3 hour course, updated 1/2005
 

The incidence of diabetes mellitus is increasing in the U.S.  It is estimated by the American Diabetes Association that there are currently over 8 million undiagnosed/untreated diabetics in our country.  These patients present a unique problem for dentistry in the management of oral problems. The Indian Health Service has reported success in an antibiotic assisted ultrasonic therapy treatment. The American Academy of Periodontology recently updated a policy statement regarding periodontal treatment guidelines for the diabetic patient. In 2001 the American Academy of Oral Medicine revised information related to treatment of the diabetic patient.  The Journal of the American Dental Association included a special supplement on diabetes in November 2003.  The pathogenesis of the three types of diabetes will be discussed. Pharmacologic management, methods to assess disease control, the complications of uncontrolled diabetes and the influence of disease control on periodontal treatment and maintenance care will be identified.  The most recent blood sugar values proposed by the American Diabetes Association  for diagnosis of diabetes and recommended blood test levels for control will be discussed.  Oral signs of uncontrolled diabetes and implications for dental management will be identified.

OBJECTIVES: The participant will

1. Consider the pathogenesis of the different forms of diabetes mellitus and the dental implications of the drugs used to treat all forms of this disease.
2. Observe the clinical appearance of oral signs of uncontrolled diabetes.
3. Review the current American Academy of Periodontology treatment guidelines for the diabetic dental patient.
4. Review the literature regarding clinical studies of the oral impact of diabetes.
5. Consider strategies for management of increased infection and poor healing responses associated with uncontrolled diabetes mellitus.
6. Update knowledge on the most current blood sugar values, diagnostic blood tests and terminology for diabetes.

I. Incidence of Diabetes                                               

            A. Type 1  ( formerly IDDM)  
            B. Type 2 (formerly  NIDDM) 

                 1.  Hypofunction of beta cells          
                 2.  Insulin intolerance

            C. Gestational diabetes
            D. Blood tests for diagnosis

II. Pathogenesis of disease                                                       

            A. Function of insulin 
            B. Deficiency of insulin  
            C. Insulin resistance                                                                    

                 1. Glitazone, metformin drug therapy        
                 2. Blood sugar level correlation                                            

III. Oral effects of disease                                                                    

            A. Clinical signs

                 1. Oral signs of uncontrolled diabetes
                 2. Increased caries issue

            B. Reduced healing
            C. Increased infection

IV. Drug-Diet Therapy

               A.  Insulin
               B.  Oral Agents
               C.  Diet and Exercise

V.  Dental Management

            A.  Antibiotic considerations
            B.  Periodontal therapy

                 1. IHS periodontal protocol
                 2. AAP policy

             C.  Preventive therapy
             D.  Maintenance therapy