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Boyer TL, Solanki P, McGregor JC, Wilson GM, Gibson G, Jurasic MM, Evans CT, Suda KJ. Risk factors for oral infection and dry socket post-tooth extraction in medically complex patients in the absence of antibiotic prophylaxis: A case-control study. SPECIAL CARE IN DENTISTRY 2024; 44:1171-1181. [PMID: 38321539 DOI: 10.1111/scd.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Dry socket and infection are complications of tooth extractions. The objective was to determine risk factors for post-extraction complications in patients without antibiotic prophylaxis stratified by early- and late-complications and complication type (oral infection and dry socket). METHODS Retrospective, case (with complications)-control (without complications) study of patients (n = 708) who had ≥1 extraction performed at any Veterans Health Administration facility between 2015-2019 and were not prescribed an antibiotic 30 days pre-extraction. RESULTS Early complication cases (n = 109) were more likely to be female [odds ratio (OR) = 2.06; 95% confidence interval (CI):1.05-4.01], younger (OR = 0.29; 95% CI:0.09-0.94 patients ≥ 80 years old, reference:18-44 years), Native American/Alaska Native (OR = 21.11; 95% CI:2.33-191.41) and have fewer teeth extracted (OR = 0.53 3+ teeth extracted; 95% CI:0.31-0.88, reference:1 tooth extracted). Late complication cases (n = 67) were more likely to have a bipolar diagnosis (OR = 2.98; 95% CI:1.04-8.57), history of implant placement (OR = 8.27; 95% CI:1.63-41.82), and history of past smoking (OR = 2.23; 95% CI:1.28-3.88). CONCLUSION Predictors for post-extraction complications among patients who did not receive antibiotic prophylaxis were similar to prior work in cohorts who received prophylaxis. Unique factors identified in a medically complex population included being younger, Native American/Alaska Native, having mental health conditions, history of a dental implant, and fewer teeth extracted.
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Affiliation(s)
- Taylor L Boyer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, U.S. Department of Veterans Affairs, Pittsburgh, Pennsylvania, USA
| | - Pooja Solanki
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Medical Center, U.S. Department of Veterans Affairs, Hines, Illinois, USA
| | | | - Geneva M Wilson
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Medical Center, U.S. Department of Veterans Affairs, Hines, Illinois, USA
- Department of Preventive Medicine, Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gretchen Gibson
- Veterans Health Administration Office of Dentistry, Washington, District of Columbia, USA
- Kansas City University College of Dental Medicine, Joplin, Missouri, USA
| | - M Marianne Jurasic
- Veterans Health Administration Office of Dentistry, Washington, District of Columbia, USA
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Medical Center, U.S. Department of Veterans Affairs, Hines, Illinois, USA
- Department of Preventive Medicine, Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katie J Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, U.S. Department of Veterans Affairs, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Dignam P, Elshafey M, Jeganathan A, Foo M, Park JS, Ratnaweera M. Prevalence and Factors Influencing Post-Operative Complications following Tooth Extraction: A Narrative Review. Int J Dent 2024; 2024:7712829. [PMID: 38756385 PMCID: PMC11098612 DOI: 10.1155/2024/7712829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Background Complications from dental extractions may result in multiple post-operative visits and adversely affect the patient's life. Preventing complications may decrease post-operative morbidity for the individual as well as lower societal costs, such as lost time from work and healthcare costs. Objectives This narrative review aims to assess the prevalence and factors influencing post-operative complications following tooth extraction, helping clinicians minimise the risk. Data Sources. Cross-sectional studies. Study Eligibility and Participants. Patients undergoing dental extractions. Our exclusion criteria included in vitro studies, animal studies, terminally ill patients, and tooth loss not due to dental extraction. Literature was collected from "PubMed" and "Web of Science" through search criteria based on the "PICO" framework. Twenty articles were used to formulate a prevalence table, and 156 articles were included for the factors influencing complications. Study Appraisal and Synthesis Methods. This narrative review was reported using the SANRA (a scale for the quality assessment of narrative review articles) checklist. Due to the scope of our narrative review and its associated objectives, the quality of cross-sectional studies (AXIS) will be conducted from the studies outlining the prevalence. Results Alveolar osteitis appears to be the most prevalent post-operative complication following tooth extraction. Predisposing factors can be significant in their ability to alter the risk of postoperative complications, and clinicians should provide patient-centred care to mitigate this risk. Limitations. Due to the breadth of context, a systematic review was not feasible, as it may have introduced heterogeneity. Conclusion This narrative review has highlighted an array of factors which can influence the prevalence of post-operative complications. Future research would benefit from individually reporting post-operative complications, reducing the heterogeneity in definitions of the complications, and including greater detail on the predisposing factors studied.
