Diabetes is a systemic illness that must be taken into consideration in the context of dental treatment. In this presentation, Dr. Markus Tröltzsch explains the pathophysiological fundamentals of the illness, the options in terms of appropriate therapy, as well as the impact of diabetes on wound healing in affected patients.
Regardless of the type of diabetes – type I diabetes is a congenital autoimmune condition characterised by a complete insulin deficiency, while type II diabetes is an acquired resistance to insulin – it will, if untreated, lead to increased HbAIc levels in patients as well as the formation of advanced glycation end-products, resulting in greater proinflammatory potential. The consequences of this range from macrovascular and microvascular damage to substantial delays in wound healing, which can also have a severely detrimental impact on the outcome of dental treatment. In a similar fashion to the condition known as diabetic foot, which can be caused by vascular damage and neuropathy following minor injury, the periapical tissue and mucosa can also be affected by dental treatment and demonstrate diminished wound-healing capacity. Surgical procedures should therefore be carried out at HbAIc levels below 7.5% as well as using local antiseptic, and where appropriate with systemic antibiotics. In addition, suturing without tension and allowing sutures to remain in situ after the generally-applicable healing period helps prevent complications in the treatment of patients with diabetes.