production of usable energy. Patients with type 1 DM inherit faulty genetic information from their parents. Possession of this gene, possibly combined with environmental triggers such as climate, viruses, and the early introduction of certain foods, can predispose a patient to type 1 DM. Type 2 diabetes is a result of insufficient insulin production or the decreased sensitivity of cells to insulin. Type 2 diabetes is typically found in overweight individuals, and the current situation in which one in six adolescents is now classified as being obese could account for the increase in the incidence of type 2 diabetes in children. With type 2 diabetes on the rise, oral health providers can be key allies in helping to promote healthy weight intervention. Dietary protocols for good oral health mirror those for good overall health. By promoting awareness of the risks of childhood obesity, dental personnel can have a positive impact on the oral and systemic health of their patients (Chen et al., 2023). or a pump. The pump system can automatically administer insulin throughout the day via a subcutaneously placed needle. Several types of insulin are available to the patient with type 1 DM, depending on blood sugar and food intake: ● Rapid-acting : Begins working in 5 minutes, with peak action in 30 to 90 minutes. ● Short-acting : Begins working in 30 minutes, with peak action in 2 to 4 hours. ● Intermediate-acting: Begins working 1 to 3 hours after administration, with peak levels in about 8 hours. ● Long-acting : Active for 20 to 26 hours. Paradoxically, hypoglycemia (low blood sugar) can be a problem for people with diabetes when they take too much medication, miss a meal, or get more exercise than usual (Mayo Clinic, 2023). Symptoms of mild hypoglycemia occur when blood sugar is at or below 70 mg/dL. These symptoms include nausea, cold/clammy skin, rapid heartbeat, and numbness or tingling of the fingertips. When blood sugar falls below 55 mg/dL, patients may experience blurry vision, dizziness, headache, poor coordination, and extreme fatigue. Severe hypoglycemia occurs below a blood sugar level of 40 mg/dL, with symptoms including seizures, hypothermia, coma, and death. control. The combination of hyposalivation and increased frequency of sugar consumption leads to significant risk for caries and requires balancing with additional protective factors. Recommendations may include decreasing non- water consumption or adding fluoride products. More frequent periodic recalls (rather than every 6 months) may be indicated for observation of changes. Additionally, patients with recurrent bouts of hypoglycemia may compensate with frequent intake of sugars to normalize glucose levels. This practice poses a concern for development of caries. An example may be the child who becomes hypoglycemic in the middle of the night. Parents may give candies, icing, or juice at that time, without realizing that this intervention increases the risk for caries. While the primary concern is glucose levels, the dental provider should educate parents and assist with options to increase protective factors (e.g., water afterward or attempting to brush with fluoride toothpaste). It is important for an oral health provider to be aware of their patient’s glycemic control and, prior to a procedure, to ask patients with DM about the type of insulin they use, when they administer it, and the meals they have eaten that day.
section will mostly examine type 1 DM and its impact on oral health. It should be noted, however, that type 2 DM, formerly called adult-onset diabetes , is increasing among children (NIH, 2023a). As of 2023, there were 422 million people with type 1 or type 2 diabetes worldwide (Chen et al., 2023). Previously known as juvenile-onset diabetes, type 1 DM is usually brought to the attention of the physician following the appearance of (a) polydipsia (excessive thirst), (b) polyphagia (excessive hunger), and (c) polyuria (excessive urination). The pediatric patient fails to gain weight or develop at a rate equal to that of their peers. In the pancreas, the islet of Langerhans cells are responsible for the production of bioactive insulin. In type 1 DM, these cells either do not produce insulin or produce insulin that is not biologically active. Insulin allows cells to remove glucose from the blood so that it can be employed in the Medical considerations/current medical therapies Upon experiencing symptoms of DM, patients are given a fasting plasma glucose and A1C test. The fasting plasma glucose test measures glucose in the bloodstream at one point in time, while the A1C test measures the average amount of glucose in the bloodstream over a period of 2 to 3 months. The glucose level should be below 5.7% (National Institute of Diabetes and Digestive and Kidney Diseases, 2023). Patients who are diagnosed with DM must maintain strict dietary regimens to control the negative long-term effects of diabetes. Long-term effects include cardiovascular disease, peripheral vascular disease, and cerebrovascular disease. Complications of these long-term effects include retinopathy, kidney disease, stroke, neuropathy, and several oral complications that will be discussed in the section on dental treatment implications. Since there is no useful production of insulin by the pancreas in type 1 DM, the patient needs exogenous insulin to maintain life. Patients must carefully monitor blood sugar on a daily basis. Enteral (oral) administration of insulin is not effective because digestive enzymes metabolize the insulin molecule before it reaches the bloodstream. Therefore, to be effective, insulin must be injected. Insulin can be delivered via needles, self-contained pen needles, Dental treatment implications Periodontal disease is one of the major oral complications of DM. Studies have shown an 8.5% prevalence of periodontitis among type 1 DM patients. Damage to blood vessels caused by hyperglycemia impairs the function of certain white blood cells and causes an increase in interleukin-1, tumor necrosis factor-alpha, and C-reactive protein. The result is chronic inflammation, diminished ability to repair vascular damage, weakened responsiveness to bacterial and viral insult, and increased periodontal destruction during adolescence (Reddy & Gopalkrishna, 2022). Another major issue for patients with DM is the decrease of saliva production in the major salivary glands. This has been associated with fatty deposits in the acinar and ductal cells leading to gland degeneration. Hyposalivation, occurring in about 30% of patients with DM regardless of glycemic control, can lead to painful soft tissue ulcers, angular cheilitis (inflammation and fissures at the corners of the mouth), fissured tongue, and lowered oral pH. Soft tissue trauma can result in opportunistic infections (Verhulst et al., 2019). Pediatric patients who experience hyposalivation may increase their consumption of sweet foods to compensate for taste alteration, which may in turn decrease glycemic
Page 146
EliteLearning.com/Dental
Powered by FlippingBook