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Affiliation(s)
- Peter Dignam
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Mariam Elshafey
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Aparna Jeganathan
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Magdalen Foo
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Joon Soo Park
- UWA Dental School, The University of Western Australia, Nedlands, Australia
- International Research Collaborative—Oral Health and Equity, School of Allied Health, The University of Western Australia, Crawley, Australia
- School of Engineering, Information Technology and Physical Sciences, Federation University Australia, Victoria, Ballarat, Australia
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Fok MR, Pelekos G, Jin L. Efficacy of Alveolar Ridge Preservation in Periodontally Compromised Molar Extraction Sites: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1198. [PMID: 38592010 PMCID: PMC10931845 DOI: 10.3390/jcm13051198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 04/10/2024] Open
Abstract
AIM To investigate the efficacy of alveolar ridge preservation (ARP) in periodontally compromised molar extraction sites. METHODS An electronic search was performed on 10th November 2023 across five databases, seeking randomised/non-randomised controlled trials (RCTs/NCTs) that included a minimum follow-up duration of four months. The RoB2 and Robins-I tools assessed the risk of bias for the included studies. Data on alveolar ridge dimensional and volumetric changes, keratinized mucosal width, and need for additional bone augmentation for implant placement were collected. Subsequently, a meta-analysis was carried out to derive the pooled estimates. RESULTS Six studies were incorporated in the present review, and a total of 135 molar extraction sockets in 130 subjects were included in the meta-analysis. ARP was undertaken in 68 sites, and 67 sites healed spontaneously. The follow-up time ranged from 4 to 6 months. The meta-analysis of both RCTs and NCTs showed significant differences in mid-buccal ridge width changes at 1 mm level below ridge crest with a mean difference (MD) of 3.80 (95% CI: 1.67-5.94), mid-buccal ridge height changes (MD: 2.18; 95% CI: 1.25-3.12) and volumetric changes (MD: 263.59; 95% CI: 138.44-388.74) in favour of ARP, while the certainty of evidence is graded low to very low. Moreover, ARP appeared to reduce the need for additional sinus and bone augmentation procedures at implant placement with low certainty of evidence. CONCLUSIONS Within the limitations of this study, alveolar ridge preservation in periodontally compromised extraction sites may, to some extent, preserve the ridge vertically and horizontally with reference to spontaneous healing. However, it could not eliminate the need for additional augmentation for implant placement. Further, longitudinal studies with large sample sizes and refined protocols are needed.
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Affiliation(s)
- Melissa Rachel Fok
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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Colella A, Yu E, Sambrook P, Hughes T, Goss A. What is the Risk of Developing Osteonecrosis Following Dental Extractions for Patients on Denosumab for Osteoporosis? J Oral Maxillofac Surg 2023; 81:232-237. [PMID: 36442534 DOI: 10.1016/j.joms.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Osteonecrosis of the jaws (ONJ) occurs in patients on antiresorptive drugs for osteoporosis with the risk with oral bisphosphonates being known to be of the order of 0.1 to 0.3% while the risk for patients on denosumab for osteoporosis is not known. The aim of this study was to determine the risk of developing ONJ in a consecutive series of patients on denosumab for osteoporosis having dental extractions. MATERIAL AND METHODS A prospective cohort study of patients on denosumab for osteoporosis having dental extractions in the period January 1, 2017 and June 30, 2021 were compared to a control group not on antiresorptives. Detailed demographic records including length of time on antiresorptives and CTX values were obtained. Comparison to further define risk factors was made between those patients developing ONJ to those who didn't. RESULTS The treatment group included 427 patients who were on denosumab for osteoporosis; they collectively underwent 561 episodes of dental treatment involving extractions for a total of 1081 extractions, with 10 developing ONJ (risk 2.3%). The control group consisted of 299 patients who were not taking denosumab; they collectively underwent 315 episodes of dental treatment for a total of 669 extractions, and none of them developed ONJ. There were significant differences in age and sex, but not medical comorbidities between the treatment and control groups. Within the treatment group, there were no significant differences in any of these characteristics between those who did, and those who didn't, develop ONJ. Within the treatment group, the number of extractions modified the risk of developing ONJ (odds ratio, 1.35; confidence interval, 1.1-1.7). Of the 76 patients who had extractions between 6 and 7 months after the last denosumab injection, none developed ONJ. CONCLUSIONS The risk of ONJ in patients on denosumab for osteoporosis is a magnitude greater than for patients on the oral bisphosphonates 2.3% v 0 - 0.3%, which is 7.7 times more likely. Number of extractions and early resumption of the next dose of denosumab increases the risk of ONJ.
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Affiliation(s)
- Anthony Colella
- Medical student, Medical School, The University of Adelaide, Adelaide, Australia
| | - Elaine Yu
- House Surgeon, Monash Medical Centre Clayton, Monash University, Melbourne, Australia
| | - Paul Sambrook
- Head of Unit, Oral & Maxillofacial Surgery Unit, Adelaide, South Australia, Australia
| | - Toby Hughes
- Professor and Postgraduate Coordinator, School of Dentistry, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alastair Goss
- Emeritus Professor and Consultant, Oral & Maxillofacial Surgery Unit, The University of Adelaide, Adelaide, South Australia, Australia.
