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characterized by hyperglycemia due to absolute or relative deficiency of insulin.

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The two main categories of Diabetes Mellitus include Type I or Insulin dependent
Diabetes Mellitus and Type II or Non insulin dependent Diabetes Mellitus. The former
is a result of absolute deficiency of insulin with its onset occurring before adulthood.
In contrast, Type II results because of insulin resistance with an insulin secretary
defect with its onset usually occuring in mid or later life although it can occur earlier
as well.2
D

Regarding pathogenesis, Type I Diabetes Mellitus results from immunological
destruction of pancreatic beta cells, while Type II results from combination of
impairment of insulin resistance and defective secretion of insulin by beta cells.
Contributing factors include genetics, obesity, physical inactivity and advancing
age. 3 Diabetes Mellitus is becoming a common disease of today’s world, in United
Kingdom one in twenty people over the age of 65 has diabetes and this rises to one
in five people over the age of 85 years. The World Health Organization predicts that
the global prevalence of diabetes will increase from 135 million to 300 million in
2025.4 Even in developing countries like Pakistan, the incidence of diabetes is
increasing rapidly and most of the cases are undiagnosed as well. People mostly
consult their physician when typical symptoms of diabetes like polyuria, polydipsia,
polyphagia occur.5 Considering oral health in diabetic patients, they are more prone
to develop caries, periodontitis, xerostomia, oral ulcers, burning mouth syndrome,
candidiasis, loss of resilience of oral mucosa, residual bone resorption, periodontal
abscess, gingival overgrowth and poor tolerance to prosthesis especially for
complete dentures. 6 Oral manifestations are most likely due to increase glucose
concentration in saliva, polyuria, impaired host resistance due to defective function of
polymorphonuclear leucocyte (PMN) and microvasculsar changes. 7
Management Considerations: General Dental Considerations
It is better to arrange appointment in the morning and avoiding lengthy
appointments. All procedures should be done involving minimal possible trauma and
should be carried in stress free environment. Maintenance of good oral hygiene is a
prerequisite for all dental procedures. In this regard application of topical agents like
chlorhexidine, fluoride gel is found very useful. The use of prophylactic medication to
avoid postoperative infection and pain is recommended in certain cases. For
management of xerostomia, diet counseling, medication, artificial salivary substitutes
are helpful. Before starting any procedure consultation with patient’s physician or
endocrinologist is also beneficial for the diabetic patients. 8
Dentist should also be able to know about the diagnosis and management of
hypoglycemic shock. It is characterized by hunger, nausea, perspiration, pallor, and
tachycardia. In severe condition seizure may occur and patient may undergo in state
of unconsciousness
Management depends upon the severity of the shock. Initially treatment should be
deferred and to monitor vital signs and administer glucose orally if possible otherwise
intravenous administration of glucose should be done.
Prosthodontics Management Considerations:

free gliding occlusion. then restoration and maintenance of good oral hygiene by any restorative procedures or root planning and scaling must be accomplished first. if needed then any alteration regarding patient’s medication must be discussed with the patient’s physician. therefore in certain cases splinting of periodontalally compromised teeth is also a good option. These all factors are beneficial for the diabetic patients if they need RPD. assessment of the patient should be done which include proper history and examination. Secondly it is better to note blood sugar level before starting any dental procedure with the help of glucometer. Occlusal vertical dimension should be appropriate Always use an occlusal scheme that has narrow bucco-lingual dimension and shortened mesiodistal length. Teeth requiring restoration must be restored by appropriate restorative procedures like filling. point contact between denture and natural abutment teeth.Eradication of any disease/s that will affect the prognosis of any dental prosthesis will be the first line of action. This approach will decrease the stress on the underlying tissue to retard bone resorption. uncovered marginal gingiva. concept of neutral zone can also be employed.10 Radiographic evaluation must be carried out. 13 Selection of particular type of RPD is also very important. impression making will be done by mucostatic technique. Diabetic patients are more susceptible to infections which in severe cases may lead to excessive oral tissue destructions. 14 When complete denture is fabricated for diabetic patients then always use tissue friendly material and technique. 15 It is also mandatory for the dentist to fully educate and motivate the patient to the importance of maintaining good oral hygiene and towards the importance of regular follow-up visits to the dentist. Patients is advised to bring reports of recently done and up to date laboratory investigation regarding blood sugar level. As diabetic patients are more prone to develop periodontal diseases. There should be no working or non-working occlusal interference between opposing teeth. 12 All components of RPD must be tissue friendly by making appropriate design of the prosthesis. As previously mentioned restoration and the maintenance of good oral hygiene is mandatory before starting any prosthodontic procedures. duration of treatment. If an acrylic denture is a preferred option then the design should incorporate the principles of ‘Every Denture’ with wider self cleansing interdental spaces and embrasures areas. On first visit. Some times periodontal surgery may be indicated. Details regarding type of prosthesis. number of appointments must be explained to the patient. Health of abutment teeth is very important and will be achieved by various means for better prognosis of RPD treatment. 11 If patient is provided removable partial denture (RPD). maximum retention following complete denture making principles. This will ensure the long term heath of the oral tissues by preventing chronic infection states such as denture related stomatitis and denture hyperplasia that could lead to more serious conditions. such patients . Patient must be instructed to consult his or her physician before initiating any procedure. endodontic treatment etc. in Diabetic patients. Denture flanges should be smooth and polished.

In certain cases procedures like crown lengthening. the role of oral health care provider becomes very important REFRENCES . All these considerations will ensure better performance of implants supported prosthesis. In this article along with oral complications of Diabetes Mellitus. 17. With an increasing incidence and prevalence of Diabetes Mellitus.may need obturators. 18 Implant supported prosthesis are not advised for patients whose blood sugar level remains uncontrollable but if conditions are favorable . type of artificial prosthesis and occlusal scheme. Fabrication of dental prosthesis would only be started after complete evaluation of diabetic patients through history. group function or mutually protected occlusal scheme is better choice for periodontally compromised teeth. then this type of prosthesis can be planned. Before embarking any procedure for dental prosthesis.20. Multi disciplinary approach is needed for the management of diabetes mellitus. 21 Conclusion Diabetes Mellitus is a complex disorder having many oral and systemic problems. introduction of dental implants helps to improve the quality of life of the patients by better masticatory ability of the dental prosthesis. Apart from conventional removable or fixed dental prosthesis. 19 Proper medication must be provided before and after implant placement. periodontal surgery and orthodontic extrusion of tooth will further improve the quality of fixed prosthesis in diabetic patients. Ante’s law should be obeyed. implant placement must be accomplished with least trauma under stress free environment. 16 For patients requiring a fixed prosthesis like crown or fixed partial denture (FPD). Like any other dental surgical procedure. Before embarking dental treatment it is better to consult patient’s physician. examination and making diagnostic cast. A narrow occlusal table. site of implant placement. Fabrication of obturator require special care in every patient and especially in diabetic patient. various Prosthodontics treatment options available for diabetic patients are discussed Management of diabetic patients in Prosthodontics should be done carefully. minimal preparation like three quarter crown can be done on teeth like pre molar. Complete history and examination along with radiographic evaluation must be carried out for selection of type of dental implant. Good oral and denture hygiene maintenance is a pre requisite for ensuring the long term successful Prosthodontics treatment. oral hygiene of the diabetic patients must be evaluated and should be improved through different surgical and nonsurgical periodontal therapies and restorative techniques. number of dental implants. the finish-line of the preparation should be placed supragingival and to provide chamfer finish-line on the facial aspect of prepared tooth as it is better than shoulder because shoulder can concentrate stresses on weakened tooth/ teeth.

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