By : Chiara Azra C.P.

/ J520160042/ Group E

ABSTRACT

DIABETES AND DENTAL PATIENT

Diabetes mellitus is a metabolic disorder involving glucose metabolism. This disease is

classified by a group of metabolic disorders with target end-organ damage and is characterized
by high blood sugar from defects in insulin secretion, defects in insulin action, or a combination
of both. Insulin is required for metabolism of fats, carbohydrates, and proteins, and when there is
a deficiency of insulin, the target tissues are affected. Diabetes is a prevalent disease that every
dentist should understand the basic of condition, know how the impact to the patient, and
understand how to manage the diabetic dental patient. This article shows the classification of
diagnosis, effects on the dental patient, and the management of the diabetic dental patient.
Commonly, there are two kind classification of diabetes mellitus, type 1 and type 2.

According to the American Diabetes Association, type 1 diabetes is an autoimmune

process which the beta () islet cells of the pancreas are damaged and leading to a defect in
insulin production. The destruction of the cells can be quite variable but tends to be more rapid
in children and slower pace in adults. Type 2 involves the remaining 90+% of the patient
afflicted with this disease. Rather than having a deficit in insulin production due to islet cell
destruction, these patients suffer a range of issues from predominantly insulin resistance with
relative insulin deficiency.

There are several medications for the diabetes mellitus patient, one of them is the using of
insulins. Insulins are calssified by how quickly they start to act, when they have their effect, and
the duration of their action. They were originally extracted from the pancreas of bovine and
porcine sources. The first kind of insulin is fast-acting insulins which are absorbed quickly from
the subcutaneous tissues and are used to control the blood sugar during meals and snacks and to
correct high blood sugar levels. The second is intermediate-acting insulins which are absorbed
more slowy, last longer, and are used to control the blood sugar overnight, while fasting, and
between meals. The last type is long-acting insulins which are absorbed slowly, dont have a
significant peak effect, and create a stable plateau effect that lasts most of the day.

Uncontrolled diabetic patients are at risk for some oral complications, such as periodontal
disease, salivary gland dysfunction, infection, neuropathy, and poor healing. Periodontal disease
is frequently seen in diabetic patients,but this periodontal disease may be more severe and
rapidly progressive because of the healing challenges associated with diabetes and the associated
impairment of immunity. Salivary gland changes also occur in diabetic patients and their most
complaint is about the dry mouth. In the patient with uncontrolled diabetes, a decreased ability to
fight infection (bacterial, fungal, and viral) is observed.

Beside the hypertension, oral manifestations such as hyposalivation, alterations in tastem

burning mouth sensation, sialorrhea, and parotid gland enlargement are seen in controlled and
also uncontrolled diabetic patients, but uniformly higher in the group of uncontrolled diabetic
petients. Lesions of the oral mucosa are commonly seen as well that are manifested in the form
of stomatitis, geographic tongue, benign migratory glossitis, fissured tongue, traumatic ulcer,
lichen planus, lichenoid reaction, and angular cheilitis.

The managements that needed by diabetic dental patients are diagnosis, treatment of the
oral manifestations of the disease, and managing the direct effect to the patients and the co-
morbidities of diabetes. Patients should have good control of their diabetes. Adjustments in
treatments can be made accordingly. There will be time when diabetic emergency occurs, such as
hypoglycemia or hyperglycemia. The management of the dental patient who presents with a
medical history of diabetes is also presented as are emergency situations that mat present with
these patients.

Source : Hardeman, John H. 2017.Diabetes and Dental Patient. Dentistry Today. America