Diabetes Mellitus and Prosthodontic Care Chanchal Katariya & Dr. Sangeetha

International Journal of Multidisciplinary Research and Modern Education (IJMRME)
Impact Factor: 6.725, ISSN (Online): 2454 - 6119

(www.rdmodernresearch.org) Volume 3, Issue 1, 2017
DIABETES MELLITUS AND PROSTHODONTIC CARE
Chanchal Katariya* & Dr. Sangeetha**
* 3rd Year BDS, Saveetha Dental College and Hospitals, Chennai, Tamilnadu
** Faculty of Prosthodontics, Saveetha Dental College and Hospitals, Chennai,
Tamilnadu
Cite This Article: Chanchal Katariya & Dr. Sangeetha, “Diabetes Mellitus and
Prosthodontic Care”, International Journal of Multidisciplinary Research and
Modern Education, Volume 3, Issue 1, Page Number 294-296, 2017.
Copy Right: © IJMRME, R&D Modern Research Publication, 2017 (All Rights Reserved). This is an Open
Access Article distributed under the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract:
The aim of the review to bring out the prosthodontic care in diabetes mellitus patients.the objective of
the review is to bring out the adverse effect of diabetes mellitus and its effect on prosthodontic treatment and the
management.Diabetes mellitus type 2 is a pandemic disease which is prevailing globally. It is usually caused
due to deficiency or absolute absence of insulin. It affects many part of the body including oral cavity. It is
characterised by chronic hyperglycaemia. Contributing factors include genetics, obesity, physical inactivity and
advancing age. Diabetes affects most parts of the human body, also oral cavity is no exception for the same. The
purpose of this review is to bring out the ultimate prosthodontic treatment options for patients with diabetes
mellitus with better care and to maintain proper oral hygiene.
Introduction:
Diabetes is a systemic condition where there is lack of insulin production in the body or insulin that is
produced is no longer as effective at cellular level. It is a syndrome not only affects the metabolism of
carbohydrates, protein and glucose, also under chronic situation causes long term damage to various organs such
as heart, eyes, kidneys, nerves & vascular system.
Classification:
Type 1 - Beta cell destruction which in turn may result in total absence of insulin or deficiency of insulin. It is
also called insulin dependent diabetes mellitus.[6] It is mostly commonly occur in childhood and adolescence of
any group of age.
Type 2 - beta cell dysfunction or insulin resistance.It is also called non- insulin dependent diabetes mellitus.[7]
It seen in patients with increase in age, obesity & lack of physical activity.
Diabetes is characterized by a complex clinical manifestation such as: nephropathy, retinopathy,
neuropathy and cardiovascular diseases. In patients with diabetes numerous oral complications are present, they
are
Oral Complications of Diabetes Mellitus:
 Xerostomia
 Gingival Inflammation
 Increased Caries Risk
 Burning Sensation
 Periodontitis
 Fungal Infections
 Poor Wound Healing
 Alveolar Bone Resorption
Xerostomia:
Xerostomia is condition of dry mouth. Patients with diabetes has polyurial action which means
increased excretion of water lead to dehydration ,increasing the sensation of dry mouth and causing xerostomia.
Secondly, Peripheral nervous system disfunction caused by diabetes (autonomous peripheral neuropathy) can
cause damage to the salivary glands and decrease of salivary flow. As a result, there is increase in stomatitis and
candidal infections in the oral cavity. Patients using removable dentures should be informed about oral care as
well as about maintenance of the dental prostheses and the need to renew them.
Poor Wound Healing:
In diabetes there is a pronounced imbalance of pro-/anti-inflammatory cytokines leading to impaired
tissue repair and weakened cellular and humoral immune defense mechanisms. Poor wound healing in diabetes
mellitus patients may be due to insufficient nerve-derived mediators i.e., neuropeptides such as substance P may
contribute to the impaired response to injury.[8] Decreased collagen formation may also leads to poor wound
healing because clotting involves collagen fibres.Impaired growth factor secretion may also be a key mechanism
for impaired wound healing in diabetics.[2]
Gingival Inflammation:
Gingival inflammation is one of the major complications for diabetes mellitus. Worsening of glycemic
level or increased glucose level in blood lead to poor metabolism which may lead to gingival inflammation.
294
Increased Risk of Fungal Infection:
Fungal infections like candidiasis is associated with poor glycemic control and use of denture. It is due
to Change in pH, increased salivary glucose levels and immune dysregulation in diabetic patients.
Burning Sensation:
In diabetes, burning mouth syndrome, which develops due to peripheral neuropathy, causes
xerostomia, candidiasis and taste disturbance in the mouth. These adversely affect the patient’s food intake and
create a negative effect on metabolic control of diabetes.
Increased Caries Risk:
