Endodontic treatment in diabetes -

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Endodontic treatment in diabetes: How to approach endodontic treatment in diabetic patients.

Diabetes Prevalence:

According to CDC, 25.8 million people (8.3% of the US population) had diabetes in 2011.
1.9 million people aged 20 years or older were newly diagnosed with diabetes in 2010.

Diabetes is the seventh leading cause of death in the US.
People with diabetes have twice the risk of death compared to those without diabetes.
Patients with diabetes requiring endodontic treatment are becoming increasingly common.

Insufficient insulin production or ineffective insulin utilization leads to elevated blood glucose levels.
Type 1 diabetes: Autoimmune destruction of pancreatic beta cells results in little to no insulin production.
Type 2 diabetes: Insulin resistance occurs, where cells become less responsive to the effects of insulin, leading to compensatory hyperinsulinemia. (ref)
In both types, impaired glucose uptake by cells leads to increased hepatic glucose production and release into the bloodstream.
Hyperglycemia stimulates the release of glucagon, further promoting hepatic glucose production.
Increased blood glucose levels contribute to osmotic diuresis, causing polyuria (excessive urination) and subsequent polydipsia (excessive thirst).
Loss of glucose in urine leads to glycosuria, further contributing to fluid and electrolyte imbalances.
Lipolysis is enhanced, leading to increased fatty acid release and subsequent ketone production, which can result in diabetic ketoacidosis in type 1 diabetes.
Chronic hyperglycemia causes advanced glycation end products (AGEs) formation, contributing to tissue damage and diabetic complications in various organs.

Well-controlled diabetes without serious complications makes a patient a candidate for endodontic treatment.
Special considerations apply during acute infections.
Non-insulin-controlled patients may require insulin adjustments.
Surgical procedures may require consultation with the patient’s physician to adjust insulin dosage, antibiotic prophylaxis, and post-treatment diet.

Patients who self-monitor glucose levels should bring a glucometer to each visit.
If pretreatment glucose levels are below normal fasting range, a carbohydrate source may be appropriate.
Signs of hypoglycemia include confusion, tremors, agitation, diaphoresis, and tachycardia.
Clinicians should obtain accurate insulin and meal history and consult the patient’s physician if necessary.

Well-managed diabetic patients without serious complications can receive any necessary dental treatment.
Patients with serious medical complications may require a modified treatment plan.
Prophylactic antibiotics may be prescribed for patients with difficult-to-control diabetes and invasive procedures.
Local anesthesia is generally safe, but caution should be exercised for patients with concurrent hypertension, recent myocardial infarction, or cardiac arrhythmia.

Inadequate diabetic control may increase the risk of oral infections, including dental pulp infection.
The success of endodontic treatment may be influenced by diabetes, particularly in cases with pretreatment periradicular lesions.
Patients with diabetes and other systemic diseases may benefit from referral to an endodontist for treatment planning.