The effects of diabetes on a patient’s oral health

Diabetes is a condition in which the patient’s body fails to produce insulin or there is resistance of the cells to the action of insulin produced in normal amounts by the pancreas.

It affects a large percentage of the population and sometimes the patient is unaware that he or she has the disease.

Following food ingestion, glucose is produced through breakdown, which is necessary for obtaining energy and the functioning of neuronal cells.

The entry of glucose into cells to serve as a source of nourishment is facilitated by insulin.

The absence of this hormone in the body or issues at the receptor level lead to disruptions that affect the entire organism.

Manifestations of diabetes in dentistry

Some signs and conditions found in the oral cavity may lead to the suspicion of diabetes, but are not the determining factors.

If the patient shows some of the following signs and does not know if he or she has diabetes, he or she may be referred for further investigations:

  • Prolonged bleeding following extractions

  • Dry mucous membranes: also called xerostomia, caused by insufficient saliva production. The effects of xerostomia are numerous and include irritation, cavities, recurrent mouth ulcers and problems with swallowing and speech.

  • Repeated infections of the mucous membranes: the immune system’s defence against microbes and bacteria is impaired. Self-defence no longer works at optimum capacity and the risk of infections increases considerably

  • Rapidly progressing periodontitis: loss of the tooth’s bony attachment is called periodontitis.

The gum and underlying bone recede at an accelerated rate, inconsistent with age. As a result of gingival retraction and bone resorption, the interdentally papilla will have a lower position, with the appearance of black areas under the contact points.

The patient will also perceive an abnormal mobility with the exposure of an increasing area of the tooth.

Through the anamnesis, the medical questionnaire at the beginning of the consultation, the doctor will obtain information about the overall health.

The patient should be informed about the values of glycemia but also glycosylated haemoglobin (it is a parameter that gives information about the average value of glycaemia over the last 3 months).

It will also specify the current treatments and any other regimen imposed by the current pathology.

Stress in the dental surgery should be kept to a minimum.

Fear of dental operations is common and somewhat justified for the patient.

However, stress leads to increased secretion of adrenaline, which is responsible for increased blood glucose, i.e. blood sugar.

If the patient is unable to control their emotions, anxiolytics should be administered before starting treatment to reduce fluctuations in blood values.

Special attention should be paid to cases where antibiotics must be administered before the start of dental treatment.

These situations are determined by the dentist, who will inform the patient of the dose and timing of the medication.

In more complicated interventions or for those with increased infectious risk, if the patient has type 2 diabetes or uncompensated diabetes, when emergency dental treatment is required, antibiotic therapy will be instituted.

Patients with diabetes can be treated in the same way as those in good health, as long as blood parameters are within normal limits.

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