Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus

Diabetes mellitus is a metabolic disorder in the body that causes sugar levels to rise. It’s a condition that arises when the body does not make enough hormone insulin or cannot use the available insulin in the body effectively (Papatheodorou et al., 2018). There are two main types of diabetes type 1 and type 2, with type 2 being a common type of diabetes mellitus. It occurs when the body develops resistance to insulin and hence blood sugar levels build up in the body. The major symptoms in this case include; thirst, hunger, frequent urination, blurred vision and extreme fatigue, while in other patients, symptoms like weight loss and sores that do not heal and may cause recurring infections. Parotid gland swelling is a condition associated with diabetes mellitus but most of these patients are not aware of the swelling. A dry mouth (xerostomia) is a common symptom in both type 1 and 2 of diabetes mellitus. according to statistics, having a body mass index of equal to or greater than 30 (obesity) is believed to account for more than 80% risk of developing type 2 diabetes in adults( De Boer et al., 2017). Periodontal diseases are likely to affect people with diabetes disease, this is because this patients bodies are susceptible to other opportunistic diseases. This case study discusses a patient named Henry with type 2 diabetes who is a regular attender at the dental care center. For individuals like Henry seeking healthcare dissertation help could be beneficial and valuable.

Dental procedures

In promoting oral health in the community, there are arrange of clinical services, including oral hygiene therapy such as sublingual scaling, LR6 extraction, smoking cessation, diet advice, salivary gland enlargement advice and dry mouth have been used as dental procedures for treating periodontal diseases that affect human beings (Estrich, Araujo & Lipman, 2019). Oral hygiene provides a wide range of clinical services such as dental examination, preventive treatments scaling and cleaning of the teeth. Mandibular third molar extraction is one of the preferred mode of teeth extraction in dental clinics. These LR6 are extracted gently using a pair of forceps. This is the last stage that is performed in dental care when a patients teeth cannot be repaired and removal is the only option. Tobacco use can lead to serious dental problems, quitting or reducing the rate of smoking in an individual reduces the effect of tooth decay. Statistics show that in 5 adults who have smoked three have been able to quit smoking.(Rao et al., 2020). The food we eat determines the health issues in the mouth, intake of sugar should be reduced in order to improve dental hygiene by reducing tooth decay. Increasing the intake of fluids reduces the issue of swollen gland enlargement and dry mouth. Rinse your mouth with warm and salty water which ensure that the pain is eased and the mouth is kept moist. To speed up the healing smoking should be avoided.

Patient’s age and sex

Henry Jones is a male patient, a 56 year old gentleman who has been regularly attending dental care services at my clinic.

Medical history

Henry is a type 2 diabetes patient who has been ailing for 12 years now, he regularly visits the diabetic clinic at his GMP where he sees his nurse for measurement of vitals. His weight is measured, blood pressure recorded, urinalysis and blood tested. He needs to see an optician for an eye test and visits the chiropodist regularly. Henry’s condition seems to be worsening as his need to see a doctor means he is having blurred visions. Individual with diabetes should have their feet regularly checked by a chiropodist to examine for any damages in the nerves or poor circulation of blood in the body system. Henry tried to control his diabetes condition through maintaining his diet before but it was unfruitful and hence worsening his condition. The patient has no allergies, no history of surgeries , no hospital admissions , no bleeding disorders, no significant family medical history, had no heart complications and his bones, renal and brain were normal with no complications.

E-Drug and allergy histories

Social history

Henry is a52 year old married man and stays home with his wife. He works as a HGV truck driver who has always been on away work trips which may be several days to weeks each time he leaves. He is a heavy smoker at 30 cigarettes a day for the last 30 thirty years. Currently with the use of an e-cigarette is now smoking 0 cigarettes per day or even lesser. Henry consumes 1-2 pints of lager a night when he is home on his non working days. This shift occurs 2-3 days in each month, his drinking is panned and on a night before he leaves for a long drive he totally doesn’t drink. He drinks less alcohol than the recommended 14 units per week. He consumes 2-4 units at a time depending on the strengths of the lager but when the strength of the lager is high he consumes 3-6 units at a time. Henry has no history of drug use and no parafunctional habits. Regularly attends the diabetic clinic to check for his vitals and conduct blood and urinalysis tests. Visits an optician for eye checkups annually and also sees a chiropodist to check on the condition of his legs to avoid nerve dysfunctions and failure of blood vessels to pump blood to all parts of the body.

Complications related to the medical condition and how it affects dental care

Chronic complications

Uncontrolled diabetes results in oral complications that are devastating .Individuals suffering from diabetes are at risk for dental problems, these conditions become severe in cases with poorly controlled sugar levels in a human body (Menon, Ganapathy & Ramanathan, 2019). Their gums are likely to be infected as diabetes reduces blood circulation in the gums. Diabetes causes dry mouth and makes the gum diseases worse. Dry mouths means there is less saliva in the mouth, these is causes by failure of the salivary gland to function. Low saliva content in the mouth can cause tooth decay and plague build up. it also results into bacterial and fungal infections causing a condition known as oral candidiasis. It is associated with hyperglycemia and occurs frequently in uncontrolled diabetes

Acute complications

Acute oral infections such as recurrent herpes simplex virus that is common in marginally controlled diabetes (Genco & Borgnakke, 2020). These infections have proved to be deadly from the immense studies conducted on the deep neck infections Studies conducted have shown that patients with type 2 diabetes are more likely to contract periodontal diseases as compared to people with no diabetic conditions. Good sugar control is important in dental care to help in avoiding these problems. Glycemic control also plays a vital role in reducing the effects of acute oral infections in diabetes patients.

