Oral Hygiene Day 2021

Oral Health Care and Diabetes

 Introduction
1st August is celebrated all over India as Oral Hygiene Day
in the loving memory of Dr. G.B. Shankwalkar who was a
renowned Periodontist and also the Founder of the Indian
Society of Periodontology.
We as KMD members unite today to empower and re-
enforce ourselves with the knowledge, tools and confidence
to secure good oral health Also to help reduce the burden of
oral diseases, which affect individuals, health systems and
economies everywhere.
 Islam and cleanliness
Islam is a religion that encourages and loves cleanliness – of the mind,
soul, and body. From verses of the Holy Quran to the hadith of the
Prophet Mohammad saw, the importance of cleanliness is deeply
apparent.
Not only does having a clean body and soul encourage purity of the
heart, but it helps keep up our health as well.
As Muslims, we have a duty to strive towards having and keeping a
clean body and soul in our daily struggle to stay on the path of Allah.
Here are some verses from the Holy Quran as well as hadith
on the beauty and importance of cleanliness, in the hopes
that we can all work towards becoming better practicing
Muslims.
In the body, there is a piece of flesh, if it is good, the whole
body is good, and if it is bad, the whole body is bad; truly it
is the heart.” (Bukhari, Iman 39)
Prophet Muhammad (pbuh) said: “Cleanliness is half of
faith” (Sahih Muslim).
“Allah loves those who are constantly repentant and loves
those who purify themselves” (Quran 2:222).
Cleanliness in Islam is of three kinds:

1- Purification from impurity (i.e. to attain purity or cleanliness, by

taking a bath ghusl or performing ablution wudu’ in states in which a
bath or ablution is necessary or desirable according to Islamic Law.

2- Cleansing one’s body, dress or place from an impurity of filth.

3- Removing the dirt or grime that collects in various parts of the

body, such as cleaning the teeth and nostrils, the trimming of nails and
the removing of armpit and pubic hair.
 Oral Hygiene and Islam
Keeping oral hygiene through cleaning the teeth with the use
of a form of toothbrush called miswak(Sivak/Miswak:Arabic
word Saka meaning to clean the teeth) is considered sunnah,
the way of Prophet Muhammad.
Prophet Muhammad saw recommended entire hygiene of
teeth, gums, through tooth brushing and washing mouths by
water three times. Actually, this was the first time in the
available literature that someone recommended maintaining of
oral hygiene. 
Prophet Mohammed (pbuh) commanded his companions to
wash their mouths after each meal, especially meals
containing a high amount of fatty substances such as milk &
sugars.
Prolonged exposure to these substances inside the oral cavity
may lead to bad breath (Halitosis) and dental caries
(Moynihan 2003, Van Der Weijden, 2011)
 History of Dental Hygiene
Modern day Dental Hygiene dates back to over one-hundred years ago and
has continued to change and grow over the decades.
In 1907, Alfred Fones, a dentist in Connecticut, understood the importance of
oral care to reduce the bacteria that caused caries.
As a result, he employed his cousin, Irene Newman, and trained her to
perform dental prophylaxis on his patients. Irene Newman was the first
“dental hygienist” to implement dental hygiene duties
 Influence of oral health on systemtic well being

It has been said that the mouth is the gateway

to your overall health. Not properly taking
care of your teeth and gums can lead to a
variety of health problems. From loss of teeth
and gum disease to heart disease and diabetes,
oral health is very important.
And that brings us to our today’s topic of
discussion: Oral Health Care and Diabetes
 Definition
Diabetes mellitus is a clinically and genetically heterogeneous group of
metabolic disorders manifested by abnormally high levels of glucose in the
blood. The hyperglycemia is the result of a deficiency of insulin secretion
caused by pancreatic -cell dysfunction or of resistance to the action of
insulin in liver and muscle, or a combination of these.
Diabetes is a complex, chronic illness requiring continuous medical care
with multifactorial risk reduction stratergies beyond glycemic control.
 Epidemiology
In 2000, according to the World Health Organization, at least 171 million
people worldwide suffer from diabetes, or 2.8% of the population
Its incidence is increasing rapidly, and it is estimated that by the year 2030,
this number will almost double.
The greatest increase in prevalence is, however, expected to occur in Asia and
Africa, where most patients will probably be found by 2030
The increase in incidence of diabetes in developing countries follows the
trend of urbanization and lifestyle changes, perhaps most importantly a
"Western-style" diet
Given the high prevalence of this disease, it is likely that every practicing
dentist will encounter patients with diabetes. In a dental practice with 2,000
patients and an average prevalence of 6 to 7%, approximately 120 to 140
patients would have diabetes. Again, only half these people would be aware
of their diabetic condition.
ADA 1977-CLASSIFICATION
Signs and symptoms
 Complications of Diabetes
Retinopathy

Periodonta Neuropathy
l disease

Altered
Nephropat
wound
healing hy

Macrovascu
lar disease
 Oral manifestations of Diabetes.

Chelosis, mucosal dryness, cracking, burning

mouth and tongue, diminished salivary flow.
Greater predominance of Candida albicans,
haemolytic streptococci, staphylococci.
Increased rate of dental caries.
Enlarged tongue, sessile pedunculated
gingival polyps, abscess formation.
 Increased susceptibility to
infection.
Severe gingival inflammation,
increased BOP.
Deep periodontal pockets, rapid
bone loss, mobile teeth.
Glossodynia
Lichen Planus
 Effects of Diabetes on periodontium

Evidence establishing link between diabetes mellitus and adverse effects on periodontal
health have been extensively reviewed by Taylor et al 2001 and Mealey et al 2006.

Under the following Sub heading:

Changes in the sub gingival microbiota.

