Orthodontic Treatment Consideration in Diabetic Patients

Abstract

Although orthodontic treatment is commonly indicated for young healthy individuals, recent trends showed an increase in number of older individuals undergoing orthodontic interventions. The increased age resulted in a proportionate increase in the prevalence of systemic diseases facing dentists during orthodontic procedures, especially diabetes mellitus. This necessitates that dentists should be aware of the diagnosis of diabetes mellitus and its early signs particularly in teeth and oral cavity. It is also essential for them to understand the implications of diabetes on orthodontic treatment and the measures to be considered during managing those patients. In this review, we focused on the impact of diabetes mellitus on orthodontic treatment. We also summarized the data from previous studies that had explained the measures required to be taken into consideration during managing those patients. We included both human and animal studies to review in depth the pathophysiological mechanisms by which diabetes affects orthodontic treatment outcome. In conclusion, this review emphasizes the need to carefully identify early signs and symptoms of diabetes mellitus in patients demanding orthodontic treatment and to understand the considerations to be adopted before and during treating these patients.

Evidence on the effect of uncontrolled diabetes mellitus on orthodontic tooth movement. A systematic review with meta-analyses in pre-clinical in- vivo research

“…Although our initial intention was to search for and document any clinical trial or prospective/ retrospective epidemiologic study with the involvement of patients or patient records of orthodontically treated individuals under the metabolic condition of diabetes, this was ultimately not applicable. There is a gap in the existing literature between human and animal research characterized by complete lack of evidence emerging from clinical research (Almadih et al, 2018;Burden et al, 2001), as no study could be identified except for isolated case reports (Maia, Monini, Jacob, & Gandini, 2011;Reichert, Deschner, & Jäger, 2009) while animal research has been identified as the sole source of evidence (Holtgrave, & Donath, 1989;Najeeb et al, 2017).…”

Infection Control in Dentistry and Drug-Resistant Infectious Agents: A Burning Issue. Part 1

“…No attention is given to ARIAs in orthodontia and orthognathic surgery. To date, there is no gold standard for the treatment of postoperative infections in orthodontic surgery and the use of prophylactic antibiotics before some orthodontic procedures (orthodontic band placement, separator placement, or screw insertion) in patients with a medical history that reveals the presence of diseases affecting the host defense system (aging, patient on corticosteroids or bisphosphonates or anticoagulants, diabetes mellitus, HIV/AIDS) since they are at high risk of developing oral infection [37,169]. Endocarditic prophylaxis is indicated only during the initial placement of orthodontic bands (not brackets).…”

Orthodontics in patients with significant medical co-morbidities

“…Oral complications of DM are multiple and include xerostomia, burning mouth and/or tongue, candida infection, altered taste, progressive periodontal disease, dental caries, acetone breath, oral neuropathies, parotid enlargement, sialosis and delayed wound healing. These complications can occur even when the blood glucose is well-controlled due to impaired neutrophil function, but they are all more severe in poorly controlled DM (Al-Maskari et al, 2011; Almadih et al, 2018; Leite et al, 2013; Patel et al, 2009). Well-controlled DM is not a contraindication for orthodontic treatment (Patel et al, 2009); however, orthodontic treatment should be avoided in patients with poorly controlled DM as they are more likely to suffer from periodontal involvement (Almadih et al, 2018).…”

“…These complications can occur even when the blood glucose is well-controlled due to impaired neutrophil function, but they are all more severe in poorly controlled DM (Al-Maskari et al, 2011; Almadih et al, 2018; Leite et al, 2013; Patel et al, 2009). Well-controlled DM is not a contraindication for orthodontic treatment (Patel et al, 2009); however, orthodontic treatment should be avoided in patients with poorly controlled DM as they are more likely to suffer from periodontal involvement (Almadih et al, 2018). If in doubt, the orthodontist should liaise with the patient and their diabetic team in the provision of care.…”