Systemic diseases to be considered in dental treatment A~Z ⑧
Former) Health Insurance Review and Assessment Service full-time reviewer Kim Young-jin, Doctor of Dentistry
1) Characteristics of diabetes
Diabetes is classified into adult type (Type II) and juvenile type (Type I). Including these two types, regarding 9% of the total population in Korea is affected by diabetes, which is an important chronic disease.
Diabetes is virtually impossible to cure, but because it can be controlled by itself, it is referred to as a ‘lifestyle disease’ along with high blood pressure.
Acute complications such as hypoglycemic shock or hyperglycemic cerebral edema caused by diabetes in an uncontrolled blood sugar level endanger the patient’s life.
In addition, arteriosclerosis, diabetic nephropathy (kidney failure), retinopathy, neuropathy, gangrene, coronary artery sclerosis, and stroke, which are caused by damaged blood vessels due to delayed association of diabetes, progress and eventually lead to death.
In particular, implant surgery or various dental surgeries performed in a state where blood sugar is not controlled ultimately increases the probability of failure due to delayed wound healing and increased susceptibility to infection due to microvascular blood flow disorders and reduced immune function. Therefore, it is necessary to control the blood glucose level before surgery by administration of hypoglycemic drugs or insulin injection, and it is necessary to pay attention to thorough blood sugar control during the healing process following surgery.
A well-controlled and desirable blood glucose level target for dental procedures such as tooth extractions and periodontal surgeries, including implant procedures, is 115-140 mg/dl. Even in patients with poor blood sugar control, successful dental surgery is possible only when the blood glucose level measured 2 hours following a meal is maintained below 150-250 mg/dl.
Even following blood sugar is maintained, it is better to set the surgery schedule as the first surgery in the morning, and blood sugar should be measured every hour during surgery and every 6 hours following surgery to maintain a normal level, which is advantageous for healing of the surgical site and prevention of infection.
According to the NIH report in the US, the implant success rate for diabetic patients is regarding 75%, which is lower than the success rate of general implant patients, which is around 90%. It turned out to be not at the right level.
Therefore, even if you are a diabetic patient, as long as your blood sugar is maintained, dental surgery or implant surgery is not contraindicated.
However, depending on the type of hypoglycemic agent commonly used by patients, it is necessary to pay attention to combination therapy because it may exhibit undesirable interactions with various drugs including antibiotics or anti-inflammatory drugs used following dental surgery.
2) Symptoms of Diabetes
Diabetes is a disease that occurs when the body’s ability to metabolize carbohydrates is reduced or incomplete. Carbohydrates are broken down into glucose in the body and used as an energy source.
Insulin, which is secreted mostly by β-cells of the islets of Langerhan of the pancreas, plays an important mediating role in this process. Therefore, glucose cannot be converted into energy when the amount of secreted insulin is insufficient or when insulin does not properly perform its role even though the secreted amount is sufficient.
Glucose, which has not been converted into energy, remains in the blood, and the turbid blood causes circulatory disorders in microvessels. If this hyperglycemic state persists, infection becomes weak and serious complications of the kidney and cardiovascular system progress.
In addition, when the mind and body fall into confusion due to hypoglycemia that appears temporarily and causes ketosis, it leads to sudden coma and death.
Most types of diabetes are Type II (adult-type diabetes), which is caused by hypotonic degeneration of the beta cells of the islets of Langerhans in the pancreas, resulting in decreased insulin secretion.
The clinical symptoms are accompanied by thirst and polyuria, and sugar is excreted in the urine. Because blood sugar is high, immunity to other diseases is lowered, and skin infections are also sensitive, resulting in continued fatigue, itching of the skin, and blurred vision. Symptoms such as impotence, tremors in the hands and feet, and headaches also appear. Adult type diabetes usually occurs around the age of 50, but recently, there are many cases of onset at a young age in the 30s.
Type I (juvenile diabetes), also called insulin-dependent diabetes, is a more serious disease than Type II because it is a state in which almost no insulin is secreted due to pancreatic dysfunction. It is a disease that is recognized as a very important cause of family history, and as the name of the disease suggests, there are many cases of onset at a very young age.
Common clinical symptoms of diabetes are sudden onset of fatigue, weight loss, muscle weakness and hunger, and may be accompanied by nausea and vomiting. Juvenile diabetes requires awareness of its symptoms. If the early symptoms of hypoglycemia are not accurately recognized and insulin is continuously administered, it is easy to fall into acute hypoglycemia.
When hypoglycemia occurs, severe hunger, stupor, drowsiness, cold sweat, tremors, and fainting state are likely to lead to loss of life due to ketosis.
Patients with the above two types of diabetes must maintain normal blood sugar levels through proper use of diet, exercise, and oral hypoglycemic agents or insulin.
If blood sugar cannot be controlled, it leads to chronic complications such as kidney disease that causes high blood pressure or renal dysfunction, polyneuritis that accompanies severe pain, and retinal degeneration that causes blindness. In addition, when it overlaps with arteriosclerosis, heart disease, or high blood pressure, complications progress more seriously and become life-threatening.
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