Management of an emergency tooth extraction in diabetic patients on the dental chair

Management of alveolar osteitis: new regenerative techniques in patients with type 2 diabetes

OBJECTIVES

Evaluation of the effectiveness Gengigel® Oral Gel (hyaluronic acid ) and photobiomodulation (magnetic laser) in the treatment of alveolar osteitis in patients with type 2 diabetes mellitus.

METHODS

This is a blind RCT study clinical prospective study in 69 patients with type 2 diabetes mellitus with alveolar osteitis. The subjects selected for study were examined under the inclusion and exclusion criteria and sign the written consent. The patients were blind randomly assigned into two groups: The Group I included 35 patients with alveolar osteitis, in which complex treatment including HA and magnetic laser therapy was carried out. The Group II is represented by 34 patients, with alveolar osteitis received treatment including antiseptic and inflammatory agents. Healing time and pain levels of the alveolar socket of the extracted tooth were appreciated. The pain levels in dynamics were assessed according to VAS.

RESULTS

After the 5th treatment session, 91% of patients in the 1st group had a VAS score of 0 (no pain), whereas in 9% of patients, the VAS score was 1-3. In group 2, a similar result of the VAS score was recorded but only on the 8th day of treatment.

CONCLUSION

The results show that the use of Gengigel® Oral Gel (hyaluronic acid ) and photobiomodulation(magnetic laser) recommended for the treatment of dry socket in patients with type 2 diabetes mellitus, can be considered as a promising method, as it has not only anti-inflammatory but also pronounced analgesic and tissue regenerating properties.

CLINICAL TRIAL NUMBER

Not applicable.

Connection between oral health and chronic diseases

Chronic diseases have emerged as a paramount global health burden, accounting for 74% of global mortality and causing substantial economic losses. The oral cavity serves as a critical indicator of overall health and is inextricably linked to chronic disorders. Neglecting oral health can exacerbate localized pathologies and accelerate the progression of chronic conditions, whereas effective management has the potential to reduce their incidence and mortality. Nevertheless, limited resources and lack of awareness often impede timely dental intervention, delaying optimal therapeutic measures. This review provides a comprehensive analysis of the impact of prevalent chronic diseases-such as diabetes mellitus, rheumatoid arthritis, cardiovascular disorders, and chronic respiratory diseases-on oral health, along with an exploration of how changes in oral health affect these chronic conditions through both deterioration and intervention mechanisms. Additionally, novel insights into the underlying pathophysiological mechanisms governing these relationships are presented. By synthesizing these advancements, this review aims to illuminate the complex interrelationship between oral health and chronic diseases while emphasizing the urgent need for greater collaboration between dental practitioners and general healthcare providers to improve overall health outcomes.

The Influence of Glycemic Control Over Post-extraction Healing in Diabetic Patients

Background Diabetes mellitus hinders wound healing after tooth extractions due to hyperglycemia, causing complications like infections and delayed recovery. The precise role of glycemic control in healing remains uncertain. This study aims to clarify it by comparing outcomes in patients with well-controlled and poorly controlled blood sugar levels. Material and methods This prospective observational study at Priyadarshini Dental College and Hospital (October-November 2023) involved 100 insulin-dependent diabetic patients (n = 100) requiring dental extractions, divided into group A with random blood sugar (RBS) ≤150 mg/dL (n = 50) and group B with RBS between 151 and 240 mg/dL (n = 50). Inclusion criteria included fully erupted teeth in patients aged 18 or older, while exclusion criteria comprised those on antibiotics, with systemic immunodeficiency, undergoing chemotherapy, or with active infections. Preoperative RBS and post-extraction wound dimensions were recorded, and clinical outcomes, such as pain, bleeding, infection, dry socket, and tissue color changes, were assessed on days 1, 7, and 14. Ethical approval was obtained from the Institutional Ethical Committee (IEC-PDCH5/4-2023) and the Indian Council of Medical Research (ICMR Reference ID: 2023-14931). Data were analyzed using chi-square and independent sample t-tests. Results The findings suggest that higher glycemic levels (151-240 mg/dL) are associated with increased pain and complications but do not significantly affect healing outcomes compared to levels ≤150 mg/dL. Group A shows better healing status, while group B has a higher incidence of moderate pain and bleeding. Conclusion This study indicates that glycemic levels between 151 and 240 mg/dL have no significant impact on post-extraction healing compared to levels ≤150 mg/dL in diabetic patients. Elevated blood sugar within this range may not increase the risk of delayed healing or complications. However, managing blood sugar levels is still critical, as uncontrolled diabetes can lead to adverse outcomes. Further research is required to determine the ideal glycemic range for optimal healing in diabetic patients.

