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Diabetes Mellitus: Endodontic Considerations
The incidence of diabetes mellitus (DM) in the United States population is estimated at 16 million and is most prevalent in ethnic minority groups. Recent studies suggest a three-fold increase in the last 40 years, which does not include the population with undiagnosed diabetes. Simply defined, DM is a metabolic disorder of carbohydrate and lipid metabolism. Both genetics and environmental factors are thought to play a role in the etiology of diabetes.
Why is DM important to the dental practitioner? DM patients are particularly susceptible to infections for two reasons:
1. Blood vessels of the vascular and peripheral nervous systems are damaged by the deposition of atheromatous materials - advanced gylcosalated end products (AGE) and low-density lipoproteins (LDL). In combination, AGE and LDL lead to calcifications and poor circulation. The retina and glomerular micro circulation of the kidneys are especially susceptible to atheromas (atherosclerosis).
2. Capillaries are unable to promote leukotaxis, impairing the microbiocidal response of polymorphonuclear leukocytes and, thereby, the entire immune system.
While a complete revies of DM is not possible here, the following list of oral manifestations of DM with Poor insulin control includes the following:
- Periodonitis
- Increaszed oral infections(candidiasis)
- Xerostomia with or without parotid gland enlargement
- Altered taste
- Reduced bone mineralization
- Increased salivary and crevicular glucose, which may increase peridontitis and caries
- Anachoresis (infection of inflamed pulps by bacteria that emanate from the blood stream)
Although not well documented, the dental pulps of patients with DM may cause pain associated with the condition "odontogenic odontalgia". These patients will require a therapeutic adjustment in their insulin levels.
Increased local inflammation associated with pulpal pathosis will result in a rise in blood glucose, which may place the diabetic patient in an uncontrolled state. These patients will require a therapeutic adjustment in theirs insulin levels.
Limited studies have demonstrated that dental pulps in DM patients show increased calcification and poor microvasculature, resulting in increased risk of infection of the pulp and periapical tissues. It is theorized that vascularchanges cause a decrease in oxygen perfusion, resulting in the promotion of anaerobic infections. According to Falk, et al1, patients with long - duration DM had more teeth with periapical pathosis than controls, and frmales had more non-healed endodontically treated teeth.
In October, 2003, the ADA has published new guidelines for treating the dental patient with diabetes. This information is available in the JADA and at http://www.ada.org.
1Falk, H., Hugoson A, Thorstensson H. Number of teeth prevalance of caries and periapocal lesions in insulin-dependent diabetes.
Scand J Dent Res, 1989;97:198-206
ENDO FACTS is intended to aid the practitioner in the management of endodontic conditions. Practitioners must always use their own best professional judgement. We neither expressly nor implicitly warrant any positive results associated with this material.
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