Académique Documents
Professionnel Documents
Culture Documents
Dr. Vimal Nayak M.D.S. Dr. Vasumati Patel M.D.S., Dr. Shalini Gupta M.D.S.
Volume 2 Issue 2
Volume 2 Issue 2
for diabetic screening, including measurement of fasting plasma glucose, glucose tolerance tests and glycated hemoglobin.14 If the test is positive, medical referral is essential to establish the diagnosis. A simple screening test for dental patient evaluation is to obtain a fasting plasma glucose level (8 or more hours of fasting) alone or in combination with a 2-hour post-glucose loading plasma test to evaluate glucose utilization. Under ideal circumstances, the 2-hour post-glucose loading plasma test should include ingestion of a measured quantity of glucose. Home monitoring devices (glucometers) are commonly used by diabetes mellitus patients for frequent or daily monitoring of their blood glucose levels. To perform the test, a one or twodrop blood sample is obtained by finger stick, placed on a reagent strip and inserted into the reflector monitor, which determines the glucose level and displays the results. In the past this technique has been used in dental offices as a screening test for suspected diabetic individuals. The test is simple, inexpensive and reasonably accurate; however, current United States federal standards regarding regulation and inspection of medical laboratories preclude its use as a screening test for suspected diabetes mellitus patients unless the dental office has been approved as a medical laboratory. It should be noted, however, that known diabetic patients can perform the reagent strip procedure in the dental office using their own glucometer as a means of monitoring their diabetes mellitus status prior to an extensive periodontal or oral surgical treatment procedure or prior to treatment likely to disrupt the patients normal dietary routine.15 Management of known diabetic patients When the periodontist is called upon to provide periodontal therapy for a previously diagnosed diabetes mellitus patient, a certain amount of detailed information should be gathered. The patient should be questioned regarding the type of diabetes, the age at onset and duration of the disease; any current medications and their method of administration. The patients degree of compliance and monitoring technique should be discussed. The practitioner should review any previous history of diabetic complications, determine the most recent laboratory results and record the name and address of the patients physician(s). By gathering this information the clinician can best relate the patients oral condition to his or her systemic status and determine whether or not medical consultation is required. Under most circumstances it would be prudent to obtain medical clearance prior to performing any extensive periodontal therapy, especially if surgery is indicated.16 In most instances the well-controlled type 1 or type 2 patient can be managed in a manner consistent with a healthy non-diabetic individual.17 Periodontal surgical procedures can be performed, although it must be assured that the patient can maintain a normal diet post-surgically. In the event that the treatment procedure modifies the patients dietary habits, dietary supplements should be recommended. Supportive periodontal therapy should be provided at relatively close intervals (2 to 3 months) since some studies indicate a slight but persistent tendency to progressive periodontal destruction despite effective metabolic diabetes mellitus control.16 17
Volume 2 Issue 2
no evidence-based information to indicate that antibiotic premedication is necessary.16 The poorly controlled type 1 patient is not a good candidate for periodontal therapy other than necessary emergency services. Medical coordination is probably indicated for any type of periodontal therapy and hospitalization may be required for emergency care. If time permits, microbiological testing is desirable to identify putative periodontal pathogens prior to antibiotic therapy. If stable metabolic control is achieved, routine periodontal therapy may be considered with close medical monitoring.1 In general, all diabetes mellitus patients should be encouraged to maintain meticulous oral hygiene and to receive supportive periodontal therapy at intervals necessary to sustain a high level of periodontal health.15 Conclusion Diabetes mellitus is a common medical disorder that will be encountered by every periodontist. Knowledge by the periodontist of the general and oral signs and symptoms of undiagnosed or poorly controlled diabetes mellitus are essential, and patients displaying these signs or symptoms should receive medical referral. Patients suspected, or known to suffer from undiagnosed or uncontrolled diabetes mellitus should receive only emergency care until their health status has been properly evaluated. In the event the degree of control of a known diabetic is unknown or the patient is poorly controlled, antibiotic therapy should be administered in conjunction with any necessary surgical procedure or in the presence of oral infection. The periodontist must be prepared to manage diabetic emergencies should they occur in the dental office, and hypoglycemic incidents are most likely. Under most circumstances, the well-controlled diabetes mellitus patient can receive safe and effective periodontal therapy with some modification of office protocol, and there is little reason to anticipate that the controlled diabetes mellitus patient cannot look forward to a lifetime of periodontal health if proper and timely periodontal therapy is rendered and the patient maintains effective oral hygiene measures accompanied by appropriate supportive periodontal recall therapy. References: 1. Mealey BL. Impact of advances in diabetes care on dental treatment of the diabetic patient. Compendium Contin Educ Dent 1998: 19: 4158. 2. American Diabetes Association. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Committee report. Diabetes Care 1997: 20: 11831197. 3. American Diabetes Association. Position statement. Implications of the diabetes control and complications trial. Diabetes Care 1997: 20(suppl 20): S62S64. 4. Murrah VA. Diabetes mellitus and associated oral manifestations: a review. J Oral Pathol 1985: 4: 272281. 5. Atkinson MA, Maclaren MK. What causes diabetes? Sci Am 1990: 263: 6271. 6. Albrecht M, Banoczy J, Tamas G Jr. Dental and oral symptoms of diabetes mellitus. Community Dent Oral Epidermiol 1988: 16: 378380. 18
Volume 2 Issue 2
8.
9.
10.
11.
12.
13. 14.
15.
16.
17.
19. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993: 329: 977986. 20. Beck JD, Garcia RG, Heiss G, Volconos P, Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol 1996: 67(suppl): 11231137. 21. Beck JD, Offenbacher S, Williams RC, Gibbs P, Garcia R. Periodontitis: a risk factor for coronary heart disease? Ann Periodontol 1998: 3: 127141. 22. DeStefano F, Anda LF, Kahn HS, Williamson DF, Rasell CM. Dental disease and risk of coronary heart disease and mortality. BMJ 1993: 306: 688691. 23. Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: a two-way relationship. Ann Periodontol 1998: 3: 5161. 24. Mattila KJ, Niemeier MS, Valtonen VV, Rasi VP, Kesaniemi YA, Syrjala SL, Jungell PS, Isoluoma M, Hietaniemi K, Jokinen MJ. Association between dental health and acute myocardial infarction. BMJ 1989: 298: 779782. 25. Offenbacher S, Beck JD, Lieff S, Slade G. Role of periodontitis in systemic health: Spontaneous preterm birth. J Dent Ed 1998: 62: 852858. 26. Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, McKaig R, Beck J. Periodontal disease as a possible risk factor for preterm low birth weight. J Periodontol 1996: 67(suppl): 11031113. 27. Scannapieco FA. Position paper. Periodontal disease as a potential risk factor for systemic diseases. J Periodontol 1998: 69: 841850. 28. Soskolne WA. Epidemiological and clinical aspects of periodontal diseases in diabetics. Ann Periodontol 1998: 3: 3 12.
18.
19