Diabetes+Type+I

=** Case #2 - Diabetes Type I **=

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Medical History
=== Patient is a 52-year-old African American male. His major reason for coming in is to have his teeth cleaned. Patient states he frequently urinates. He was diagnosed with type I diabetes in 1997. His mother, brother, and sister all have type II diabetes. Patient has not seen the dentist in 2 years due to being busy at work and realized the implications of this. Patient is experiencing bleeding gums when he brushes and states his lower teeth are “wiggly”. ===

His medications are Insulin (glargine) 80 units every morning.
=== Insulin: used in the treatment of type I diabetes mellitus insulin dependent and type II diadetes mellitus noninsulin dependent requiring basal (long acting) insulin to control hyperglycemia. //Dental implications:// no information available to require special precautions. //Dental contraindication:// Type I (insulin dependent) should be scheduled for morning appointments to reduce chance of stress induced hypoglycemia. ===

Skeletal profile: mesognathic
Probing depths: generalized 3-6 mm Recession: Please see perio chart. Mobility: Please see perio chart. Mucogingival defects: none noted Fremitus: Please see perio chart. Furcations: Please see perio chart. RCC calculus code: med/heavy


 * Radiographic findings:**

** Generalized ADA III **
AAP: Generalized severe chronic periodontitis due to plaque and calculus, modified by diabetes



Diabetic patients are prone to infections in the oral cavity. The infections may be bacterial, viral, and fungal. These can and do occur on the gingiva. Acute infections are common and require special attention. Diabetic patients are also more susceptible to periodontal disease. They experience a delay in wound healing as a result of changes in salivary flow and composition. Therefore, after periodontal treatment, they do not usually heal as well as a non-diabetic patient. Diabetics that do not have extremely good oral hygiene habits are more likely to see these problems. When good oral hygiene is implemented, periodontal disease can sometimes be controlled. When the Diabetes is controlled the prognosis of the case will increase, and the gingival description may improve, when the diabetes is not controlled the tissue will appear much more edemutus and erythemic, possiably with local lesions. It is vital for the clinician to be aware of the effect insulin or lack of, can have on the gingiva. The dental proffesional plays a role in the detection of diabetes.
 * Effects and correlation between diabetes and periodontal health**

A thorough review of proper brushing technique will need to be done. The use of an electric toothbrush vs. a manual toothbrush should be recommended. Discussing the importance of proper brushing and correlating it to the patient’s systemic condition is part of this education. We would need to spend time at each appointment discussing OHI. Included should be flossing, the use of a proxy-brush, and an at-home fluoride rinse. The use of gum with xylitol would be encouraged due to the benefits in cavity prevention. Good oral hygiene habits are important for diabetic patients because their bodies are not as effective at fighting infections, so patients must be very good at helping prevent infection with good hygiene habits.
 * Oral hygiene instructions given to patient**

Appt. #1 FMX Assessments DDS Exam 2nd check in
 * Treatment plan**

Appt. #2 Plaque Index + OHI Anesthesia UR root planning CHX

Appt. #3 OHI Anesthesia LR root planning CHX

Appt. #4 OHI Anesthesia UL root planning CHX

Appt. #5 OHI Anesthesia LL root planning CHX

Appt. #6 4-6 week re-eval Review OHI & Fluoride And 1-month re-care

The prognosis of this case would be poor. This patient has a systemic disease that is constantly affecting his oral health. Type I diabetes affects his body’s ability to heal and fight off infection, including in the oral cavity. The patient has moderate to advanced bone loss and presents with tooth mobility. Although the patient handles his systemic condition well, he is not very cooperative with maintenance of his oral health. The patient's prognosis could never be excellent, because of his underlying systemic condition.
 * Prognosis**


 * Questions**

1. What is the allowable blood sugar level to treat diabetes patients? a. Under 100 mg/dl b. 100-150mg/dl c. Under 200mg/dl d. 200-300mg/dl

2. All of the above correlate diabetes with periodontal disease EXCEPT: a. Impaired wound healing b. Susceptibility to infections c. Patients continual blood glucose level (controlled or uncontrolled) d. None of the above

3. What would be an appropriate recall interval for a diabetic patient? a. 4-6 weeks b. 3 months c. 4 months d. 6 months

4. What is the best prognosis a controlled diabetic could have? a. Excellent b. Good c. Fair d. Poor

5. How can you tell if a diabetic patient has his/her disease controlled? a. Asking the patient if they took his/her medications and if he/she checks his/her blood glucose level daily b. Looking at the condition of his/her gingival tissue c. Taking his/her blood glucose level in your office d. All of the above

6. What is a question on a medical history that could correlate to diabetes if the patient has not yet been diagnosed? a. Do you have any allergies to any medications? b. Are you frequently thirsty?/Do you frequently urinate? c. What medications are you taking? d. Do you have a lot of sugar intake in your diet?

7. Type I diabetics are non-insulin dependent. Type II Diabetics are insulin dependent. a. Both statements are TRUE. b. Both statements are FALSE. c. The first statement is TRUE; the second statement is FALSE. d. The first statement is FALSE; the second statement is TRUE.

8. The 3 "P" symptoms of hyperglycemia are: a. Polydipsia, polyphagia, polyuria b. Pruritus, polyphagia, polyuria c. Polydipsia, postprandial, polyuria d. Polyuria, polyphagia, postprandial

9. The following are all functions of insulin EXCEPT: a. Facilitates glucose uptake from blood into tissues, lowering the blood glucose level b. Slows the oxidation of glucose within the cells to use for energy c. Facilitates conversion of glucose to fat in adipose tissue d. Stimulates growth, DNA synthesis, and cell replication

10. All of the following are characteristics of Type I Diabetes EXCEPT: a. Ketoacidosis is common b. Efforts are required for stability and are generally unstable and difficult to control c. Onset is slow, progresses over years, and goes undiagnosed for years d. Body weight is normal or below normal

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