SPECIAL CONSIDERTIONS IN DENTAL TREATMENT

MORNING APPOINTMENTS
DIABETIC PATIENTS ARE MORE STABLE IN THE MORNING BECAUSE MOST DIABETIC REGIMENS INCLUDE THE USE OF MEDICATION EXERCISE AND PRESCRIBED BREAKFAST IN THE MORNING
DENTAL CARE THEREFORE SHOULD BE PROVIDED IN THE MORNING
APPOINTMENT SHOULD BE SHORT.
MEDICATIONS
STABLE DIABETICS SHOULD TAKE THEIR MEDICATION AT USUAL TIME.
UNSTABLE DIABETICS DO REQUIRE PHYSICIAN-GUIDED ALTERATION IN MEDICATION.
DIET:
STABLE DIABETICS SHOULD TAKE THEIR NORMAL DIET PRIOR TO ENTAL CARE
UNSTABLE DIABETICS REQUIRE COUNSELLING WITH REGARD TO NUTRITIONAL INTAKE BEFORE AND AFTER DENTAL TREATMENT.
STRESS REDUCTION
FOR ALL DIABETICS STRESS MUST BE REDUCED
IF NECESSARY, PREMEDICATION AND/OR ANALGESICS TO CONTROL PAIN SHOULD BE CONSIDERED.
STRESS RELEASES ENDOGENOUS EPINEPHRINE AND CAN LEAD TO MOBILIZATION OF GLYCOGEN FROM THE LIVER AND CAUSE AADITIONAL HYPERGLYCEMIA
OPPURTUNITIES TO USE BATHROOM AND AVAILABILITY OF SMALL SNACKS GREATLY IMPROVE THE PATIENTS FEELING OF WELL BEING. THEY ALSO REDUCE LEVEL OF STRESS.

DENTAL CARE OF DIABETIC PATIENTS

DENTAL CARE IN DIABETIC APTIENTS FALL IN THREE CATEGORIES.
1. MAJOR SURGICAL PROCEDURES
2. INVASIVE PROCEDURES
3. NON-INVASIVE PROCEDURES.
MAJOR SURGICAL PROCEDURES:
THESE INCLUDE:
FACIAL BONE FRACTURE REPAIR
JAW SURGERY FOR TUMOR REMOVAL
ORTHOGNATHIC SURGERY, ETC.
INVASIVE PROCEDURES:
THESE INCLUDE
TOOTH EXTRACTION
PERIODONTAL SURGERY
APICAL ENDODONTIC SURGERY
SURGICAL DRAINAGE OF ABSCESSES ETC.
NON-INVASIVE PROCEDURES :
THESE INCLUDE
RESTORATIVE PROCEDURES
PROSTHODONTIC APPLIANCES
INJECTION OF LOCAL ANAESTHESIA
INTRACANAL ENDODONTICS
ORTHODONTIC PROCEDURES
DENTAL IMPRESSIONS
ROUTINE ORAL PROPHYLAXIS
FLOURIDE TREATMENT
INTAORAL RADIOGRAPHS ETC.

DENTAL MANAGEMENT OF DIABETIC PATIENTS

ORAL MANIFESTATION OF DIABETES MELLITUS:-
THE ORAL MANIFESTATIONS OR COMPLICATIONS OF UNCONTROLLED DIABETES MELLITUS INCLUDE:
XEROSTOMIA
PAROTID GLAND ENLARGEMENT
ORAL CANDIDIASIS
PROGRESSIVE PERIODONTITIS
BURNING MOUTH
ALTERED TASTE
INCREASED CARIES RATE
ORAL NEUROPATHIES
PERIAPICAL ABCESSES
THE ORAL FINDINGS IN PATIENTS WITH UNCONTROLLED DIABETES ARE MOST LIKELY RELATED TO THE FOLLOWING FACTORS:
1.THE EXCESSIVE LOSS OF FLUID THROUGH FREQUENT AND EXCESSIVE URINATION
2.ALTERED RESPONSE TO INFECTION
3.THE MICROVASCULAR CHANGES
4. THE INCREASED CONCENTRATIONS OF GLUCOSE IN SALIVA.
XEROSTOMIA IN DIABETES
XEROSTOMIA OR DRY MOUTH CAN LEAD TO CRACKING AND ATROPHY OF THE ORAL MUCOSA.
MUCOSITIS , ULCER FORMATION, DESQUAMATION, INCREASED LIKELIHOOD OF BACTERIAL AND FUNGAL INFECTIONAND DEPAPILATION OF THE DORSUM OF THE TONGUEARE COMMONLY ENCOUNTERED INUNCONTROLLED DIABETIC PATIENTS.
XEROSTOMIA MAY ALSO PREDISPOSE TO ACCUMULATION OF DENTAL PLAQUE AND CONTRIBUTE TO PERIODONTAL DISEASE AND CARIES.
BURNING MOUTH AND ALTERED TASTE IN DIABETES
MAY BE DUE TO DIABETIC NEUROPATHY.
PERIODONTAL DISEASE AND DENTAL CARIES IN DIABETES
DECREASED COLLAGEN SYNTHESIS
INCREASED COLLAGENOUS ACTIVITY
DECREASED BONE MINERAL CONTENT (IN IDDM)
SECONDARY HYPOPARATHYROIDISM DUE TO DIABETIC NEPHROPATHY.
DEFECTIVE POLYMORPHONUCLEAR LEUKOCYTES CHEMOTOXINS.
EACH OF THESE FACTORS COULD RESULT IN ACCELERATED ALVEOLR BONE DESTRUCTION.
DENTAL CARIES IN DIABETIC PATIENTS IS RELATED TO THE INCREASED LEVELS OF GLUCOSE IN SALIVA AND CREVICULAR FLUID.