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Letter to the Editor
Prosthodontic care in
diabetes mellitus: Old
problem, new findings,
yet more questions
Sir,
Diabetes mellitus is a chronic endocrinal disease that
occurs when the production of insulin from pancreas is
inadequate or when the body cannot utilize the insulin it
produces. Diabetes mellitus almost affect every organ of
the body including their long term damage. As a dental
professional, Prosthodontist is one who handles patients of
almost every ages and are supposed to apprehend the fact
that this well established metabolic disorder can have a
considerable impact on final outcome of the Prosthodontic
management. The saliva play an imperative role in the
retention of removable prosthetics and in the maintenance
of oral microbiota equilibrium is well recognized and
cannot be overlooked.[1] Diabetes mellitus is well known
to fetch the qualitatively and quantitatively alteration
in the parenchyma of major salivary glands leading into
hypo salivation and associated polyurea. Hypo salivation
is normally coupled with the augmentation of fungi
such as Candida and other species leading to enhance
the chances of oral infections. Moreover, the raised
blood glucose levels interfere with vascular functions
and normal defense mechanism of polymorphonuclear
neutrophils subjecting the patient to more deleterious
immune-compromised state. Other common oral
manifestations of candidiasis includes median rhomboid
glossitis, atrophic glossitis, denture stomatitis and angular
chelitis.[2] Long term usage of complete dentures can
further stimulate the proliferation of fungi especially with
the prosthesis in poor condition. The majority of complete
denture diabetic patients usually report an altered taste
sensation with other neurosensory disorders like burning
mouth syndrome. Furthermore, the presence of diabetic
retinopathy and neuropathy severely compromise the
patient’s oral and denture hygiene activity. The risk of
dental caries in diabetic patients is frequently aggravated
by xerostomia and reduced buffering activity of saliva
which further limits the possibility of that particular tooth
to be used as an abutment for fixed prosthesis and for
overdenture fabrication.[3] As this condition is commonly
associated with impaired wound healing, any surgical
procedure like pre-prosthetic surgery or dental implant
placement should be performed only when the diabetes
is in well controlled state.[4] Other diabetic factors like
86 Dental Hypotheses
reduced blood supply increase the amount of residual
ridge resorption making the fabrication of complete
denture more challenging for the Prosthodontists. With
regards to dental implantology, diabetes is a relative
contraindication for implant placement however, careful
selection of patients with well controlled glycaemic levels
and adequate antibiotic administration are considered
to improves the implant survival in such patients.[5] The
ultimate goal of any Prosthodontic therapy for patients
with diabetes requires thorough understanding of the
disease and acquaintance with its clinical manifestations.
This letter is an attempt to draw an attention towards the
potential risks of diabetes associated with Prosthodontic
care and relevant treatment modification to achieve
optimal prognosis. I hope it will prove to be a gentle nudge
to steer the researchers in this direction.
Prince Kumar, Roshni Goel1, Ashish Kumar2,
Vishal Singh3
Shree Bankey Bihari Dental College and Research Centre, Ghaziabad,
1
Conservative Dentistry, Institute of Dental Studies and Technology,
Ghaziabad, 2Department of Prosthodontics, Institute of Technology
and Sciences (ITS)-ITS Dental College, Ghaziabad, 3Dental College
Azamgarh, Uttar Pradesh, India
Address for correspondence: Dr. Prince Kumar, Shree Bankey Bihari
Dental College and Research Centre, Ghaziabad, India.
E-mail: princekumar@its.edu.in
References
1. Darvel BW, Clark RK. The physical mechanism of complete
denture retention. Br Dent J 2000;189:248-52.
2. Guggenheimer J, Moore PA, Rossie K, Myers D, Mongelluzzo
MB, Block HM, et al. Insulin-dependent diabetes mellitus and
oral soft tissue pathologies, II: Prevalence and characteristics of
Candida and Candidal lesions. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 2000;89:570-6.
3. Miko S, Ambrus SJ, Sahafian S, Dinya E, Tamas G, Albrecht
MG. Dental caries and adolescents with type 1 diabetes. Br
Dent J 2010;208:E12.
4. Loo WT, Jin LJ, Cheung MN, Wang M. The impact of diabetes
on implants and periodontal healing. Afr J Biotechnol
2009;8:5122-7.
5. Javed F, Romanos GE. Impact of diabetes mellitus and
glycemic control on the osseo integration of dental implants:
A systematic literature review. J Periodontol 2009;80:1719-30.
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DOI:
10.4103/2155-8213.100397
Apr-Jun 2012 / Vol 3 | Issue 2