Diabetes mellitus (DM) is a chronic and multifactorial pathology characterized by the existence of hyperglycemia, an inevitable consequence of an absolute or relative insufficiency of insulin secretion and insensibility or resistance of tissues to the metabolic effect of insulin. Over time, the disease can cause damage, dysfunction and failure of various organs.
Diabetes is not a single disease, it encompasses a heterogeneous group of carbohydrate metabolism alterations with different genetic patterns, as well as different etiologies and pathophysiological mechanisms.
Mainly two types of diabetes are known:
- Type 1 diabetes (DM1): usually occurs in childhood or adolescence. It is a disease of autoimmune nature, which generates a deficit of insulin production, so patients need exogenous insulin contributions throughout life.
- Type 2 diabetes (DM2): usually appears in adult life and is related to obesity, physical inactivity and unhealthy eating habits. It is the most common form of diabetes (around 90% of the cases in the world) and its treatment can consist of lifestyle changes, including weight reduction, oral drugs or even exogenous insulin contributions.
Diabes mellitus is considered a multisystemic disease, and therefore, it presents oral manisfestations that we must take into account, either for the diagnosis as in the follow-up and for the control of it when we go to the dentist’s office.
The main manifestations or repercussions in the mouth of patients with diabetes are:
– Greater predisposition to dental caries
– Increased incidence of periodontal disease (commonly known as “pyorrhea”)
– Worst process of healing in the surgery processes (extractions of teeth, surgery to place implants, etc.)
The microorganisms responsible for dental caries transform the carbohydrates of the diet. The diet of diabetic patients has little effect on the pathogenesis of dental caries, but it has been shown that high glucose concentrations are present in saliva and crevicular fluid in diabetic patients compared to the general population. This is complemented by the fact that the
buffer effect is reduced due to the relatively low salivary fluid rates.
b) Periodontal disease:
Both diabetes mellitus type 1 and type 2 have been considered as risk factors for periodontal disease, especially presenting more severe forms in those poorly controlled individuals and in cases in which the diagnosis of the disease was made in age youth.
There are studies that show that type 2 patients have markedly increased insertion loss, loss of alveolar bone and teeth. In addition, it is considered that periodontal disease can affect the control of diabetes, and therefore that metabolic control is essential for the proper maintenance of periodontal disease.
c) Poor healing:
The vascular changes, higher incidence of infections, alteration in the defensive cells of the organism and other alterations caused by diabetes means that any surgical intervention performed in the mouth of the patients may imply an increased risk of complications in the healing process.
On the other hand it is vitally important that the diabetic patient is well controlled when he or she is going to be treated at the dental office. Two situations of urgency must be taken into account, which can be the crises of both hyper and hypoglycaemia. These situations can be extremely serious. Diabetic patients can be treated with normality, but it is important that they come to the consultation with their adequate metabolic control (glycemia) and the dentist will be responsible for taking the appropriate preventive measures so that the treatment can be carried out normally. Among these preventive measures area use adequate anesthesia, give antibiotic prophylaxis if surgical interventions are going to be performed, perform maneuvers to control bleeding and more important than these measures is to insist on these patients
the need for extreme oral hygiene and early diagnosis of the illness.
In relation to advances in the field of genetics, it is important to note that not only certain genomic variants show the predisposition to different diseases, including autoimmune diseases, but also Precision Medicine takes on a vital importance at the time to improve and optimize pharmacological treatments, achieving individualization to achieve excellence. Therefore, prevention measures are so important.