An update in diabetes mellitus

Department of Pediatric Dentistry
St Joseph Hospital

Resident’s Name: Craig Elice Date: May 29, 2009
Article title: An update in diabetes mellitus
Author(s): Dahms, WT
Journal: Pediatric Dentistry
Volume (number): 13(2)
Month, Year: 1991
Major topic: Discussion of dental implications of diabetes
Minor topic(s): n/a
Type of Article: review article
Main Purpose: Reviews concepts of Diabetes Mellitus and its treatment and implications in dentistry
Overview of method of research: Type I (aka Insulin Dependent Diabetes Mellitus-IDDM) affects mostly children with only 10% having onset over 21. It affects 1 in 700 children at 16 years of age. Treatment consists of two injections of NPH or insulin per day. The Beta cells of the islets in the pancreas are destroyed by the body’s autoimmune system over at least several years before symptoms appear. Symptoms include significant variables in blood sugars and both hypoglycemia and ketoacidosis.
Type II or adult onset diabetes is more common affecting 5 % of the population, mostly affecting patients over 40, and is related to obesity and a positive family history. It can be controlled by diet or hypoglycemic agents. Normal number of islets are noted but they are sluggish.
Several advances in the management of diabetes have occurred. Self blood glucose monitoring allows patients to monitor blood glucose levels during daily activity. Insulin pumps permit more predictable blood glucose control. Highly purified insulin prevents allergic reactions. Different techniques have been developed to determine the success of regulating blood glucose control. These include blood glycosylated hemoglobin in the form of total glycosylated hemoglobin, GgA1c, and HgA1. Treatment investigations under review include immuno-suppression to prevent an autoimmune response.
Dental implications: Diabetes does not increase the risk of dental decay. However, the frequency and severity of periodontal disease increased with age. Gingival inflammation appears related to patients with diabetes who have poor metabolic control. It is uncertain if chronic inflammation is related to decreased salivary flow, elevated salivary glucose concentration, or poor oral hygiene. There is some speculation that hyperglycemia can produce neutrophil dysfunction. Patients with diabetes have chronic hyperglycemia which causes poor neutrophil function and may make the diabetic patient more susceptible to periodontal disease.
Dental Treatment: In case of limited ability to eat, patients should have ready access to rapidly acting carbohydrates like sugar, orange juice, candy bars, etc. In general anesthesia cases, modifications should be made in cases of long periods of fasting like early AM surgeries, larger bedtime snacks, or less NPH before dinner and lastly postponement of AM insulin until after surgery.
Assessment of article: good summary, but needs updating.