Diabeties Flashcards
Why does diabetic patients prone to develop infections ?
Cause high blood sugar levels ( diabetes ) cause vascular abnormalities like ( ischemia , athercolosis…) weave decrease blood perfusion which lead to decrease of WBC espicially to infection site
Leading to , delay healing , infection , caries…
If the patient is good oral hygiene can caries , periodontitis , gingivitis develop ?
Yes of course .
1. Due to low perfusion
2. Due to xerostomia
According to ( glycated hemoglobin , glycogemoglobin , glycosylated gemoglobin ) A1c which levels are normal , prediabetic , diabetic ?
Normal : <5.7
Pre : 5.7-6.4
Diabetic : >= 6.5
What’s fasting blood glucose levels ?
Normal <99
Pre 100-125
Diabetic >125
What’s the ranges of random blood glucose (glucose tolerance test ) mg/dl?
Normal <140
Pre 140-199
Diabetes >200
In type 2 what’s the medications that patient take and why ?
Metformen
Glucophage XR
Riomet
Cause this type is common in obesity high fatty acids levels decrease insulin receptors sensitivity to it , so this drug increase sensitivity
Sometimes in gestirional diabetes taking metaformin
Which type of diabetes in pregrancy and why ?
Dental prospective ?
Gestational
Due to excessive weight gain , genetic history of diabetes
Increase oral infections
Which type of diabetes may be with Sjögren’s syndrome and why ?
Dental prospective ?
Type 1 cause its autoimmune reaction against pancreatic beta cells ( juvenile onset ) , sjogrens also autoimmune leading to xerostomia .
Treatment : insulin injections
Type 1 and 2 each of them common in which populations ?
Type 1 : ( juvenile onset ) youngs , children , genetic , autoimmune , insulin defiency
Type 2 : olders ( adult onset ) , insulin resistance ( need tablets ) , obesity , inactive life style. , heredity
What’s the oral manifestations of diabetes ?
● Dry mouth
● Delayed wound healing (vascular damage)
● Increased infection risk
● Caries
● Oral candidiasis
● Enlargement of parotid glands
● Periodontal disease
Why does xerostomia happen even if there is no type 1 diabetes ?
Osmolarity diabetes , high blood osmolarity due to sugar when it secreted by urine take off with it water which decrease water left in body = dryness = decrease tears , saliva , hydration ( dehydration ) .
What’s the mechanism in which diabetes cause vessels pathology that lead to nerve damage also ?
Where to look in patients body to check diabetes ?
Glucose will damage the endothelium and oclude the vessels and nerves start loss blood supply causing nerve distribution , loss sensation …
Always check between patients fingers if there is any unhealed wound , infections …
Which sensations in oral cavity related to nerves damage ?
Burning mouth symptoms
What’s the diabetes kidney complications that we most be aware to ?
CKD : chronic kidney disease ( due to high glucose secretion that take off with it water it lead to hyperperfusion to kindney glomerular causing decrease blood supply to kidney )
Always ask about kindney condition and creatinin .
Don’t give ibuprofen ( Morton , Advil )
What’s the diabetes complications that we most be aware to ?
CKD
CAD ( coronary artery disease due to increase fat = occluding. )
Retinopathy ( free radicals decrease blood supply to retina )
Neuropathy
Gastopathy
What’s the risk of infection during dental treatment like endo , extraction .. ?
FBG <230 (206-230) = 20% risk
FBG >230 = 80% risk
Antibiotics required
Does all dental treatments need Ab prophylaxis ?
No for example , cleaning , Carie’s no need
What’s analgesics 3 lines ?
1) paracetamol , Panadol ( not in hepatic patients )
2) NSAIDs (aspirins in liver disease no ) , ibuprofen ( not for renopathy ) , voltarine
4) opioids
What to perscribe Analgesics in normal and abnormal kindney function ?
Normal : NSAIDs ( ibuprofen , voltarin … )
Abnormal : 1. Paracetamol (panadol )
acetaminophen ( Tylenol )
2. Opioids ( cadeine , tramol..)
Ab perspectionn ?
Pencil in always first line if allergic clindamycin ( macrolid )
Anaerobic ( flagyl )
Others : amoxicillin , clavaluic acid ( augmantine )
How to deal with well controlled patient ?
○ Short morning appointments, ensure medications ( normal insulin , tablets … ) taken and meals eaten
○ Have glucose source available
• make good position don’t change rapidly to avoid orthostatic hypotension
○ Be aware of drug interactions
- Avoid NSAIDs with sulfonylureas drugs ( patients who take sulfony it will worse hypoglycemia )
- Avoid glucocorticoids ( lead to hyperglycemia ).
- Avoid levofloxacin ( this drugs treat oral infections but cause hypoglycemia )
how to deal with poorly - controlled patients ?
○ Defer elective treatment ( aesthetic .. )
○ If urgent treatment and asymptomatic → manage infections ( incision , ENDO , extraction , Ab cause they have low ability to fight infection. ) and refer to physician
○ If urgent treatment and symptomatic → call EMS to adminster IV Ab , manage insulin levels ..
There is high cooperation between diabetes and blood pressure so follow the epinephrine constructions .
Which most to be considered as poorly controlled ?
FBG 220mg/dl
HbAc1 9<
Potient with diabetes undergo general anesthesia , what do you do ?
- Severe diabetes should not go to general due to the fasting
- Controlled can
Patient has trouble remembering if he took their insulin today , what you gonna do ?
Depend on there recent HbA1c , FGT , and your FGT at clinic
Patient has trouble remembering if he took their insulin today , what you gonna do ?
Depend on there recent HbA1c , FGT , and your FGT at clinic
How to deal with hypoglycemia emergency ?
○ Blood glucose < 70 mg/dL
○ Tachycardia, irritable, restless, hungry, diaphoresis
○ If conscious → administer glucose tab
○ If unconscious → call EMS, IV dextrose or IM
glucagon
How to deal with Hyperglycemia emergency ?
○ Blood sugar >/= 126 mg/dL fasting, >/= 200 mg/dL
after meal
○ Ketone breath, thirsty, nausea, vomiting, frequent
urination, blurred vision
○ Call EMS
