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Transcript of 496 dm
ENDOCRINOPATHIES
DIABETES MELLITUS
MODERATOR
DR.ASHISH SHRESTHA
DR.VINAY MARLA
DEPARTMENT OF ORAL PATHOLOGY AND HISTOLOGY
PRESENTER
ROSHAN KUMAR SHAH
BDS: 3RD YEAR(2011)
ROLL NO:496
CONTENTS
INTRODUCTION
CLASSIFICATION
PATHOPHYSIOLOGY
CLINICAL FEATURES
DIAGNOSIS
ORAL MANEFESTATION
DENTAL MANAGEMENT OF DIABETIC
PATIENT
DIABETES MELLITUS
A clinically and genetically heterogenous metabolic disordercharacterized by abnormally elevated blood glucose level (hyperglycemia) and dysregulation of carbohydrate, protein, and lipid metabolism.
Results from either a defect in insulin secretion from pancreas or resistance of body’s cells to insulin action, or both.
Affects almost all tissues in the bodY
Associated with significant complications of multiple organ system, including eyes, nerves, kidneys, and blood vessels.
CLASSIFICATION
Etiological Classification of DM by the
American Diabetes Association (1997)
Type 1 diabetes mellitus
Type 2 diabetes mellitus
Other specific types of diabetes
Mellitus
Gestational diabetes mellitus
TYPE 1 DIABETES MELLITUS
Autoimmune destruction of the insulin-producing beta cells of pancreas.
5-10% of DM cases.
Common occurs in childhood and adolescence, or any age.
Absolute insulin deficiency.
High incidence of severe complications.
TYPE 2 DIABETES MELLITUS
Result from impaired insulin function. (insulin
resistance)
Constitutes 90-95% of DM
Specific causes of this form are unknown.
Risk factors : age, obesity, alcohol, diet,
family History and lack of physical activity,
etc.
THE PANCREAS
PANCREAS – ENDOCRINE PART
Accounts for only 2% of the pancreatic mass
Nests of cells - islets of Langerhans
Four major cell types
Alpha (A) cells secrete glucagon
Beta (B) cells secrete insulin
Delta (D) cells secrete somatostatin
F cells secrete pancreatic polypeptide
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY CONTD…..
Normal blood glucose level to be maintained within 60 to 150 mg/dL.
As blood sugar levels became elevated, glucose is excreted in the urine and causes excessive urination occurs due to osmotic diuresis.
Increased fluid loss leads to dehydration and excess thirst.
Since cells are starved of glucose, the patient experiences increased hunger.
RISK FACTORS
CLINICAL PRESENTATIONS
polyuria polydipsia
polyphagia
Weight loss
weakness
Delayed wound healing
Obesity
0RAL MANIFESTATIONS
In people with diabetes, the first signs and
symptoms of a medical condition can
develop in the mouth.• oral conditions include xerostomia,
burning sensations, overgrowth of gum tissue, tooth decay, periodontal disease (6th complication)fungal infections, fruity (acetone) breath,A WARNING SIGN increased thickness of saliva
PERIODONTITIS
Periodontal tissues frequently manifest these changes because of chronic bacterial infections.
Recent epidemiologic evidence shows that the prevalence of diabetes in patients with periodontitis is significantly greater (by two times) than in people without periodontitis.
Given that diabetes may be present for a number of years before it is diagnosed, dentist may be the first health professional to detect a patient’s diabetes.
PERIODONTITIS AS A RISK FACTOR FOR DIABETES MELLITUS
Diabetes has long been believed to be a risk factor for periodontal disease. Results of new studies show that the reverse might also be true.
In individuals with periodontitis :
Increase in local and systemic expression of inflammatory cytokines, such as TNF-alpha and IL-6
Both TNF-alpha and IL-6 have been shown to impair intracellular insulin signaling, which may lead to
insulin resistance
In a longitudinal study of patients with type 2 DM:
Increased risk of worsening glycemic control seen in patients who had severe periodontitisover a period of time which led to various complications.