GCF glucose levels.
Periodontal vasculature.
Host response.
Collagen metabolism.
Changes in Sub gingival microbiota
The increased glucose content in GCF and blood in diabetic patients could
change the environment of the microflora.
Patients with type 1 diabetes mellitus and periodontitis have been reported to
have a subgingival flora composed mainly of Capnocytophaga, anaerobic
vibrios and Actinomyces species.
 GCF Glucose Levels
Increased blood glucose levels are reflected in increased levels of GCF
glucose.

In vitro studies showed that because of increased glucose in GCF there
was decreased chemotaxis of periodontal ligament when placed in a
hyperglycemic environment compared with normoglycemic conditions.
Periodontal Vasculature
Increase in thickness of gingival capillaries , endothelial cell,
basement membrane and walls of small blood vessels.

Results in narrowing of the lumen

Impaired oxygen diffusion and nutrient provision across basement
membrane

Altered normal periodontal tissue homeostasis

Advanced glycated end product
formation (AGE)
 AGE
Receptor for AGE (RAGE) formed on surface of: Smooth muscle cells
Endothelial cells
Neurons
Monocytes
Macrophages
Hyperglycaemia results in increased expression of this receptors for AGE and
increased interaction between them causing an increase in vascular permeability
and thrombus formation.
 In the oral cavity, the pathophysiology of destructive periodontal diseases related to
diabetes mellitus is predicated on a variety of elements, including, but not limited,
to the absence of insulin, the presence of tumor necrosis factor-à, vascular changes,
the formation of advanced glycation end-products, an increased amount of matrix
metalloproteinases, as well as altered host defense cell functions
. Lalla E, Papapanou PN. Nat Rev Endocrinol 2011: 7: 738–748.
 Host response
Defects in PMN – adherence
chemotaxis
phagocytosis.
Driver and colleagues in 1993: suggested that there is hyper
responsiveness or increased number of PMN’s within gingival crevice of
poorly controlled diabetes patients (as indicated by elevated levels of
PMN derived enzyme ß – glucoronidase.)
 Collagen metabolism

Increased collagenase activity, decreased collagen synthesis.

Chronic hyperglycemia adversely affects
synthesis,maturation,maintainence of collagen and extracellular matrix.
Collagen is cross linked with AGE formation ,makes it less soluble
and less likely to be repaired or replaced.
Cumulative effects of altered cellular response, impaired tissue
integrity and altered collagen metabolism play a significant role in
susceptibility of diabetic patients to infection and destructive periodontal
disease
DENTAL MANAGEMENT
OF
DIABETES MELLITUS
Key considerations related to dental treatment of the diabetic patient include
• Stress reduction and adequate pain control are important in treating the
diabetic patient.
• Efforts to allay patient apprehension and minimize discomfort are important and
may include preoperative sedation and analgesia.
• Most diabetic patients can be easily managed in the dental office on an
outpatient
• Antibiotics are not necessary for routine dental treatment in most diabetic
patients but may be considered in the presence of overt infection or poorly
controlled diabetes
• If the patient takes insulin, the dentist should determine the exact type being
used. Its onset of activity and time of peak activity relative to the planned dental
therapy should be determined
•
• The greatest risk of hypoglycemia is usually during the time of peak
insulin activity:
30 to 90 minutes after injection of lispro insulin;
2 to 4 hours after injection of regular insulin,
6 to 8 hours after injection of NPH or Lente insulin
When possible, it is best to plan dental treatment either before or after
periods of peak insulin activity because hypoglycemic reactions are
more likely to occur when insulin levels are high.

Next, it is important to find out when the patient last ate and what they
ate.
• Carbohydrate intake must be adequate to “match” plasma insulin
levels or hypoglycemia will result.
UNDIAGNOSED..
Suspect if;
Any polyuria,polydipsia,polyphagia or presence of
ORAL INFECTIONS IN SEEMINGLY HEALTHY PATIENTS
Dry mouth,glossitis,burning mouth in abscence of apparent physical
changes
Diagnosed
Assess glycaemic control
HbA1c
<10 %for surgery
<8% responds as non diabetic
 Focus on
Eating health and have regular meals
Watching your weight
Physical activity
Take control: Keep in touch with your physician & dentist.
Let your dentist know:
-If you have been diagnosed with diabetes
-If the disease is under control
-If you take insulin, when you last dose was administered
-If there is any change in medical history & medications
Your oral hygiene routine should
include:
-Visiting your dentist regularly
-Brushing 2 times a day
-Flossing once a day
-Using toothpaste containing fluoride
-Dryness of mouth treated with salivary substitute, topical fluoride application
and cavities treated
Denture wearers should remove them overnight and clean them regularly
-Patient should be encouraged to quit smoking as it greatly increases risk of
periodontal disease in diabetic patients
How can I protect my oral health?

To protect your oral health, practice good oral hygiene daily.

•Brush your teeth at least twice a day with a soft-bristled brush using
fluoride toothpaste.
•Floss daily.
•Use mouthwash to remove food particles left after brushing and
flossing.
•Eat a healthy diet and limit food with added sugars.
 CRITERIA for the diagnosis of diabetes
FPG ≥ 126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h.
OR 2-h PG ≥ 200 mg/dL (11.1 mmol/L) during OGTT. The test should be performed as
described by the WHO, using a glucose load containing the equivalent of 75 g anhydrous
glucose dissolved in water.
OR A1C ≥ 6.5% (48 mmol/mol). The test should be performed in a laboratory using a method
that is NGSP certified and standardized to the DCCT assay.
OR In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random
plasma glucose ≥ 200 mg/dL (11.1 mmol/L).