Course overview Diabetes mellitus, a chronic disease of metabolism, poses a significant public health challenge in the United States. According to the Centers for Disease Control and Prevention 34.2 million Americans, or approximately 10% of the U.S. population, live with diabetes Centers for Disease Control and Prevention, 2020). Of these people, 26.8 million have been diagnosed with diabetes, while 7.3 million remain undiagnosed (Centers for Disease Control and Prevention, 2020.). In addition, approximately 1.5 million new cases are diagnosed each year (American Diabetes Association, 2018). Diabetes is a leading cause of death and disability. The complications of diabetes include blindness, heart and blood vessel disease, strokes, kidney failure, amputations, and nerve damage (International Diabetes Federation, 2020). Appropriate management of the patient with diabetes by the dental team requires an understanding of the patient’s metabolic control, as well as the patient’s potential for and limitations
related to response to treatment with current therapy. The dental team plays a vital role in the overall health care of patients with diabetes through recognition and treatment of their oral needs, especially regarding tooth loss and related periodontal conditions. The purpose of this basic-level course is to equip dental professionals with the ability to recognize the classifications and classic signs and symptoms of diabetes mellitus, to grasp the relationship between periodontal disease and diabetes, and to identify periodontal and other oral manifestations associated with diabetes, including attachment loss, alveolar bone loss, gingivitis, xerostomia, and oral candidiasis. Moreover, this course discusses dental treatment considerations for patients with diabetes, adverse interactions between hypoglycemic medications and adjunct dental treatment medications, and emergency management procedures for patients with diabetes.
DIABETES
The term diabetes mellitus refers to a group of genetically and clinically heterogeneous chronic disorders characterized Classification Diabetes mellitus is currently classified into three main types: type 1, type 2, and gestational. Other, rare forms of diabetes account for only 1% to 5% of all cases (Solis-Herrera et al., 2018; International Diabetes Federation, 2020).. Type 1 diabetes was previously called insulin-dependent diabetes mellitus or juvenile-onset diabetes because it typically has its onset in childhood and requires administration of exogenous insulin. Type 2 diabetes was previously known as non-insulin-dependent diabetes mellitus, adult-onset diabetes , or maturity-onset diabetes because historically it was more likely to have its onset in adulthood and did not typically require administration of exogenous insulin. Gestational diabetes mellitus is defined as the intolerance of glucose which is first diagnosed during pregnancy, and is usually diagnosed in the second or third trimester (Solis-Herrera et al., 2018). Gestational diabetes occurs in 4% to 10% of all pregnancies and usually resolves on completion of the pregnancy (Joslin Diabetes Center, 2021). This course addresses diabetes types 1 and 2. The etiology of type 1 diabetes involves an autoimmune destruction of the insulin-secreting beta cells of the pancreas, as evidenced by four autoantibodies directed against the pancreatic beta cells. These four types of autoantibodies are detected in approximately 80% to 90% of people with type 1 diabetes (Sarkar & Donner, 2020). . This pathological course causes an absolute deficiency of insulin production and requires Signs and symptoms The classic signs and symptoms of untreated type 1 diabetes mellitus include the triad of polyuria (frequent urination), polydipsia (increased thirst), and polyphagia (increased appetite), often accompanied by pruritus of the skin, rectum, or vagina. Excess glucose in the blood is excreted in the urine. This causes an increase in the volume of urine (polyuria), a commensurate loss of water, dehydration, and increased thirst (polydipsia) as a physiological response. Insulin is needed for the uptake of glucose by cells for the production of energy (American Dental Association [ADA], 2019). An increased appetite (polyphagia) is the physiological response to this lack of cellular nourishment. Symptoms for patients with type 2 diabetes are gradual and insidious in their development but ultimately may be similar to those of untreated type 1 diabetes.
by glucose intolerance and affecting carbohydrate and lipid metabolism.
the patient to use an exogenous source of insulin for life. Type 1 diabetes usually occurs in children and young adults and makes up approximately 5% to 10% of all diabetic cases (Brutsaert, 2020). Type 2 diabetes makes up approximately 90% to 95% of all diabetes cases (Marieb & Hoehn, 2018). The etiological origin of type 2 diabetes involves insulin resistance and a relative deficiency in the production of insulin. Insulin resistance involves the decreased uptake of glucose into the tissues whose receptors are normally responsive to the hormonal control of insulin. The production of insulin in people with type 2 diabetes may be low, normal, or increased (Brutsaert, 2020). The categorization of diabetes as type 1 or type 2 provides an initial basis for nomenclature, but must not be construed as an absolute and rigid boundary. Approximately one-third of people with type 2 diabetes require insulin (Harvard Health Publishing, 2018). Similarly, a growing problem of decreased physical activity and an increased prevalence of obesity among children and young adults have led to an increase in the incidence of type 2 diabetes among these patient populations (The Centers for Disease Control and Prevention, 2019). Treatment for type 2 diabetes can vary and can include individual or combined regimens of increased physical activity, weight loss, the use of oral hypoglycemic agents, and insulin.
Patients with diabetes are susceptible to certain chronic and acute complications – many of which may eventually become
life-threatening – such as: ● Acute hyperglycemia. ● Blindness. ● Complications in pregnancy. ● Gangrene.
● Heart disease. ● Ketoacidosis. ● Kidney failure. ● Nephropathy.
● Neuropathy. ● Retinopathy. ● Stroke. ASSOCIATION BETWEEN PERIODONTAL DISEASE AND DIABETES
Periodontal disease is a common inflammatory disease, and it is estimated that half of Americans over the age of 30 have periodontitis (American Academy of Periodontitis, 2021). The
risk of developing periodontal disease among diabetic patients is increased approximately threefold when compared to patients without this condition (Oyapero et al., 2019). Moreover,
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