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Sykara M, Maniatakos P, Tentolouris A, Karoussis IK, Tentolouris N. The necessity of administrating antibiotic prophylaxis to patients with diabetes mellitus prior to oral surgical procedures-a systematic review. Diabetes Metab Syndr 2022; 16:102621. [PMID: 36183455 DOI: 10.1016/j.dsx.2022.102621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Μany studies suggest the use of antibiotic prophylaxis (AP) as an appropriate preventive measure for patients with diabetes mellitus (DM) due to the increased possibility of an impaired wound healing and infections after surgical procedures in the oral cavity. Existing recommendations regarding antibiotic prophylaxis before surgical procedures are not definitive and are based on expert opinions. The purpose of this study was to review the available scientific data about the necessity of administrating AP as a preventive measure prior to oral surgical procedures. METHOD PubMed®, Scopus® και Cochrane Central Register of Controlled Trials (CENTRAL) were used as databases to search for published research. All articles were initially identified and classified based on the title and subsequently on their abstract. For the next level the full scientific paper was read and evaluated. RESULTS Overall, 22 articles were included in the study, of which 2 were systematic reviews, 2 cohort studies, 2 case-control studies, 1 case series, 8 case reports and 7 professional association publications. CONCLUSIONS In the scientific literature, there is a wide range of recommendations and inconsistency regarding the need to administer AP prior to surgical dental operations in patients with DM, while there is no scientific evidence demonstrating its' effectiveness as a precautionary measure. Both blood glucose level measurements and recent HbA1c measurement should be evaluated before any dental procedure. Poor regulation may result to life-threatening infections after tooth extraction. AP is recommended prior to the placement of dental implant. Randomized, controlled, clinical trials with large number of participants and greater variety of surgical dental procedures are needed.
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Affiliation(s)
- Maria Sykara
- Department of Periodontology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Maniatakos
- Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Laiko General Hospital, Athens, Greece.
| | - Ioannis K Karoussis
- Department of Periodontology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Laiko General Hospital, Athens, Greece
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Radović K, Brković B, Roganović J, Ilić J, Milić Lemić A, Jovanović B. Salivary VEGF and post-extraction wound healing in type 2 diabetic immediate denture wearers. Acta Odontol Scand 2022; 80:9-14. [PMID: 34033524 DOI: 10.1080/00016357.2021.1930149] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Oral wound healing in healthy could be promoted by VEGF in saliva, and immediate denture wearing, but data in type 2 diabetes are lacking. Aims were to investigate the timeline of extraction wound healing in diabetic participants wearing immediate dentures and its correlation to salivary VEGF, as well as to examine the impact of the palatal plate on tissue VEGF during palatal wound healing in rat diabetic model. MATERIAL AND METHODS Healthy (42) and type 2 diabetic (36) denture wearers, candidates for teeth extractions were included. Extraction wound healing was followed via measurements of socket closure, gingival hyperaemia, pain and presence of necrosis on 3rd, 7th, 14th and on 21st-day post-extraction. Salivary VEGF was measured before and on the 3rd and 21st day after the extraction. In streptozotocin-induced diabetic (30) as well as non-diabetic rats (30), tissue VEGF was measured in palatal wounds healing under or without a palatal plate. RESULTS Type 2 diabetic prosthetic patients exhibit delayed socket closure, with pronounced hyperaemia, pain and necrosis. Salivary VEGF is increased in diabetes and positively correlates to socket closure while negatively with pain on 21st day after the extraction. Palatal incision induced VEGF increase in non-diabetic and diabetic, but less pronounced in diabetic rats. Wound healing under the palatal plate exhibit higher tissue VEGF. CONCLUSION Type 2 diabetes-induced increase in salivary VEGF may mitigate diabetes-induced detrimental effects on extraction wound healing. Lack of adequate tissue VEGF response to injury may underly dysregulation of diabetic oral wound healing.
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Affiliation(s)
- Katarina Radović
- Faculty of Dental Medicine, Department of Prosthetic Dentistry, University of Belgrade, Belgrade, Serbia
| | - Božidar Brković
- Faculty of Dental Medicine, Department of Oral Surgery, University of Belgrade, Belgrade, Serbia
| | - Jelena Roganović
- Faculty of Dental Medicine, Department of Pharmacology in Dentistry, University of Belgrade, Belgrade, Serbia
| | - Jugoslav Ilić
- Faculty of Dental Medicine, Department of Restorative Odontology and Endodontics, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Milić Lemić
- Faculty of Dental Medicine, Department of Prosthetic Dentistry, University of Belgrade, Belgrade, Serbia
| | - Boris Jovanović
- Faculty of Dental Medicine, Department of Prosthetic Dentistry, University of Belgrade, Belgrade, Serbia
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Panneerselvam E, Asoka S, Pandya A, Raja VBK, Ravi P. Effect of platelet-rich fibrin on extraction socket healing in diabetic patients – A split-mouth crossover study: A prospective clinical trial. Natl J Maxillofac Surg 2022; 13:39-43. [PMID: 35911800 PMCID: PMC9326197 DOI: 10.4103/njms.njms_422_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022] Open
Abstract
Aims: The aim of this study is to evaluate the effectiveness of platelet-rich fibrin (PRF) in postextraction socket healing in diabetic patients. Subjects and Methods: The investigators implemented a randomized, split-mouth study in 100 Type 2 diabetic patients undergoing dental extraction of two or more teeth. Following extraction, the experimental socket was packed with PRF and sutured, while the control socket was sutured without packing. The primary outcome measures were soft-tissue healing (assessed by color, bleeding on palpation, granulation tissue, and incidence of suppuration and dry socket), hard-tissue healing (measured by visual interpretation, area of bone coverage, and grayscale analysis), and visual pain scores. Statistical Analysis: Statistical analysis was done using the independent and paired t-tests, analysis of variance, and Chi-square test Results: Both soft-tissue healing and hard-tissue healing were significantly better in the experimental socket as compared to the control socket. Pain levels, as measured by the visual analog score, were similar in both the extraction sockets. Conclusions: The use of PRF has beneficial effects in extraction socket healing in diabetic patients.
