This is just an experience that I would like to share. Whilst I was working for an emergency dental service over a weekend, a patient attended with a “swelling.” Little did he know but this swelling was extremely dangerous and required urgent attention!
The patient was not registered with a dentist, he had a fractured tooth in he lower jaw which had been painful a “few months ago” but had since settled. The swelling to the lower jaw had rapidly become worse over the past 48hours and now he was struggling to swallow.
The patient had developed a diffuse dental abscess relating to the lower left molar tooth. This had spread down, under the jaw bone, had raised the floor of the mouth and was now crossing the midline over the patients throat and airway. He was developing a Ludwig’s Angina.
Immediately I contacted the on-call SHO for the local maxillo-facial department. The patient was immediately admitted to the maxillo-facial ward and ssurgical drainage of the abscess was provided. the patient had drains in place for a week and IV antibiotics.
This case shows the importance of regular dental check-ups and that any toothache/pain should not be ignored. By delaying dental treatment and ignoring the early signs of pulpitis/apical periodontitis the patient had placed himself at risk.
It is Diabetes Week from the 12th – 18th of June but what effect does it have for the dental team?
Diabetes (Diabetes Mellitus) is a metabolic disease where there is an imbalance of blood sugar due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. This leads to high levels for glucose (sugar) in the blood. There are three main types of diabetes mellitus:
Type 1 diabetes is characterised by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas, leading to insulin deficiency which is needed for the absorption of glucose from the blood.
Type 2 begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop. The primary cause is excessive body weight and not enough exercise.
Gestational diabetes, is the third main form and occurs when pregnant women without a previous history of diabetes develop high blood-sugar levels
It is important to tell your dentist about your diagnosis. Whether you are type 1 or type 2 diabetic and if you are diet controlled, taking tablets or having insulin injections. This will allow your dentist to plan a preventative oral health programme, risk assess any oral health issues and also in the event of any medical emergencies – diagnose and treat accordingly.
Diabetes and dentistry
Although it may seem that diabetes and dentistry may have very little in common, studies show that Diabetes increases the prevalence of periodontitis, the extent of periodontitis (that is, number of affected teeth) and the severity of the disease. Patients with uncontrolled diabetes and established periodontitis may progress quicker and be harder to treat, compared with people who do not have diabetes. In well controlled diabetes with HbA1c of around 7% (53 mmol/mol) or lower, there appears to be little effect of diabetes on risk for periodontitis. However, the risk increases exponentially as glycaemic control deteriorates. Overall, the risk of periodontitis in patients with diabetes increases by 2-3 times.
Medication and effects?
It is important to tell your dentist what medications you are taking. Occasionally, medications can have other oral manifestations, such as lichenoid mucosal reactions (White patches) to metformin. Other oral consequences of diabetes may include xerostomia (Dry Mouth) resulting in increased risk of dental decay, thrush infections and chronic mouth ulcers.
It is important therefore that people who are newly diagnosed as being diabetic are also informed of the increased risk they have of developing periodontal disease. The Dental and Medical profession should encourage regular dental and periodontal assessments as studies have also shown that poor periodontal control can also have an negative effect on glycemic control.
With good glycemic control, good plaque control and regular/appropriate periodontal treatment, Periodontitis can be controlled and managed.
If you need a dentist or further advice please contact: