Issuu on Google+

INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.com


Statement of problem ď‚— The oral mucosa has been reported to have a variety

of changes in subjects with diabetes mellitus

www.indiandentalacademy.com


Oral manifestations of diabetes mellitus in complete denture wearers

www.indiandentalacademy.com


DIABETES MELLITUS ď‚— Diabetes mellitus is a chronic metabolic disease

characterised by hyperglycaemia, associated with irregularities in the metabolism of carbohydrates, lipids, and proteins, and susceptibility to the development of specific form of renal , occular, neurological, cardiovascular diseases.

www.indiandentalacademy.com


 TYPE I:  This is common before 40yrs of age.  It is insulin dependent  Not related to obesity  Due to destruction of islets of langerhans  If it is from child hood – JUVENILE DIABETES

www.indiandentalacademy.com


 Type II: also called non insulin dependent  It is the 5th most common condition and ,6th most    

common cause leading cause of mortality. This type occurs only after 40yrs And the prevalence increases with age Their cause is more genetic and it is not associated with any auto immune diseases The predisposing factors are: obesity and sedenterism

www.indiandentalacademy.com


ď‚— Patients with D.M present a higher susceptibility of

infections due to a deficiency of polymorph nuclear leucocytes, as a result of vascular alterations and neuropathies . ď‚— D.M increases the susceptibility to erosion and ulceration of the mucosa where it comes in contact with the base of the complete denture

www.indiandentalacademy.com


Cardinal signs of D.M  1) polyurea  2) polydypsia  3) polyphagia

www.indiandentalacademy.com


Purpose of the study ď‚— The purpose was to compare diabetic and non-

diabetic subjects wearing complete dentures with regard to salivary flow, salivary buffering capacity, denture retention and oral mucosal lesions

www.indiandentalacademy.com


Materials and methods ď‚— This sample consisted of 60 individuals in which 60

were denture wearers 30 were suffering from type II D. M and the other 30 were controls with matching age, sex and race.

www.indiandentalacademy.com


 Stimulated salivary flow was classified as:  1) normal: 1-2ml/min  2) hypo: 0.7 ml/ min  3) xerostomic: 0.1 ml/ min

www.indiandentalacademy.com


 Buffering capacity was classified as:  1) low: 4.5 pH  2) medium: 4.5-5.5 pH  3) high: >5.5 pH

www.indiandentalacademy.com


ď‚— Each subject was evaluated regarding denture

retention and was asked for a self report of comfort, efficiency, and occlusion of the complete denture. ď‚— Retention was considered to be present when the subject did not complain about moment or displacement of complete denture during mastication, talking , breathing, smiling, or even at rest.

www.indiandentalacademy.com


Prosthodontic point  Subjects commonly report  1) dry mouth  2) loss of taste  3) speech difficulty  4) lack of adaptation of the dentures  5) burning sensation of the mouth  6) difficulty in mastication

www.indiandentalacademy.com


What we observe  1) loss of tissue resiliency  2) high degree of inflammatory response.  3) ketonic breath {striking feature}  4) a high frequency of periodontal disease  5) residual bone resorption  6) periodontal abscess,  7) vascular alterations  8) candidasis  9) xerostomia www.indiandentalacademy.com


ď‚— Sennerby etal in his study concluded that lose of

stability in dentures was because of lose of resiliency of underlying tissues and that was because of osteoclastic activity ď‚— Berghal and berghal showed that psychological factors accentuate for xerostomia ď‚— And he even concluded that drugs like anti depressants, anti hypertensive's will play role in xerostomia in diabetics

www.indiandentalacademy.com


Results  Comparison of two groups revealed no difference in

salivary flow  A significant difference in mean buffering capacity was observed between case and control groups  And blood glucose also showed a mean difference between the two groups

www.indiandentalacademy.com


DISCUSSION  Skyes etal observed that subjects with D.M are more

susceptiable to infections as a result of vascular alterations and neuropathies.  Astro etal reported an increased risk of infections in the presence of reduced flow, low buffering capacity and inadequate hygiene of complete dentures.  With in the scope of investigation statistical analysis failed to reveal a difference in salivary flow rate between the groups www.indiandentalacademy.com


ď‚— The buffering capacity of saliva is responsible for the

maintenance of the oral pH in order to guarantee the tooth integrity and to inhibit acid production by bacterial plaque.

www.indiandentalacademy.com


ď‚— Dry mouth is an uncomfortable and potentially harm

full oral symptom which is usually caused by a decrease in the salivary secretion rate. ď‚— This condition is more prevalent in the elderly population primarily because of the increased use of drugs and susceptibility to disease in this age group

www.indiandentalacademy.com


Prosthodontic considerations  SHORT APPOINMENTS- only in mornings  NO STRESS  ALGINATE- thin mix  FULL SPACER  MONOPLANE TEETH  TISSUE SIDE SHOULD BE SMOOTH  FREQUENT RECALLS  RELINING AND REBASING  TISSUE CONDITIONERS www.indiandentalacademy.com


REFERENCES  1. Daniell Cristina de lima, DDS, etal

ORAL MANIFESTATIONS OF DIABETES MELIITUS IN COMPLETE DENTURE

Journal of Prosthetic Dentistry 2008; 64-69  2. Leanne m,sykes , Bsc,Bds, Mdent etal POTENTIAL RISK WARERS

OF SERIOUS ORAL INFECTIONS IN THE DIABETIC PATIENT A CLINICAL REPORT : Journal

of Prosthetic Dentistry 2001; 569-573  3. Macedo Firoozamand l, etal STUDY OF DENTURE INDUCED FIBROUS HYPERPLASIA CASES DIAGNOSED FROM 19792001: QUINTESSENCE

INT 2005; 36: 825-829

www.indiandentalacademy.com


Thank you For more details please visit www.indiandentalacademy.com

www.indiandentalacademy.com


Jc on diabetus mellitus2003/ dental implant courses by Indian dental academy