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Yang S, Li Y, Liu C, Wu Y, Wan Z, Shen D. Pathogenesis and treatment of wound healing in patients with diabetes after tooth extraction. Front Endocrinol (Lausanne) 2022; 13:949535. [PMID: 36213270 PMCID: PMC9538860 DOI: 10.3389/fendo.2022.949535] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Diabetes mellitus is a common systematic chronic disease amongst dental patients. The elevated glucose microenvironment can prolong the healing of tooth extraction sockets. Therefore, the promotion of healing up tooth extraction sockets is of great clinical importance to the patients with diabetes mellitus. The current evidence indicates the mechanism of the recovery period of extraction sockets in hyperglycaemia conditions from physiological, inflammation, immune, endocrine and neural aspects. New advancements have been made in varied curative approaches and drugs in the management of wound healing of tooth extraction sockets in diabetes. However, most of the interventions are still in the stage of animal experiments, and whether it can be put into clinical application still needs further explorations. Specifically, our work showed topical administration of plasma-rich growth factor, advanced platelet-rich fibrin, leukocyte- and platelet-rich fibrin and hyaluronic acid as well as maxillary immediate complete denture is regarded as a promising approach for clinical management of diabetic patients requiring extractions. Overall, recent studies present a blueprint for new advances in novel and effective approaches for this worldwide health ailment and tooth extraction sockets healing.
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Ko KI, Sculean A, Graves DT. Diabetic wound healing in soft and hard oral tissues. Transl Res 2021; 236:72-86. [PMID: 33992825 PMCID: PMC8554709 DOI: 10.1016/j.trsl.2021.05.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022]
Abstract
There is significant interest in understanding the cellular mechanisms responsible for expedited healing response in various oral tissues and how they are impacted by systemic diseases. Depending upon the types of oral tissue, wound healing may occur by predominantly re-eptihelialization, by re-epithelialization with substantial new connective tissue formation, or by a a combination of both plus new bone formation. As a result, the cells involved differ and are impacted by systemic diaseses in various ways. Diabetes mellitus is a prevalent metabolic disorder that impairs barrier function and healing responses throughout the human body. In the oral cavity, diabetes is a known risk factor for exacerbated periodontal disease and delayed wound healing, which includes both soft and hard tissue components. Here, we review the mechanisms of diabetic oral wound healing, particularly on impaired keratinocyte proliferation and migration, altered level of inflammation, and reduced formation of new connective tissue and bone. In particular, diabetes inhibits the expression of mitogenic growth factors whereas that of pro-inflammatory cytokines is elevated through epigenetic mechanisms. Moreover, hyperglycemia and oxidative stress induced by diabetes prevents the expansion of mesengenic cells that are involved in both soft and hard tissue oral wounds. A better understanding of how diabetes influences the healing processes is crucial for the prevention and treatment of diabetes-associated oral complications.
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Affiliation(s)
- Kang I Ko
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, 19104
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland
| | - Dana T Graves
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, 19104.
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Bone quality analysis of jaw bones in individuals with type 2 diabetes mellitus-post mortem anatomical and microstructural evaluation. Clin Oral Investig 2021; 25:4377-4400. [PMID: 33694028 DOI: 10.1007/s00784-020-03751-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES With the higher risk of dental implant failure with type 2 diabetes mellitus (T2DM), there is a need to characterize the jaw bones in those individuals. The aim of this post mortem study was to compare jaw bone quality of individuals with T2DM to healthy controls. MATERIAL AND METHODS Bone cores from the edentulous lower first molar region and the region of mandibular angle were collected from male individuals with T2DM (n = 10, 70.6 ± 4.5 years) and healthy controls (n = 11, 71.5 ± 3.8 years) during autopsy. Within the T2DM, a subgroup treated with oral antidiabetics (OAD) and one on insulin were identified. Bone quality assessment encompassed evaluation of bone microstructure, matrix composition, and cellular activity, using microcomputed tomography (micro-CT), quantitative backscattered electron imaging (qBEI), Raman spectroscopy, and bone histomorphometry. RESULTS In the mandibular angle, T2DM showed 51% lower porosity of the lingual cortex (p = 0.004) and 21% higher trabecular thickness (p = 0.008) compared to control. More highly mineralized bone packets were found in the buccal cortex of the mandibular angle in insulin-treated compared to OAD-treated T2DM group (p = 0.034). In the molar region, we found higher heterogeneity of trabecular calcium content in T2DM insulin compared to controls (p = 0.015) and T2DM OAD (p = 0.019). T2DM was associated with lower osteocyte lacunar size in the trabecular bone of the molar region (vs. control p = 0.03). CONCLUSIONS Alterations in microstructure, mineralization, and osteocyte morphology were determined in jaw bone of individuals with T2DM compared to controls. CLINICAL RELEVANCE Future studies will have to verify if the mild changes determined in this study will translate to potential contraindications for dental implant placements.
