Diabetes is a pathology that involves a chronic increase in the level of glucose in the blood, generating, in the patient who is affected, a state of hyperglycaemia, a condition that can also affect dental care, let’s try to understand why.
There are two types of diabetes:
- Type 1 diabetes: occurs when the pancreas does not produce insulin, the inability of the pancreas to synthesize the insulin hormone determines the patient’s need to inject insulin into his body every day throughout his life
- Type 2 diabetes: the pancreas produces insulin but this is not absorbed by the cells and accumulates in the blood
Diabetes is a widespread pathology, in developed countries its growth is unstoppable. The individuals affected by the disease in the world are now close to 400 million and the estimate is that they reach 600 million by 2035.
For this reason, the fight against diabetes is one of the three health emergencies identified by the United Nations Organization and the World Health Organization.
In Italy, it is above all type 2 diabetes that accounts for about 90% of cases in our country. In 1985 there were about 1.5 million known cases of diabetes and now they are close to 4 million, so they have more than doubled in 30 years. This is a case for every 16 residents. These are the data of the latest survey conducted by the Italian Society of Diabetology.
What impact does diabetes have on dental care?
Among the consequences that diabetes entails there is a greater sensitivity to infections and particularly long times for wound healing.
The higher concentration of sugars in the blood slows down and sometimes almost inhibits the function of the cells of the immune system and that of the platelets dedicated to the coagulation and repair of tissues. Healing of cuts and wounds is therefore less efficient, as is the immune response to viruses and bacteria.
Diabetic patients become ill more easily with complications affecting various organs and tissues, in particular, as regards the oral cavity, they are particularly prone to gingivitis and periodontitis.
Until recently, diabetes was also considered a negative variable for dental implant surgery, but today, thanks to the immediate load, even patients with diabetes can have fixed teeth in 24 hours.
A 2010 study published in Italian Oral Surgey would show that diabetes can be a risk factor for implant failure in percentages identical to those obtained from exogenous factors such as smoking or poor oral hygiene.
Can a diabetic patient face an implant surgery?
Immediate load implantology minimizes any operative risk: bleeding, drop in blood sugar, risk of infections, not only for diabetic patients, but for any type of patient.
Before facing an implantology intervention with a diabetic patient the dentist will have to make sure that the patient has a balanced diabetes (HbA1C between 6% and 6.5% over 3 months), in the planning of the intervention the timing of the antibiotic therapy will be indicated (from 3 to 4 grams of Amoxicillin up to a / two hours before the intervention), finally the intervention can be scheduled at two particular times of the day: in the morning after breakfast or in the afternoon after lunch.
Local anesthesia will be based on anesthetic with a low concentration of adrenaline in order to avoid a hyperglycemic effect.
Taking into account this particular protocol, the diabetic patient will be able to face his intervention serenely.
These types of intervention cannot be performed in common dental practices, it is always better to turn to dental centers specialized in implantology that have a medical team and all the tools to deal with any type of complication.