Patients with diabetes mellitus have increased risk of caries and periodontal problems. As there is
change in the oral environment due to decreased salivary flow and pH and increased pathogenic bacterial
growth in the mouth causes damage to the hard and soft tissue of the teeth.
Prosthodontic Care in Diabetes Mellitus:
The restoration and the maintenance of good oral hygiene is mandatory before starting any
prosthodontic procedures.
 Medical History: It is important to take proper medical history of the patient’s Blood glucose levels,
Medication, dosage and timing of medication taken. Make sure the patient had donetheir blood glucose
level test prior to the treatment.HbA1C is evaluated to check overall glycemic control for a period of 3
months.It is very important to evaluate proper medical history and assess glucose level at the initial
appointments in all the patients older than 45 years of age.
 Diet: It should be ensured that patient has had his/her breakfast and medication before treatment.
 Scheduling of the Patient’s Visit: Diabetic patients should be scheduled preferably in the morning.
Since endogenous cortisol level is higher during morning time which in turn increases blood glucose
level
 In RPD: All components of RPD must be designed appropriately such that prosthesis is tissue friendly.
Proper oral hygiene and denture hygiene or maintenance instructions should be given to the patients.
 In CD: Denture border and tissue surfaces of the dentures should be smooth without any sharp nodules
or over extensions to prevent tissue damage.Impressions should be taken in mucostatic technique
without pressure. Concept of neutal zone technique can be employed to reduce the bone resorption
.Proper oral hygiene instructions can be given to patients to avoid fungal infections.As there is decrease
denture retentiondue to less salivation, frequent sipping of water and use of sugarless gums may help
them to maintain salivary flow.
 In FPD: It is better to keep the finish line supragingival to avoid damaging soft tissue. The chamfer
margin is a better option as it applies less force or stress on weakened tooth.Ante's law should be
obeyed as the diabetic patient more prone for periodontal infection.Proper flossing should be done to
maintain the oral hygiene. During tooth preparation, care should be taken to avoid trauma to the soft
tissue as diabetes patients have poor wound healing. Hygienic pontic should be preferred as much as
possible for ease of cleansing action.
 In Implant or Implant Supported Dentures: Implant supported prosthesis are not indicated for
uncontrolled diabetic patients but if conditions are favorable, then this type of prosthesis can be
planned.Proper medication must be provided before and after implant placement. Patient should
maintain their sugar level even after the surgical placement of implants.
Conclusion:
Diabetes is a common metabolic disorder associated with hyperglycemia and its complications.
Management of diabetic dental patient should focus on general oral health & the delivery of comprehensive
dental care with minimal disruption of metabolic homeostasis.Its important to give a proper prosthodontic care
to diabetes patient inspite of the complications they posses.Good oral&denture hygiene maintenance and proper
dental check up is a pre requisite for ensuring the long term successful Prosthodontics treatment.
References:
1. Lamster IB, Lalla E, Borgnakke WS, Taylor GW.The relationship between oral health and diabetes
mellitus.The Journal of the American Dental Association. 2008 Oct 31;139:19S-24S.
2. Daniel R, Gokulanathan S, Shanmugasundaram N, Lakshmigandhan M, Kavin T. Diabetes and
periodontal disease. J Pharm BioallSci 2012;4, Suppl S2:280-2
3. Kansal G, Goyal D. Prosthodontic Management Of Patients With Diabetes Mellitus. J Adv Med Dent
Scie Res 2013;1(1):38-44.
4. Consultation, W. H. O. "Definition, diagnosis and classification of diabetes mellitus and its
complications." (1999): 25.
5. Mealey BL. Diabetes and periodontal disease: two sides of a coin. CompendContinEduc Dent.
2000;21:943-6, 948, 950.
6. Chang PC, Lim LP. Interrelationships of periodontitis and diabetes: A review of the current literature.
Journal of Dental Sciences. 2012 Sep 30;7(3):272-82.
295
7. Bascones-Martinez A, Matesanz-Perez P, Escribano-Bermejo M, González-Moles MÁ, Bascones-
Ilundain J, Meurman JH.Periodontal disease and diabetes-Review of the Literature.Med Oral Patol Oral
Cir Bucal. 2011 Sep 1;16(6):e722-9.
8. Gibran NS, Jang YC, Isik FF, Greenhalgh DG, Muffley LA, Underwood RA, Usui ML, Larsen J,
Smith DG, Bunnett N, Ansel JC. Diminished neuropeptide levels contribute to the impaired cutaneous
healing response associated with diabetes mellitus. Journal of Surgical Research. 2002 Nov
1;108(1):122-8.
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International Journal of Multidisciplinary Research and Modern Education (IJMRME)

Impact Factor: 6.725, ISSN (Online): 2454 - 6119

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