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Gadicherla S, Smriti K, Roy S, Pentapati KC, Rajan J, Walia A. Comparison of Extraction Socket Healing in Non-Diabetic, Prediabetic, and Type 2 Diabetic Patients. Clin Cosmet Investig Dent 2020; 12:291-296. [PMID: 32765113 PMCID: PMC7381775 DOI: 10.2147/ccide.s264196] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/08/2020] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Srikanth Gadicherla
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Komal Smriti
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sreea Roy
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kalyana-Chakravarthy Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jyotsna Rajan
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Apoorva Walia
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Bafilomycin A1 Accelerates Chronic Refractory Wound Healing in db/db Mice. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6265701. [PMID: 32714982 PMCID: PMC7354638 DOI: 10.1155/2020/6265701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 12/26/2022]
Abstract
Numerous studies have reported that autophagy plays an important role in chronic wound healing, and enhancement of autophagic activity impairs cutaneous wound healing. The autophagy inhibitor Bafilomycin A1 (Baf A1) inhibits autophagy by preventing the formation of autophagosomes. This study aimed at elucidating the effect of Bafilomycin A1 on chronic refractory wound healing in diabetic mice. A total of 40 diabetic (db/db) mice and 20 nondiabetic (db/m) mice were used in this study. Full-thickness skin defects were generated in the db/db mice models, which were then divided into the following two groups: the nontreated (db/db group) and Baf A1-treated groups (Baf A1 group). The same skin defects were generated in db/m mice (db/m group) to serve as a control. We demonstrated that Baf A1 treatment significantly accelerated wound healing in db/db mice and exerted good healing effects. Moreover, Baf A1 inhibited autophagy in the newly generated epidermis and had minor effects on metabolism in db/db mice. PCNA expression, as detected by immunohistochemistry, and collagen thickness, as detected by Masson's trichrome staining on the 14th day, were higher in the db/m and Baf A1 groups than in the db/db group. In addition, the expression of the proinflammatory cytokine TNF-α in the db/m and Baf A1 groups increased significantly on day 6, and the expression of the anti-inflammatory cytokine IL-10 also increased significantly on day 9. However, there were no significant changes in the expression levels of TNF-α and IL-10 in the db/db group. Therefore, Baf A1 may accelerate diabetic chronic refractory wound healing by promoting cell proliferation, collagen production, and regulating the inflammatory balance.
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Krishnan B, Prasad GA, Saravanan R, Madhan B, Kadhiravan T. Do preoperative glycosylated hemoglobin (HbA1C) and random blood glucose levels predict wound healing complications following exodontia in type 2 diabetes mellitus patients?-a prospective observational study. Clin Oral Investig 2020; 25:179-185. [PMID: 32472252 DOI: 10.1007/s00784-020-03349-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/15/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Many dental surgeons consider a type 2 diabetic patient to be at higher risk for wound healing complications following exodontia. Random blood glucose (RBG) and glycosylated hemoglobin (HbA1C) values help the surgeon determine the glycemic control and assess if the patient can undergo the surgical procedure. OBJECTIVES The purpose of this study was to analyze if preoperative HbA1C and RBG testing could predict the risk of wound healing and infectious complications in type 2 DM patients undergoing exodontia in an office setting. METHODS This prospective observational study included 133 type 2 diabetic patients and age- and gender-matched non-diabetic patients undergoing exodontia. Preoperative HbA1C values and random blood glucose levels were obtained for patients in both groups. Wound healing and infectious complications and additional interventions performed were recorded. RESULTS Duration of diabetes ranged from 1 to 25 years. 80.5% of diabetics were treated with oral hypoglycemics. A vast majority of patients in both groups underwent extraction of only a single tooth. There was no significant difference in non-infectious complications between the two groups. The absolute risk of infectious complications in diabetics was 10.5% compared to a 6.8% risk among the control group. Age, RBG values, HbA1C, duration of DM, and number and nature of exodontia performed did not show any statistical significance. CONCLUSION This study observed a slight, but not statistically significant increase in the risk of infectious complications in type 2 DM patients undergoing exodontia. Surgical site infections were amenable to surgical drainage with or without oral antibiotics on an outpatient basis with favorable healing outcomes. CLINICAL RELEVANCE The RBG and HbA1C values were not significantly associated with risk of infectious complications. Resorting to prophylactic antibiotics and warning about possible adverse healing for routine exodontia in type 2 DM patients is unnecessary.
