MANAGEMENT OF DIABETES MELLITUS
PATIENTS IN PROSTHODONTICS
Mehmood Hussain, BDS,
Nazia Yazdanie BDS,MSc, Ph.D
Jodat Askari BDS,FCPS
Diabetes Mellitus is a nutritional metabolic disorder characterize by various oral and systemic problems. These
patients when referred to dentist or prosthodontist for the provision of prosthetic treatment require multidisciplinary
approach. In this article special focus is emphasized on the various factors important factors to be kept in mind when
providing prosthodontic treatment for such patients. .
KEY WORDS: Diabetes Mellitus, Clinical features, Prosthodontics Management.
J Pak Dent Assoc 2010;19(1):46-48
INTRODUCTION as well. People mostly consult their physician when
typical symptoms of diabetes like polyuria, polydipsia,
iabetes Mellitus is a clinical syndrome polyphagia occur. Considering oral health in diabetic
characterized by hyperglycemia due to absolute patients, they are more prone to develop caries,
or relative deficiency of insulin.1 The two main periodontitis, xerostomia, oral ulcers, burning mouth
categories of Diabetes Mellitus include Type I or Insulin syndrome, candidiasis, loss of resilience of oral mucosa,
dependent Diabetes Mellitus and Type II or Non insulin residual bone resorption, periodontal abscess, gingival
dependent Diabetes Mellitus. The former is a result of overgrowth and poor tolerance to prosthesis especially for
absolute deficiency of insulin with its onset occurring complete dentures. 6 Oral manifestations are most likely
before adulthood. In contrast, Type II results because of due to increase glucose concentration in saliva, polyuria,
insulin resistance with an insulin secretary defect with its impaired host resistance due to defective function of
onset usually occuring in mid or later life although it can polymorphonuclear leucocyte (PMN) and microvasculsar
occur earlier as well.2 changes.7
Regarding pathogenesis, Type I Diabetes Mellitus results Management Considerations:
from immunological destruction of pancreatic beta cells,
General Dental Considerations:
while Type II results from combination of impairment of
insulin resistance and defective secretion of insulin by It is better to arrange appointment in the morning and
beta cells. Contributing factors include genetics, obesity, avoiding lengthy appointments. All procedures should be
physical inactivity and advancing age. 3 Diabetes Mellitus done involving minimal possible trauma and should be
is becoming a common disease of today's world, in United carried in stress free environment. Maintenance of good
Kingdom one in twenty people over the age of 65 has oral hygiene is a prerequisite for all dental procedures. In
diabetes and this rises to one in five people over the age of this regard application of topical agents like
85 years. The World Health Organization predicts that the chlorhexidine, fluoride gel is found very useful. The use of
global prevalence of diabetes will increase from 135 prophylactic medication to avoid postoperative infection
million to 300 million in 2025.4 Even in developing and pain is recommended in certain cases. For
countries like Pakistan, the incidence of diabetes is management of xerostomia, diet counseling, medication,
increasing rapidly and most of the cases are undiagnosed artificial salivary substitutes are helpful. Before starting
any procedure consultation with patient's physician or
* Incharge, Prosthodontics Department , Hamdard College of endocrinologist is also beneficial for the diabetic patients.
Medicine & Dentistry Karachi.
** Former Head, Prosthodontics Department, & Principal Dentist should also be able to know about the diagnosis
de’Montmorency College of Dentistry, Lahore and management of hypoglycemic shock. It is
*** Associate Professor, Dept of Prosthodontics, Sir Syed Institute of characterized by hunger, nausea, perspiration, pallor, and
Medical Sciences , Karachi. tachycardia. In severe condition seizure may occur and
Correspondence: Dr. Mehmood Hussain <email@example.com> patient may undergo in state of unconsciousness.
