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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.

Impact of Diabetes:

  •   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.

Pathophysiology of Diabetes:

  • 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.

Considerations for Endodontic Treatment in Diabetic Patients:

  •   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.

Glucose Monitoring and Hypoglycemia:

  •   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.

Dental Treatment Planning:

  •   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.

Impact on Endodontic Treatment:

  •   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.

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