Dental considerations for the patient with diabetes

Abstract

Diabetes mellitus (DM) is one of the most frequent pathologies that dentists encounter, due to its high prevalence worldwide. It is diagnosed by the repeated obtaining of fasting plasma glucose levels of 126 mg/ dl or higher, or glycosylated hemoglobin of 6'5% or higher. Diabetes (especially if it is not well controlled) brings with it a greater risk of periodontal disease, which is the most frequent complication. On the other hand, the possible influence of periodontal disease on glycemic control is still not well established. Other reported manifestations are xerostomia, sialadenosis and burning mouth syndrome. With regard to dental caries, oral lichen planus and candidosis, recent studies have not revealed a significantly higher incidence in these patients. For dental treatment, the type of diabetes suffered, the treatment given for the disease, and the glycemic control status (using the glycosylated hemoglobin test) should be known. Patients should receive short morning appointments to reduce stress. The dentist has to be aware of the possible occurrence of an acute complication (hypoglycemia or hyperglycemia). Furthermore, these patients suffer from delayed wound healing and major susceptibility to infections.

Efect of periodontal disease and non surgical periodontal treatment on C-reactive protein. Evaluation of type 1 diabetic patients

“…This prevalence should be even higher in patients with diabetes because clinical and epidemiological studies have reported that patients with a long history of diabetes seem to have more periodontal tissue breakdown than age matched, non-diabetic controls ( 2 , 3 ). Severity and progression of the periodontitis is also higher in individuals with diabetes ( 4 ).…”

State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature

“…Prior to dental treatment, a comprehensive medical history should be performed, singularly recording the type of diabetes, complications, treatment, and control status [249]; • International consensus guidelines state HbA1c levels <6.5% as the main parameter to measure and confirm an appropriate metabolic control [250]; • Pre-prandial blood glucose levels ranging between 70 and 130 mg/dL and postprandial blood glucose levels < 180 mg/dL also should be confirmed to ensure an adequate metabolic control [250];…”