Dentists will be no stranger to how to a systemic condition can affect a patient’s overall health, and they may be familiar with how it can affect their oral health too.
Today I’m going to talk about the unique challenges presented by a patient with diabetes mellitus.
Type 1 (insulin dependent) and Type 2 (non-insulin dependent) diabetes mellitus
Patients with undiagnosed or poorly-controlled diabetes mellitus have particular susceptibility to periodontal diseases.
On the other hand, most well-controlled diabetic patients can maintain periodontal health and should respond favourably to periodontal therapy.
Treatment considerations for patients with periodontitis associated with diabetes should include:
1. Identification of signs and symptoms of undiagnosed or poorly controlled diabetes.
2. Consultation with the patient’s physician as necessary.
3. Consideration of diagnosis and duration of diabetes; level of glycemic control; medications and treatment history.
4. Consideration of adjunctive systemic antibiotics for periodontal procedures if the diabetes is poorly controlled.
5. Preparation to diagnose and manage medical emergencies associated with diabetes.
It’s also worth mentioning, while we’re on the subject of systemic conditions affecting the mouth, pregnancy.
Hormonal fluctuations in the female patient may alter the status of periodontal health. Such changes may occur during puberty, the menstrual cycle, pregnancy, or menopause.
Changes may also occur with the use of oral contraceptives.
The most pronounced periodontal changes occur during pregnancy and treatment considerations for pregnant patients with periodontal disease include:
1. Consultation with the patient’s physician as necessary.
2. Consideration of postponement of periodontal treatment during the first trimester.
3. Performance of emergency periodontal treatment at any time during pregnancy.
4. Consideration of deferral of periodontal surgery until after parturition.
5. Performance of periodontal maintenance as needed.
6. Administration of antibiotics and other drugs with caution.
7. Use of local anaesthesia in preference to general anaesthesia or conscious sedation.
If you treat patients experiencing either of these conditions, I welcome your response to this article.
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