18. Diabetes mellitus. Dental management of the patients.

Question 1

Diabetes definition

Answer 1

• Relative or absolute deficiency in insulin
• Causes persistently raised blood glucose
• Type 1(insulin dependent) and type 2(Maturity onset)

Question 2

Type 1 diabetes

Answer 2

• Insulin dependent
• 10% of cases
• Thirst, polyuria, hunger, loss of weight and susceptibility to infection
• Failure of insulin secretion due to autoimmune destruction of pancreatic islets
• Treatment-insulin replacement

Question 3

Type 2 diabetes

Answer 3

• Maturity onset
• 90% of cases
• Middle aged and obese
• Many cases asymptomatic
• May cause, poor vision, thirst, polyuria and fatigue
• Resistance to insulin
• Treated with dietary restriction and oral hypoglycaemic drugs

Question 4

Complications of diabetes mellitus that can affect dental management

Answer 4

• Susceptibility to infection, particularly candidosis, also
  mucormycosis
• Hypoglycaemic coma
• Diabetic coma
• Ischaemic heart disease
• Acceleration of periodontal disease if control is poor
• Dry mouth secondary to polyuria and dehydration
• Oral lichenoid reactions due to oral hypoglycaemic
  drugs
• Delayed healing
• Sialadenosis

Question 5

Dental management of diabetics

Answer 5

• Time treatment to avoid disturbance of routine insulin
  administration or meals
• Use local anaesthesia for routine dentistry – the
  amount of adrenaline (epinephrine) in local anaesthetic
  solutions has no significant effect on the blood sugar
• Sedation can be given if required
• Deal with any diabetic complications
• Manage hypoglycaemic coma
• General anaesthesia requires special precaution