This case report describes the long-term follow-up of a 22-year-old, female patient with type 1 diabetes managed by conservative oral care and glycemic control measures. She is on a twice a day insulin regimen. Tooth numbers 13 and 37 had pockets less than 6 mm while all remaining teeth had greater than 6 mm. Periodontal management consisted of root planing combined with instructions on diabetes self-management skills at home. Nine weeks after the first sextant was treated, pocket depth measurements in 93 (81.6%) out of 114 sites and bleeding on probing (BOP) scores in 11 (57.9%) out of 19 teeth decreased. There was a 50% reduction in the C reactive Protein and a 46.7% decrease in the fructosamine assay levels. Initial glycohemoglobin level of 8.3% decreased substantially to 7.1%. The goal of the dentist is no longer just the improvement of oral health but ultimately the overall health of the patient and the physician's goal is to include oral health in the promotion of overall health.

Human ; Female ; Adult ; Young Adult ; Blood Glucose ; C-reactive Protein ; Clinical Protocols ; Dentists ; Diabetes Mellitus, Type 1 ; Diabetes Mellitus ; Fructosamine ; Insulin ; Oral Health ; Self Care ; Tooth Root ; Periodontitis

OBJECTIVE: The aim of this paper is to examine the oral health of children attending a diabetes camp. Despite studies showing diabetes to be a risk factor for periodontitis on the one hand and periodontitis having been shown to affect glycemic control and increase the risk for developing complications among diabetic patients, oral health is only beginning to receive much needed attention as an important aspect of general health in diabetic patients.

METHODOLOGY: A simple count of the number of decayed, missing, and filled teeth was performed and added to come up with the Decayed Missing and Filled Teeth index (DMFT). Periodontal examination was performed using a Community Periodontal Index of Treatment Needs (CPITN) probe. Pocket probing was performed on six sites (mesiobuccal, midbuccal, distobuccal, mesiolingual, mid-lingual, and distolingual) on each tooth. The teeth were then scored on a scale of 0–4 similar to the CPITN method of the World Health Organization.

RESULTS: The proportion of participants with dental caries was 72% (18) with a mean number of decayed, missing and filled teeth (DMFT) of 4.6. 5 (20%) of the participants had a DMFT score of 0, meaning that they have no decayed missing or filled teeth while 10 (40%) either already had permanent teeth extracted. or required tooth extraction for nonrestorable, severely decayed permanent teeth. Periodontitis (Pockets > 3.5 mm; CPITN = 4) was found in only 1 (4%) patient. 21 (84%) of the participants either had a CPITN score of 1 or 2, meaning bleeding upon probing or calcular deposits were observed. 3 (12%) had a CPITN score of 0.

CONCLUSIONS. Diabetes camps are a good place to screen oral health problems among type 1 diabetic patients given the different socio-economic factors, levels of concern for oral health, and availability of dental care providers among families of with type 1 diabetic children. Physicians managing type 1 diabetics should motivate their patients to see the dentist twice a year for preventive visits and strongly encourage them to have treatment when dental diseases are present. An oral exam should be part of the cursory examination performed by physicians handling these patients.
Periodontitis

We report a case of severe gingival bleeding in a 15-year old, type 1 diabetic female. Examination revealed severe gingival inflammation with periodontal pockets (<6 mm), indicating mild-moderate periodontitis. Periodontal therapy resulted in reduction of fructosamine level (-72.98) after four weeks, but HbA1c level checked 3 months after treatmentincreased (+0.7). Reduction in gingival bleeding and periodontal pockets improved the patient’s quality of life. Insulin resistance is offered as a possible reason for non-improvement in HbA1c levels.
Periodontitis