Glu-Ensemble: An ensemble deep learning framework for blood glucose forecasting in type 2 diabetes patients

Diabetes is a chronic metabolic disorder characterized by elevated blood glucose levels, posing significant health risks such as cardiovascular disease, and nerve, kidney, and eye damage. Effective management of blood glucose is essential for individuals with diabetes to mitigate these risks. This study introduces the Glu-Ensemble, a deep learning framework designed for precise blood glucose forecasting in patients with type 2 diabetes. Unlike other predictive models, Glu-Ensemble addresses challenges related to small sample sizes, data quality issues, reliance on strict statistical assumptions, and the complexity of models. It enhances prediction accuracy and model generalizability by utilizing larger datasets and reduces bias inherent in many predictive models. The framework's unified approach, as opposed to patient-specific models, eliminates the need for initial calibration time, facilitating immediate blood glucose predictions for new patients. The obtained results indicate that Glu-Ensemble surpasses traditional methods in accuracy, as measured by root mean square error, mean absolute error, and error grid analysis. The Glu-Ensemble framework emerges as a promising tool for blood glucose level prediction in type 2 diabetes patients, warranting further investigation in clinical settings for its practical application.

Oral Manifestations: A Reliable Indicator for Undiagnosed Diabetes Mellitus Patients

OBJECTIVES

 This article identifies undiagnosed DM (UDM) cases in the Pakistani population by perceiving the signs and symptoms of DM and associating them with oral manifestations.

MATERIAL AND METHODS

 In this cross-sectional study, patients showing at least three or more classical or warning signs like polydipsia, polyuria, polyphagia, and general weakness were considered UDM cases. Detailed oral examination for gingivitis, periodontitis, halitosis, xerostomia, and tongue manifestations was done followed by the hemoglobin A1c (HbA1c) analysis.

RESULTS

 Out of 5,878 patients, 214 UDM cases were identified, where 31.8% and 39.7% of the patients were diagnosed as prediabetics and diabetics, respectively, based on HbA1c analysis. Prevalence of gingivitis (97.6%), fissured tongue (91.8%), generalized periodontitis (85.9%), thick saliva (87.1%), xerostomia (84.7%), burning mouth syndrome (63.5%), yellow discoloration of tongue (57.6%), and ecchymosis/ulcers (43.5%) were more in diabetics as compared to prediabetic patients and normal population.

CONCLUSION

 The oral manifestations can be crucial for identifying UDM cases. Dentists can play a pivotal role by taking detailed history and thorough oral examination. If three or more symptoms as concluded above are present, an HbA1c analysis should be conducted to prevent preop and postop complications associated with DM.

Association between Hyperglycemia and Medication-Related Osteonecrosis of the Jaw (MRONJ)

BACKGROUND

Medication-related osteonecrosis of the jaw (MRONJ) is a type of jawbone necrosis caused by the use of drugs for some types of cancer and osteoporosis. The current study aimed to evaluate the associations between hyperglycemia and the development of medication-related osteonecrosis of the jaw.

METHODS

Our research group investigated data collected between 1 January 2019 and 31 December 2020. A total of 260 patients were selected from the Inpatient Care Unit, Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University. Fasting glucose data were used and included in the study.

RESULTS

Approximately 40% of the necrosis group and 21% of the control group presented with hyperglycemia. There was a significant association between hyperglycemia and MRONJ (p < 0.05, p = 0.003). Vascular anomaly and immune dysfunction caused by hyperglycemia can lead to necrosis after tooth extraction. Necrosis is more common in the mandible (75.0%) and in the case of parenteral antiresorptive treatment (intravenous Zoledronate and subcutaneous Denosumab). Hyperglycemia is a more relevant risk factor than bad oral habits (26.7%).

CONCLUSIONS

Ischemia is a complication of abnormal glucose levels, a possible risk factor for necrosis development. Hence, uncontrolled or poorly regulated plasma glucose levels can significantly increase the risk of jawbone necrosis after invasive dental or oral surgical interventions.

