Category : Dental Surgery
ORAL CHANGES AS A MANIFESTATION OF DIABETES: THE ORAL CHANGES, ORAL HEALTH MAINTENANCE AND TREATMENT PROTOCOLS
Diabetes is a metabolic disease with a hyperglycemic state wherein, several signs and symptoms are classical including polydipsia, polyuria and polyphagia. Uncontrolled diabetes leads to various complications, like kidney disease, cardiovascular changes, impaired wound healing. Periodontitis (gum disease) is also considered a 6th complication of diabetes. Diabetes is also a global economic burden considering the everyday use of insulin and/or oral medications. The complications associated with it also causes economic burden, inclusive of the hospital admission and the treatment charges. Research suggests that gum treatment to an extent reduces blood sugar levels hence the significance of oral hygiene and dental care.
ORAL CHANGES IN DIABETES- Increased prevalence of
- Periodontitis- Bleeding gums, food lodgement, , multiple gum swelling/abscess, pus discharge from gums, loose teeth, pain on chewing, tooth migration
- Dental caries- Untreated leading to swelling within the mouth or on the cheek, chin or face region
- White lesions
- Reduced salivation
- Bad odor(halitosis)
- Altered taste sensation
- Burning mouth
- Black hairy tongue
TWO WAY RELATIONSHIP BETWEEN DIABETES AND GUM DISEASE.
American dental association has also confirmed that gum disease is often found in patients with diabetes. Diabetes can also have negative effect on the glycemic control. The severity of gum disease increases in uncontrolled diabetes. Increased blood sugar levels are also demonstrated in saliva.
Increase of advanced glycation end product (AGE) in gum disease is a classical feature. Binding of these AGEs to its receptor called RAGE results in increased production of certain serum and saliva inflammatory markers/mediators. The increase of these AGEs increases the susceptibility of periodontitis associate with diabetes and reduce repair.
ORAL MICRO BIOTA IN GUM DISEASE
Gum microorganisms such as Streptococcus mutants, P. gingivalis, Fusobacterium , P.Intermedia are all increased in gum disease.
Management of diabetes- is-complex to prevent cardiovascular and micro vascular complications
- Education
- Life style changes
- Monitoring blood sugar levels
- Monitoring blood pressure, lipids
- Physician/Endocrinologist consultation
- Dental evaluation, monitoring and treatment – Strict maintenance of oral hygiene
DENTAL ASPECTS-WHAT ONE SHOULD DO?
| Prediabetic stage | Controlled diabetes | Uncontrolled diabetes |
| Oral screening | Oral screening | Physician monitoring/treatment to reduce blood sugar levels within normal limits |
| Oral hygiene care by patient | Oral hygiene care by patient | Strict oral hygiene care by patient |
| Dental treatment | Dental treatment | Dental treatment |
ORAL HYGIENE CARE
- Brush twice daily
- Use tooth brush tooth paste
- Correct tooth brushing technique- visit a dentist to learn
- Use soft bristled tooth brush
- Rinse mouth after each meal
- Interdental brushing as specified by dentist
- Regular flossing
- Change tooth brush once in 3 months
- Tongue cleansing
A special interest group (SIG) on diabetes and oral care is formed as a unit of JSS Dental College and Hospital, with a team of dentists, physicians, microbiologist, biochemist and pharmacologist. The SIG team is involved in educating the masses, organizing conferences for dental students and faculty, oral screening, treatment and research related to the same. The SIG has two subunits/ clinics-
- Department of Periodontology, JSS Dental college and hospital, Shivarathreeshwara Nagara, Mysore
- Department of Dental science, JSS Multispecialty Hospital, MG Road, Agrahara
( Units of JSSAHER)
Patients can contact regarding diabetes and oral care –screening and treatment required
- Dr. Anitha Subbappa- Periodontist/ Gum specialist- Team Leader-Thursday, Fridays & Saturdays @ Dental Sciences Department JSS MULTISPECIALITY HOSPITAL
- Dr. Suneeth Shetty- Endodontist
- Dr. Prasanna Kumar- Physician (JSS HOSPITAL)