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Affiliation(s)
- B Krishnan
- Department of Dentistry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), 74, 4th Cross, Thanthai Periyar Nagar, Pondicherry, 605005, India.
| | - G Arun Prasad
- Department of Dentistry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), 74, 4th Cross, Thanthai Periyar Nagar, Pondicherry, 605005, India
| | - R Saravanan
- Department of Dentistry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), 74, 4th Cross, Thanthai Periyar Nagar, Pondicherry, 605005, India
| | - B Madhan
- Department of Dentistry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), 74, 4th Cross, Thanthai Periyar Nagar, Pondicherry, 605005, India
| | - T Kadhiravan
- Dept of Internal Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605005, India
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Taguchi A, Ikegami S, Tokida R, Kamimura M, Sakai N, Horiuchi H, Takahashi J, Kato H. Fragility fractures and delayed wound healing after tooth extraction in Japanese older adults. J Bone Miner Metab 2020; 38:357-362. [PMID: 31897747 DOI: 10.1007/s00774-019-01063-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/30/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Fragility fractures can cause delayed wound healing after tooth extraction, which contributes to an increased risk of osteomyelitis of the jaw. We evaluated whether a history of fragility fracture was associated with increased risk of delayed wound healing after tooth extraction in older adults in Japan. MATERIALS AND METHODS Of 5352 people aged 50-89 years in the 2014 basic resident registry of the town of Obuse, the present study included 376 subjects (190 men and 186 women) who completed a structured questionnaire and measurement of the bone mineral densities (BMDs) of the bilateral femoral neck. Delayed wound healing after tooth extraction was self-reported. Fragility fractures were confirmed via examination of hospital medical records. Logistic regression analyses adjusted for age and gender were used to evaluate association of clinical variables with delayed would healing after tooth extractions. Odds ratios (ORs) and the 95% confidence intervals (CIs) of all possible associated variables for the presence of delayed wound healing were calculated. RESULTS Subjects with a history of fragility fractures had a significantly higher risk of delayed wound healing compared with those without previous fragility fractures (OR 2.68; 95% CI 1.11-6.46, p = 0.028). This association still remained after adjusted for all other variables (OR 2.70; 95% CI 1.10-6.60, p = 0.030). Delayed wound healing was not significantly associated with the BMD of the femoral neck. CONCLUSIONS History of fragility fracture may be associated with increased risk of delayed wound healing after tooth extraction in Japanese men and women aged 50-89 years.
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Affiliation(s)
- Akira Taguchi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, 1780, Gobara, Hirooka, Shiojiri, Nagano, 399-0781, Japan.
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
- Rehabilitation Center, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Ryosuke Tokida
- Rehabilitation Center, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Mikio Kamimura
- Center for Osteoporosis and Spinal Disorders, Kamimura Orthopedic Clinic, 595-17, Kotobuki, Matsumoto, 399-0021, Japan
| | - Noriko Sakai
- Nagano Children's Hospital, 3100, Toyoshina, Azumino, Nagano, 399-8288, Japan
| | - Hiroshi Horiuchi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
- Rehabilitation Center, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Borgnakke WS. IDF Diabetes Atlas: Diabetes and oral health - A two-way relationship of clinical importance. Diabetes Res Clin Pract 2019; 157:107839. [PMID: 31520714 DOI: 10.1016/j.diabres.2019.107839] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/06/2019] [Indexed: 12/22/2022]
Abstract
The current scientific evidence for the bi-directional associations between oral health and diabetes is summarized. The universal biologic mechanisms and demographic and behavioral risk drivers underlying these associations in both directions are also described. Dysglycemia, even slightly elevated blood sugar levels, adversely affects oral health, manifesting itself in several oral diseases and conditions. In the opposite direction, any oral infection with its subsequent local and systemic inflammatory responses adversely affects blood glucose levels. Moreover, painful, mobile, or missing teeth may lead to intake of soft food items representing a sub-optimal diet and hence poor nutrition, and thereby contribute to incident type 2 diabetes or to poorer glucose control in existing diabetes. Treatment of inflammation related oral conditions, such as non-surgical periodontal treatment and extraction of infected teeth, can lead to a clinically significant decrease in blood glucose levels. Attention to infectious oral diseases and referral to dental care professionals for treatment can therefore be an important novel tool for medical care professionals in preventing and managing diabetes mellitus. Dental professionals can detect unrecognized potential dysglycemia and refer for medical examination. Such interprofessional, patient centered care may contribute to improved health, wellbeing, and quality of life in people with diabetes.
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Affiliation(s)
- Wenche S Borgnakke
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Avenue Rm# 3060, Ann Arbor, MI 48109-1078, USA.