Preoperative HbA1c and Blood Glucose Measurements in Diabetes Mellitus before Oral Surgery and Implantology Treatments

Diabetes mellitus has become a worldwide epidemic and is frequently accompanied by a number of complications proportional to the duration of hyperglycemia. The aim of this narrative review is to assess the most up-to-date guidelines on DM provided by both diabetes and dental associations. Furthermore, to gather evidence on the uni/bidirectional relationships of elevated HbA1c levels on dental surgery, implantology, bone augmentation, and periodontology and to demonstrate the importance of measuring HbA1c levels before invasive dental treatments. HbA1c and blood glucose measurements are a minimally invasive method for preventing complications in diabetes mellitus. The authors conducted a literature review to determine which oral conditions are affected by diabetes mellitus. MEDLINE served as a source with the use of a specific search key. Regarding oral complications of diabetes, prevention is the most vital factor. With this publication, we hope to assist physicians and dentists to make prompt diagnoses and to help in recognizing various oral manifestations of diabetes and follow the existing guidelines.

Obtaining a Reliable Diagnostic Biomarker for Diabetes Mellitus by Standardizing Salivary Glucose Measurements

Salivary glucose is frequently utilized in diabetes mellitus (DM), and it might be proposed as a potential biomarker candidate for DM, as it is non-invasive and cost-effective and achieves adequate diagnostic performance for DM patients. However, salivary glucose levels may change under specific conditions. It is consequently essential to maintain a consistent strategy for measuring saliva, taking into account the possibility of external factors influencing salivary glucose levels. In this study, we analyzed salivary glucose levels under different handling conditions and donor-dependent factors, including age, interdiurnal variations, and collection and processing methods. A structured questionnaire was used to determine the symptoms and predisposing factors of DM. The glucose oxidase peroxidase method was used to estimate glucose levels in the blood and saliva of people in a fasting state. The aim of this study is to investigate the effect of such conditions on salivary glucose levels. We found that these extraneous variables should be taken into account in the future when salivary glucose is used as a predictive biomarker for DM.

The changes in levels of blood cortisol, glucose, and oxygen saturation in type 2 diabetic patients during tooth extraction

OBJECTIVES

The extraction of a tooth exacerbates the stress in diabetic patients leading to diabetic complications so the aim was to evaluate the changes in blood cortisol, glucose, and oxygen saturation in type 2 diabetic patients during tooth extraction to pay special attention during a routine surgical procedure.

MATERIALS AND METHODS

The research included 40 patients with type 2 diabetes with indications of tooth extraction. They were divided into two subgroups by 20 participants and split according to local anesthesia (lidocaine with additional adrenaline or lidocaine only). Cortisol, blood sugar, blood pressure, arterial pulse, and blood oxygen saturation were measured. Patients were also evaluated for their sensitivity to pain through the Visual Analog Scale (VAS).

RESULTS

Cortisol and glucose levels scientifically increased throughout the procedure. Meanwhile, systolic, and diastolic blood pressure and saturation showed no difference between the measurements during and after tooth extraction (p = .280; p = .090; p = .590, respectively). Most patients (60.0%) felt no pain during/after the procedure. None of the subjects was feeling more pain than 30 points by VAS. The comparison between groups receiving lidocaine showed no statistical differences when adding adrenaline to lidocaine. Evaluation of pain by VAS showed that more patients felt pain when they were receiving lidocaine without adrenaline.

CONCLUSIONS

Diabetic patients require a more cautious approach when undergoing teeth extractions despite it being a routine procedure.

A Comparison of Pre-Emptive Co-Amoxiclav, Postoperative Amoxicillin, and Metronidazole for Prevention of Postoperative Complications in Dentoalveolar Surgery: A Randomized Controlled Trial

Objective: To compare the effectiveness of different oral antibiotics for prevention of dry socket and infection in adults following the surgical extraction of teeth under LA. Methods: This randomized controlled study was conducted from 10 September 2020 until 10 May 2021. Forty-six patients were randomly allocated to three groups. Sixteen patients were in the postoperative co-amoxiclav (625 mg) group, fifteen in the preoperative co-amoxiclav (625 mg) plus postoperative metronidazole (500 mg) group and fifteen in the preoperative co-amoxiclav (625 mg) plus postoperative amoxicillin (500 mg) group. Evaluation of the postoperative signs of alveolar osteitis and infection was made by a dental surgeon five days postoperatively. Evaluation of the post-surgical extraction pain was made by patients immediately and five days postoperatively on standard 100 mm visual analogue scales (VAS). Furthermore, difficulty of surgery was recorded for all patients immediately postoperatively using (VAS). Results: all antibiotics used in this study were effective. Only 15% of patients had painful alveolar osteitis and 2% had oral infections. There was no significant decrease in the number of patients with severe alveolar osteitis or infection for co-amoxiclav plus metronidazole and co-amoxiclav plus amoxicillin groups compared to co-amoxiclav group at 5 days post-operation (p-values: 0.715, 0.819 & 0.309). Clinically, metronidazole was more effective in protecting the extracted tooth socket from alveolar osteitis compared to co-amoxiclav and amoxicillin. Moreover, there were significant decreases in mean pain scores at 5 days post-operation compared with the levels of pain immediately after surgery (p-value: 0.001). Conclusions: Administration of a single preoperative dose of co-amoxiclav with a full postoperative dose of amoxicillin or metronidazole was more effective than conventional treatment with postoperative co-amoxilcalv in reducing the incidence of both alveolar osteitis and infection after surgical extractions. However, these differences were not statistically significant. Interestingly, patients in metronidazole group had the lowest incidence of dry socket.