JPDA Vol.19 No.1 Jan-Mar 2010 45
Hussain M, Yazdanie N, Askari J Management of Diabetes Mellitus Patient in Prosthodontics
Management depends upon the severity of the shock. Always use an occlusal scheme that has narrow bucco-
Initially treatment should be deferred and to monitor vital lingual dimension and shortened mesiodistal length. This
signs and administer glucose orally if possible otherwise approach will decrease the stress on the underlying tissue
intravenous administration of glucose should be done. to retard bone resorption, concept of neutral zone can also
Prosthodontics Management Considerations: be employed. Denture flanges should be smooth and
polished. There should be no working or non-working
Eradication of any disease/s that will affect the prognosis occlusal interference between opposing teeth.15
of any dental prosthesis will be the first line of action.
Teeth requiring restoration must be restored by It is also mandatory for the dentist to fully educate and
appropriate restorative procedures like filling, endodontic motivate the patient to the importance of maintaining
treatment etc. As previously mentioned restoration and the good oral hygiene and towards the importance of regular
maintenance of good oral hygiene is mandatory before follow-up visits to the dentist.
starting any prosthodontic procedures. On first visit, This will ensure the long term heath of the oral tissues by
assessment of the patient should be done which include preventing chronic infection states such as denture related
proper history and examination. Details regarding type of stomatitis and denture hyperplasia that could lead to more
prosthesis, duration of treatment, number of appointments serious conditions. Diabetic patients are more susceptible
must be explained to the patient.10 to infections which in severe cases may lead to excessive
Radiographic evaluation must be carried out. Patients is oral tissue destructions, such patients may need
advised to bring reports of recently done and up to date obturators. Fabrication of obturator require special care in
laboratory investigation regarding blood sugar level. every patient and especially in diabetic patient.
Secondly it is better to note blood sugar level before For patients requiring a fixed prosthesis like crown or
starting any dental procedure with the help of glucometer. fixed partial denture (FPD), the finish-line of the
Patient must be instructed to consult his or her physician preparation should be placed supragingival and to provide
before initiating any procedure, if needed then any chamfer finish-line on the facial aspect of prepared tooth
alteration regarding patient's medication must be
11 as it is better than shoulder because shoulder can
discussed with the patient's physician. concentrate stresses on weakened tooth/ teeth. Ante's law
If patient is provided removable partial denture (RPD), should be obeyed; minimal preparation like three quarter
then restoration and maintenance of good oral hygiene by crown can be done on teeth like pre molar.
any restorative procedures or root planning and scaling
A narrow occlusal table, group function or mutually
must be accomplished first. Health of abutment teeth is
protected occlusal scheme is better choice for
very important and will be achieved by various means for
12 periodontally compromised teeth.17. In certain cases
better prognosis of RPD treatment. All components of
procedures like crown lengthening, periodontal surgery
RPD must be tissue friendly by making appropriate design
of the prosthesis. As diabetic patients are more prone to and orthodontic extrusion of tooth will further improve the
develop periodontal diseases, therefore in certain cases quality of fixed prosthesis in diabetic patients.18 Implant
splinting of periodontalally compromised teeth is also a supported prosthesis are not advised for patients whose
good option. Some times periodontal surgery may be blood sugar level remains uncontrollable but if conditions
indicated.13 Selection of particular type of RPD is also are favorable , then this type of prosthesis can be planned.
very important, in Diabetic patients. If an acrylic denture Like any other dental surgical procedure, implant
is a preferred option then the design should incorporate placement must be accomplished with least trauma under
the principles of 'Every Denture' with wider self stress free environment.19
cleansing interdental spaces and embrasures areas, Proper medication must be provided before and after
uncovered marginal gingiva, point contact between implant placement. Complete history and examination
denture and natural abutment teeth, free gliding occlusion, along with radiographic evaluation must be carried out for
maximum retention following complete denture making selection of type of dental implant, number of dental
principles. These all factors are beneficial for the diabetic implants, site of implant placement, type of artificial
patients if they need RPD. prosthesis and occlusal scheme.
When complete denture is fabricated for diabetic patients All these considerations will ensure better performance of
then always use tissue friendly material and technique, implants supported prosthesis. 20, 21
impression making will be done by mucostatic technique.
Occlusal vertical dimension should be appropriate.
46 JPDA Vol.19 No.1 Jan-Mar 2010
Hussain M, Yazdanie N, Askari J Management of Diabetes Mellitus Patient in Prosthodontics
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