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Zhang S, Song S, Wang S, Duan Y, Zhu W, Song Y. Type 2 diabetes affects postextraction socket healing and influences first‐stage implant surgery: A study based on clinical and animal evidence. Clin Implant Dent Relat Res 2019; 21:436-445. [PMID: 31025528 DOI: 10.1111/cid.12780] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Sijia Zhang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Implant DentistrySchool of Stomatology, The Fourth Military Medical University Xi'an China
- Department of Biochemistry and Molecular BiologyCenter for DNA Typing, Air Force Medical University, 169 Changle West Road, Xi'an, Shaanxi 710032 P.R. China
| | - Shuang Song
- Peking University, School of Stomatology Beijing China
| | - Shuyan Wang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Disease, School of StomatologyThe Fourth Military Medical University Xi'an China
| | - Yansheng Duan
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Implant DentistrySchool of Stomatology, The Fourth Military Medical University Xi'an China
| | - Wenzhong Zhu
- Department of Implant DentistryThe Second People's Hospital Xi'an China
| | - Yingliang Song
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Implant DentistrySchool of Stomatology, The Fourth Military Medical University Xi'an China
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Power DJ, Sambrook PJ, Goss AN. The healing of dental extraction sockets in insulin-dependent diabetic patients: a prospective controlled observational study. Aust Dent J 2019; 64:111-116. [PMID: 30525221 DOI: 10.1111/adj.12669] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to determine whether there was a difference in delayed healing following dental extractions for insulin-dependent diabetics as compared to non-diabetic patients. METHODS Prospective patients referred to the Adelaide Dental Hospital exodontia clinic for dental extractions were recruited into two groups: Known insulin-dependent diabetics and healthy non-diabetics. All had a random blood glucose level (BGL). Delayed healing cases were identified, and statistical evaluation was performed. RESULTS There were 56 insulin-dependent diabetic patients (BGL 10.03, range 4.9-26) and 49 non-diabetic, age- and sex-matched patients. Seven patients (12.5%) in the study group showed delayed healing following extraction, while only four patients (8.2%) in the control group suffered delayed healing. This difference was not statistically significant. Two of the study group developed postextraction infections, requiring incision, drainage and antibiotics. CONCLUSION The study shows that Type 1 and insulin-dependent Type 2 diabetic patients, if well controlled, tend to heal up well following dental extractions but with a small but not statistically different rate of postextraction complications including infection. This is contrary to what is usually taught. Clinicians should take great care with management of insulin-dependent diabetic patients, as compared to non-insulin dependent diabetics or non-diabetic patients.
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Affiliation(s)
- D J Power
- Oral and Maxillofacial Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - P J Sambrook
- Oral and Maxillofacial Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Dentistry, The University of Adelaide, Adelaide, South Australia, Australia
| | - A N Goss
- Oral and Maxillofacial Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Dentistry, The University of Adelaide, Adelaide, South Australia, Australia
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Melatonin protects endothelial progenitor cells against AGE-induced apoptosis via autophagy flux stimulation and promotes wound healing in diabetic mice. Exp Mol Med 2018; 50:1-15. [PMID: 30459300 PMCID: PMC6249246 DOI: 10.1038/s12276-018-0177-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 12/19/2022] Open
Abstract
Wound healing is delayed in diabetic patients. Increased apoptosis and endothelial progenitor cell (EPC) dysfunction are implicated in delayed diabetic wound healing. Melatonin, a major secretory product of the pineal gland, promotes diabetic wound healing; however, its mechanism of action remains unclear. Here, EPCs were isolated from the bone marrow of mice. Treatment of EPCs with melatonin alleviated advanced glycation end product (AGE)-induced apoptosis and cellular dysfunction. We further examined autophagy flux after melatonin treatment and found increased light chain 3 (LC3) and p62 protein levels in AGE-treated EPCs. However, lysosome-associated membrane protein 2 expression was decreased, indicating that autophagy flux was impaired in EPCs treated with AGEs. We then evaluated autophagy flux after melatonin treatment and found that melatonin increased the LC3 levels, but attenuated the accumulation of p62, suggesting a stimulatory effect of melatonin on autophagy flux. Blockage of autophagy flux by chloroquine partially abolished the protective effects of melatonin, indicating that autophagy flux is involved in the protective effects of melatonin. Furthermore, we found that the AMPK/mTOR signaling pathway is involved in autophagy flux stimulation by melatonin. An in vivo study also illustrated that melatonin treatment ameliorated impaired wound healing in a streptozotocin-induced diabetic wound healing model. Thus, our study shows that melatonin protects EPCs against apoptosis and dysfunction via autophagy flux stimulation and ameliorates impaired wound healing in vivo, providing insight into its mechanism of action in diabetic wound healing. Melatonin, a sleep-regulating hormone, may speed wound healing in patients with diabetes by protecting blood-borne wound-healing cells known as endothelial progenitor cells (EPCs). In diabetes, EPCs become damaged, lose their capacity to migrate to wounds and form new tissue, and die prematurely. Delayed healing can lead to ulcers, infection, and sometimes amputation. Melatonin has recently been reported to promote wound healing, but the mechanism remains unclear. Xiangyang Wang and Xiaolei Zhang at Wenzhou Medical University, China, and coworkers hypothesized that melatonin might protect EPCs from diabetes-induced damage. They found that melatonin improved EPCs’ ability to eliminate damaged components, allowing them to repair themselves and restoring their wound-healing function. In further experiments, diabetic mice treated with melatonin healed faster than untreated mice. These results may help improve treatments for complications of diabetes.