Measuring the Level of Medical-Emergency-Related Knowledge among Senior Dental Students and Clinical Trainers

OBJECTIVES

This study aimed to measure the level of medical-emergency-related knowledge among senior dental students and clinical trainers in Saudi Arabia.

METHODS

This cross-sectional pilot survey was conducted at Taibah Dental College, Madina, Saudi Arabia between March 2017 and November 2018. Two hundred and seventy-five self-administered anonymous questionnaires on the management of common medical emergencies were distributed to all senior dental students and clinical trainers at Taibah Dental College.

RESULTS

There was a serious lack of knowledge regarding the management of medical emergency scenarios among the participants. Only 54% of participants knew the correct management for some frequent and life-threating conditions such as "crushed chest pain", and only 30-35% of participants knew the correct management of deeply sedated patients with benzodiazepine overdose and crisis of hypoadrenalism. Moderate-quality knowledge (50-74% of participants responded correctly) was noted for the following conditions: sudden onset of brain stroke, psychiatric patient, unconscious patient with hypoglycemia, patient with postural hypotension, and patient with hyperventilation. Based on the scale of knowledge, there were significant differences in the level of knowledge between clinical trainers, senior dental students, and junior dental students (p ≤ 0.01). Almost all students and 90% of trainers declared the need for further training.

CONCLUSIONS

The overall knowledge regarding the management of medical emergency crises in the dental chair was moderate. However, the scale of knowledge regarding the management of medical emergency crises has gradually increased with the number of years of experience. Most participants recognize the need for further training.

Third Molar Extraction: Irrigation and Cooling with Water or Sterile Physiological Solution: A Double-Blind Randomized Study

BACKGROUND

The present study aimed to ascertain whether any significant reduction in patients' postoperative pain and inflammation could be achieved by using sterile physiological solution instead of normal water to irrigate the surgical field and cool the dental bur during third molar extractions.

METHODS

The study concerned 22 patients (11 females and 11 males) in good general health, who were referred to the Dental Clinic at Padova University hospital for lower third molar extractions. They were randomly assigned to two groups. Only the fluid used to irrigate the surgical field and cool the dental bur differed between the two study groups, being sterile physiological solution for group A, and mains water for group B. Postoperative pain, swelling, trismus and inflammation with high sensitivity CRP where measured and statistically evaluated. The numerosity of our sample was calculated on the grounds of an endpoint based on data in the literature.

RESULTS

Eighteen patients needed bilateral extractions, and 4 required only one extraction, so a total of 40 third molars were extracted. A sterile physiological solution was used to irrigate the surgical field in 20 extractions, while water was used in the other 20 cases. Data analysis with Wilcoxon test show no differences between the two groups (p < 0.05).

CONCLUSIONS

no differences between groups for any of the parameters considered, after third molar extraction procedures undertaken using either sterile physiological solution or water for irrigation and cooling purposes.

Management of periodontal disease in patients with diabetes- good clinical practice guidelines: A joint statement by Indian Society of Periodontology and Research Society for the Study of Diabetes in India

There is a huge body of literature suggesting an association and a bidirectional relationship between periodontal disease and diabetes. Diabetes and periodontal diseases are both chronic diseases with a high prevalence. Dentists/periodontists, in their daily clinical practice, very often attend to diabetes patients with diverse oral health conditions and cater to their dental treatment needs. Safe and effective periodontal therapy in this population requires a broad understanding of diabetes, medical management of diabetes, and essential modifications to dental/periodontal therapy that may be required. This paper describes a joint statement put forth by the Indian Society of Periodontology and the Research Society for the Study of Diabetes in India aiming to provide expert consensus and evidence-based guidelines for optimal clinical management of periodontal conditions in diabetes patients or patients at risk for diabetes. Although this paper is not envisioned to be a comprehensive review of this topic, it intends to provide the guidelines for dental professionals and periodontists.