( Taylor GW,Burt BA Becker MP et al,1996)
These trials often examined the effects of scaling and root planing on glycemic control, either alone or in combination with adjunctive systemic tetracycline therapy.
( Tetracyclines decrease the production of matrix metalloproteinase such as collagenase )
In a more recent evaluation of scaling and root planing combined with systemic doxycycline therapy for 2 wks ,diabetic pts showing improvement in periodontal health also had significant improvement in glycemiccontrol and vice versa.
When researchers performed scaling and root planing but did not administer adjunctive antibiotic therapy, some studies showed significant improvement in glycemic control after treatment, while others showed no significant improvement in glycemic control despite improvements in patients’ periodontal health.
Multiple periodontal abscesses
SALIVARY GLAND DYSFUNCTION
Dry mouth (xerostomia) and salivary hypofunction is common in patients with diabetes.
When the normal environment of the oral cavity is altered because of a decrease in salivary flow or alteration in salivary composition, a healthy mouth becomes susceptible to dental caries and tooth deterioration.
DIABETES AND CANDIDIASIS
Contributing factors for oral candidiasis in patients with diabetes salivary dysfunction
compromised immune function
salivary hyperglycemia that provides a potential substrate for fungal growth
Oral lesions associated with candidiasis include median rhomboid glossitis
atrophic glossitis
denture stomatitis
angular cheilitis
Amphotericin B, nystatin, clotrimazole, miconazole, ketoconazole, fluconazole, itraconazole
ACUTE ORAL INFECTIONS
Recurrent bouts of herpes simplex virus,
periodontal abscesses or palatal ulcers are
common in patients with diabetes.
Published reports of life-threatening deep
neck infection from a periodontal abscess
and fatal palatal ulcers are available.
DIAGNOSIS
COMPLICATIONS
Microvascular
Retinopathy, cataract
Nephropathy
Peripheral Neuropathy
Foot disease
Macrovascular
MI
Stroke
Ischemia
DENTAL CONSIDERATIONS
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
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
When the level of control of diabetes is not known, consult patients physician .
KNOWN DIABETIC PATIENTS
Patients, receiving good medical management without serious complications such as renal disease, hypertension, or coronary atherosclerotic heart disease, can receive any indicated dental treatment
Local anesthesia is preferred, but such patients can even be safely treated in general anesthesia
Morning appointments should be preferred because this is the time of high glucose and low insulin activity
This reduces the risk of hypoglycemic episodes during the dental procedures
KNOWN DIABETIC PATIENTS
a source of glucose such as an orange juice must be available in the dental office to avoid hypoglycemic attacks
Prophylactic antibiotics for patients taking high doses of insulin to prevent post-operative infection are recommended
It's best to do surgery when blood sugar levels are within normal range
KNOWN DIABETIC PATIENTS
To avoid hyperglycemia use anxiety reduction protocol
Emotional stresses and painful conditions increase the amount of cortisol and epinephrine secretion which induce hyperglycemia so pre-treatment anxiety should be reduced by
sedation pain during procedures can be avoided by a
potent anesthesia
INSTRUCTIONS TO BE GIVEN TO A DIABETIC
diabetic patients should be strongly motivated to maintain a good oral hygiene by brushing after every meal
using floss daily
keeping their dentures clean
patients should be frequently recalled for dental examinations
prophylactic measures, such as topical fluorides should be applied
The patients should be encouraged to quit smoking as it greatly increases the risk of periodontal disease in diabetic patients
Diabetics should be informed that they are more likely to catch dental diseases than the normal ones because awareness and knowledge increases the tendency to seek preventive dental care, and improves chances of maintaining healthy mouth
REFERENCES
Davidson’s principles and practice of
Medicine 21st Edition
Burket’s oral medicine 11th Edition
Medical emergencies in dental office, Stanley
F Malamed 4th Edition
Medical problems in dentistry C. Scully & R.
A. Cawson 4th Edition
Carranza’s clinical periodontology 11th edition
THANK YOU