Download - Dental Management of Diabetic Patient
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Dental management of
diabetic patient
Presented by: Jamal .Q.
Ahmed
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Oral Manifestations ofDM
None arepathognomonic
Commonlyassociatedconditions:
xerostomia enlargement of
parotidglands
burning
mouth/tongue altered taste candidias periodontal
disease
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Oral manifestations andcomplications
No specific oral lesions associated with diabetes.
However, there are a number of problems by present of
hyperglycemia.
Periodontal disease Microangiopathy altering antigenic challenge.
Altered cell-mediated immune response andimpairment of neutrophil chemotaxis.
Increased Ca+ and glucose lead to plaque formation.
Increased collagen breakdown.
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Oral manifestations andcomplications
Salivary glands Xerostomia is common, but reason is unclear.
Tenderness, pain and burning sensation of tongue.
May secondary enlargement of parotid glands with
sialosis.
Dental caries Increase caries prevalence in adult with diabetes.
(xerostomia, increase saliva glucose)
Hyperglycemia state shown a positive associationwith dental caries.
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Oral manifestations andcomplications
Increased risk of infection Reasons unknown, but macrophage metabolism
altered with inhibition of phagocytosis.
Peripheral neuropathy and poor peripheral circulation Immunological deficiency
High sugar medium
Decrease production of Ab
Candical infection are more common and addingeffects with xerostomia
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Oral manifestations andcomplications
Delayed healing of wounds Due to microangiopathy and utilisation of protein for
energy, may retard the repair of tissues.
Increase prevalence of dry socket.
Miscellaneous conditions Pulpitis : degeneration of vascular.
Neuropathies : may affect cranial nerves. (facial)
Drug side-effects : lichenoid reaction may be
associated with sulphonylurea. (chlopropamide) Ulcers
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Dental management
considerations To minimize the risk of an intraoperative emergency,clinicians need to consider some issues before initiatingdental tx.
Medical history : take hx and assess glycemic
control at initial appt. Glucose levels
Frequency of hypoglycemic episodes
Medication, dosage and times.
Consultation
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Dental managementconsiderations
Scheduling of visits Morning appt. (endogeneous cortisol) Do not coincide with peak activity.
Diet Ensure that the patient has eaten normally and taken
medications as usual. Blood glucose monitoring
Measured before beginning. (
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Dental managementconsiderations
During treatment The most complication of DM occur is hypoglycemia
episode.
Hyperglycemia
After treatment Infection control
Dietary intake
Medications : salicylates increase insulin secretionand sensitivity avoid aspirin.
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Emergency management
Hypoglycemia
Initial signs : mood changes,decreased spontaneity, hunger and
weakness. Followed by sweating, incoherence,
tachycardia.
Consequenced in unconsiousness,hypotention, hypothermia, coma,even death.
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Emergency management
15 grams of fast-acting oralcarbonhydrate.
Measured blood glucose.
Loss of conscious, 25-30ml 50% dextrosesolution iv. over 3 min period.
Glucagon 1mg.
Emergency call
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Emergency management
Severe hyperglycemia
A prolonged onset
Ketoacidosis may develop with
nausea, vomiting, abdominal painand acetone odor.
Difficult to different hypo- or hyper-.
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Emergency management
Hyperglycemia need medicationintervention and insulin administration.
While emergency, give glucose first !
Small amount is unlikely to causesignificant harm.
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Conclusion