COVID-19 Guidelines to Protect Healthcare Workers at Hospitals and Dental Professionals at Dental Office

BACKGROUND

Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. This study aimed to address the preventive procedures to protect healthcare workers at hospital to avoid COVID-19, and infection control procedures to protect dental professionals in dental office.

METHODS

We conducted a search of published articles from PubMed, google scholar databases using key words such as COVID-19, healthcare worker, infection control, and dental practice. Relevant articles were identified and reviewed. Most published papers were clinical reports and case studies. We have selected some of the current published papers written in English in 2020.

RESULTS

Infection control procedures to protect health workers at hospitals, and dental professionals at dental office were summurised and presented. Infection control procedures for healthcare workers at hospitals include Personal protective equipment, Korea filter (KF)94 respirator, goggles, face protector, disposable waterproof long-arm gown, and gloves, and others. Extra-protection procedures should be taken with old and vulnerable healthcare workers. Dental professionals should evaluate patients in advance before starting dental treatment. Aerosols generating procedures should be avoided and personal protective equipment should be used. Dental treatment should be restricted to emergency cases only.

CONCLUSION

Old medical staff should be in safer distance to avoid infection, but young physicians and nurses should work at frontline as their immunity is better than their colleagues at old age. Screening patients and measurement of the body temperature are essential measures before dental treatment.

Comparison of Extraction Socket Healing in Non-Diabetic, Prediabetic, and Type 2 Diabetic Patients

OBJECTIVE

To compare the healing of extraction socket among non-diabetic, prediabetic, and diabetic patients.

MATERIALS AND METHODS

A single-center prospective observational study was conducted. Glycated hemoglobin and random blood glucose were recorded for all the participants before the procedure. A trained and calibrated examiner evaluated the socket size on postoperative days 0 and 7. Postoperative pain (PoP), discharge, swelling, infection, erythema, dry socket, and the number of analgesics were also recorded.

RESULTS

A total of 100 participants completed this study with a mean age of 54.7±12.11. There was no significant difference in the mean socket size among the three study groups on day 0 (P=0.101). However, there was a significant difference in the mean socket size on day 7 among the three groups. A post hoc test showed that the diabetic group had a larger socket size than the non-diabetic group (P=0.011). Complications like swelling and infection were more in the diabetic group. There was no significant difference in the mean number of analgesics among the three groups (P=0.169). The adjusted means for the socket size on postoperative day 7 was significantly higher for diabetic than the non-diabetic group.

CONCLUSION

The socket dimension was larger on postoperative day 7 in people with diabetes which suggested delayed healing without persistent complications. Dental extractions can be performed safely in optimally controlled diabetic patients with minimal complications.

Evaluation of Surgical Treatment of Oroantral Fistulae in Smokers Versus Non-Smokers

Background and Objectives: Smoking has been found to interfere with wound healing processes. Therefore, the purpose of this study was to compare surgical treatment of oroantral fistulae (OAFs) in smokers and non-smokers. Materials and Methods: Medical records of all consecutive patients who underwent surgical closure of OAFs between 2003 and 2016 at the oral and maxillofacial surgery department, Rabin Medical Center, Israel were reviewed. Patients' demographic data, preoperative signs and symptoms, surgical method of repair, and postoperative complications were recorded. Results: The cohort consisted of 38 smokers and 59 non-smokers. Age and gender distributions were similar in both groups. The main etiology in both groups was tooth extraction, followed by pre-prosthetic surgery in smokers and odontogenic infection in non-smokers (p = 0.02). Preoperative conditions were not significantly different between smokers and non-smokers in terms of size of soft tissue fistula and bony defect, chronic sinusitis and foreign bodies inside the sinus. OAFs were repaired by local soft tissue flaps without consideration of smoking status. Smokers experienced more moderate-severe postoperative pain (p = 0.05) and requested more weak opioids (p = 0.06). Postoperative complications included infection, delayed wound healing, residual OAF, pain, sensory disturbances and sino nasal symptoms. These were mostly minor and tended to be more frequent in smokers (p = 0.35). Successful closure of OAFs was obtained in all patients except one smoker who required revision surgery. Conclusions: Smokers may be more susceptible to OAFs secondary to preprosthetic surgery. In this cohort, there was no statistically significant difference in outcome between smokers and non-smokers in terms of failure. However, smokers tended to have more severe postoperative pain and discomfort and to experience more postoperative complications. Further studies with larger sample sizes should be conducted to validate these results.