without these factors. Glycemic control appears to play an important role in the response to periodontal therapy. Well-controlled diabetic patients with periodontitis have positive responses to nonsurgical therapy, periodontal surgery, and maintenance that are similar to those of people without diabetes. However, poorly controlled diabetic patients respond much less favorably, and short-term improvements in periodontal health are frequently followed by regression and by recurrence of disease. It is imperative that the dental practitioner have a clear understanding of each diabetic patient's level of glycemic control prior to initiating treatment. Patients may present to the dental office with oral conditions that suggest an undiagnosed diabetic state. An example is severe rapidly progressing periodontitis that exceeds what would be expected given the patient's age, habit history, oral hygiene, and level of local factors (plaque, calculus). Other findings seen in some undiagnosed diabetic patients include enlarged gingival tissues that bleed easily upon manipulation and the presence of multiple peri Continue reading >>

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