Planning dental treatment

Treatment regimes for candidiasis, in this case, dentists are advised to first asses the sugar levels in the medications they give their patients before prescribing them. Medicines with high sugar levels such as clotrimazole troches should be strictly avoided as it sugar content is fatal to diabetes patients (Stavreva, Cana & Jakupi, 2018). Fluconazole and Ketoconazole she be used in dosage of 100mg and 200mg a day respectively to treat diabetic patients with oral candidiasis. In management of the salivary gland dysfunction, a treatment which aims at providing salivary stimulation to keep the mouth lubricated and moist.

Management of recurring herpes virus is also an important consideration in dental care and hygiene (Blaschke et al., 2021). Diabetes patients with these conditions should have an early initiated treatment plan to prevent severe later cases such as appearance of lesion. Oral acyclovir and oral therapy are used as the main treatments for herpes condition in non diabetic patients. However in diabetes patients, the treatment should be avoided as it cases nephrotoxicity. There are also surgical considerations in periodontal care and management where dentist can perform surgical procedures. These dentists should first of all review their patient’s history to asses if they have had a similar procedure before. They should consult their patient’s physicians and nutritionist as there may be alternative treatment procedures that are related to diet and therapy and surgery may not be needed in some cases. The above treatment procedures and plans have played a positive role in the management of Henry’s medical condition by helping him in dental hygiene care and maintaining his insulin levels.

Outcome of the treatment

The outcome of treatment was successful without any complications. The patient provided all the necessary information including a medical history and a full drug history. He listed all the drug names, route and dose and told me relevant information that I should have known of. I used the BNF to find out about the drugs take , interactiosn, their side effects, interactions and complications which can occur.

Reflection

In this scenario I would seek advice from my tutor to ensure I am carrying out treatment in the safest way possible to ensure I don’t worsen his medical conditions. For example I would seek advise about the parotid gland enlargement to find out a definitive diagnosis and if it was severe I would have to refer to oral surgery. I would prepare before treatment is carried out in a timely manner so there are no delays. If I was to prescribe any medicine, such as analgesia post extractions, I would consult his GMP to make sure there are no drug interactions or the GMP may provide alternative medicines if there was to be any drug interactions. With the history taking I would have liked to know the negative findings as it wasn’t mentioned and any previous history of medical emergencies as the patient regularly visits the diabetic clinic. I would like to know more about problems that have occurred in the past with his diabetes such as hypoglycaemic events and what happened when hba1c levels weren’t controlled. If this was not a hypothetical patient I would have asked for this information. The sdcep guidelines state that I should consider contacting the GMP as the patient has type 2 diabetes and periodontal disease (SDCEP, 2021). I now have a deeper undertasngin of the condition and feel more prepared for patients that I may encounter who have diabetes. I feel more confident in preparing to treat a patient with typ2 diabetes and I feel more prepared for any medical emergencies which may occur.

If a similar case was to happen in the future, I would make sure that I am prepared for any complications that I think may occur such as in this instance HHS, hypotension and hypoglycameia which are the acute complications. I would also take into account the chronic complications and give advise where possible or refer to the patients GMP for more advice. I would not start treatment unless I am aware of the patients medical conditions and their effects on oral health and treatment. I would use the relevant guidleines such as the BNF, medical emergencies guide and SDCEP guidelines to reduce any complications from occurring. This is so the patient isn’t left in a worse condition and possible increased anxiety. If I wasn’t prepared, I would not know what to do if anything went wrong and this could lead to a serious risk to the patients’ health.

Reference

Blaschke, K., Hellmich, M., Samel, C., Listl, S., & Schubert, I. (2021). The impact of periodontal treatment on healthcare costs in newly diagnosed diabetes patients: Evidence from a German claims database. Diabetes Research and Clinical Practice, 172, 108641.

De Boer, I. H., Bangalore, S., Benetos, A., Davis, A. M., Michos, E. D., Muntner, P., ... & Bakris, G. (2017). Diabetes and hypertension: a position statement by the American Diabetes Association. Diabetes care, 40(9), 1273-1284.

Dennis, J. M., Henley, W. E., McGovern, A. P., Farmer, A. J., Sattar, N., Holman, R. R., ... & MASTERMIND consortium. (2019). Time trends in prescribing of type 2 diabetes drugs, glycaemic response and risk factors: a retrospective analysis of primary care data, 2010–2017. Diabetes, Obesity and Metabolism, 21(7), 1576-1584.

Dobrică, E. C., Găman, M. A., Cozma, M. A., Bratu, O. G., Pantea Stoian, A., & Diaconu, C. C. (2019). Polypharmacy in type 2 diabetes mellitus: insights from an internal medicine department. Medicina, 55(8), 436.

Estrich, C. G., Araujo, M. W. B., & Lipman, R. D. (2019). Prediabetes and diabetes screening in dental care settings: NHANES 2013 to 2016. JDR Clinical & Translational Research, 4(1), 76-85.

Genco, R. J., & Borgnakke, W. S. (2020). Diabetes as a potential risk for periodontitis: Association studies. Periodontology 2000, 83(1), 40-45.

Menon, A., Ganapathy, D., & Ramanathan, V. (2019). Diabetes mellitus: Dental consideration. Drug Invention Today, 12(5).

Papatheodorou, K., Banach, M., Bekiari, E., Rizzo, M., & Edmonds, M. (2018). Complications of diabetes 2017.

Rao, P. K., Poojary, D., Kudva, S., Jeppu, A. K., Kumar, K. A., & Dubey, A. (2020). Oral Health Care Guidelines for Patients with Diabetes Mellitus: A Review. Indian Journal of Forensic Medicine & Toxicology, 14(4).

Stavreva, N., Cana, A., & Jakupi, J. A. (2018) Considerations of Oral Manifestations and Prosthodontic Management of Patients with Diabetes Mellitus

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