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Nazir MA, AlGhamdi L, AlKadi M, AlBeajan N, AlRashoudi L, AlHussan M. The burden of Diabetes, Its Oral Complications and Their Prevention and Management. Open Access Maced J Med Sci 2018; 6:1545-1553. [PMID: 30159091 PMCID: PMC6108795 DOI: 10.3889/oamjms.2018.294] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/27/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM), chronic disease, is a public health problem that affects 8.5% adult population worldwide. The number of adults with DM has risen sharply from 108 million in 1980 to 422 million in 2014. In 2012, 1.5 million individuals died because of DM and an additional 2.2 million deaths occurred because of high blood glucose level resulting in cardiovascular and other systemic diseases. DM brings huge economic loss to patients, their families, and healthcare systems. Globally, the cost of DM was US$1•31 trillion in 2015. AIM This review article utilised the prevalence data of diabetes mellitus from the World Health Organization and International Diabetes Federation to provide a comprehensive picture of the disease in different parts of the world. METHODS Electronic databases such as Google Scholar, Medline via PubMed, Scopus, and Web of Science were used to search the literature. The library resources of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia were used to retrieve studies on the topics of the present review. RESULTS Systemic complications of DM include heart attack, kidney disease, limb loss, blindness, and peripheral nerve damage. More than 90% of diabetic patients were found to have oral manifestations. It is known that DM severely damages oral tissues causing periodontal disease, tooth loss, xerostomia, caries, burning mouth disorder, taste and salivary gland dysfunction, delayed wound healing, lichen planus, geographic tongue, and candidiasis. The evidence is mounting about a strong bidirectional relationship between DM and periodontal disease. Unfortunately, many diabetic patients are unaware of the association between DM and oral health, and only a small percentage of them visit the dentist for routine dental check-ups. Changes in lifestyles (control of blood glucose levels and self-care practices), regular dental check-ups with emphasis on periodontal assessment, and reinforcement of oral health instructions can effectively prevent oral complications of DM. Scaling and root planning are effective in improving glycemic control among diabetic patients. CONCLUSION Dental professionals should be part of the multidisciplinary team that helps individuals with diabetes.
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Affiliation(s)
- Muhammad Ashraf Nazir
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Lamiah AlGhamdi
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mariam AlKadi
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Noura AlBeajan
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Latifah AlRashoudi
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mai AlHussan
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Lee UK, Chang TI, Polanco JC, Pisegna JR, Friedlander AH. Prevalence of Panoramically Imaged Carotid Atheromas in Alcoholic Patients With Chronic Pancreatitis and Comorbid Diabetes. J Oral Maxillofac Surg 2018; 76:1929.e1-1929.e7. [PMID: 29859950 DOI: 10.1016/j.joms.2018.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Men with alcohol-related chronic pancreatitis (ARCP) resulting in type 3c diabetes mellitus (DM) are at a uniquely elevated risk of adverse ischemic events given the role of inflammation in both the underlying disease processes and atherosclerosis. We hypothesized that their panoramic images would show a prevalence of calcified carotid artery atheromas (calcified carotid artery plaques [CCAPs]) significantly more often than a general population of similarly aged men. PATIENTS AND METHODS We implemented a retrospective observational study. The sample was composed of male patients older than 30 years having panoramic images. The predictor variable was a diagnosis of ARCP-DM, and the outcome variable was the prevalence rate of CCAPs. The prevalence of CCAPs among the patients with ARCP-DM was then compared with that of a historical general population composed of similarly aged men. Descriptive and bivariate statistics were computed, and the P value was set at .05. RESULTS Of the 32 men (mean age, 61.7 ± 11.2 years) with ARCP-DM, 8 (25%) (mean age, 63.3 ± 4.80 years) had atheromas (CCAPs). There was a statistically significant (P < .05) association between a diagnosis of ARCP-DM and the presence of an atheroma on the panoramic image in comparison with the 3% rate manifested by the historical general-population cohort. The presence or absence of classic atherogenic risk factors within the ARCP-DM cohort failed to distinguish between individuals with and individuals without atheroma formation on their panoramic images. CONCLUSIONS The results of this study suggest that CCAP, a risk indicator for future adverse cardiovascular events, is frequently seen on the panoramic images of male patients with ARCP-DM. Dentists treating male patients with the disorder must be uniquely vigilant for the presence of these lesions.
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Affiliation(s)
- Urie K Lee
- Oral and Maxillofacial Surgery VA Special Fellow, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Tina I Chang
- Director of Research Fellowship and Inpatient Oral and Maxillofacial Surgery, Veterans Affairs Greater Los Angeles Healthcare System, and Instructor of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, Los Angeles, CA
| | - John C Polanco
- Clinical Researcher, Hospital Regional Universitario Jose Maria Cabral y Baez, Santo Domingo, Dominican Republic
| | - Joseph R Pisegna
- Chief of Gastroenterology and Hepatology, Veterans Affairs Greater Los Angeles Healthcare System, and Professor in Residence Medicine-Gastroenterology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Arthur H Friedlander
- Associate Chief of Staff/Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System; Director, Quality Assurance Hospital Dental Service, Ronald Reagan UCLA Medical Center; and Professor-in-Residence of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, Los Angeles, CA.
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Affiliation(s)
- PJ Sambrook
- Oral & Maxillofacial Surgery Unit; Faculty of Health Sciences; The University of Adelaide; Adelaide South Australia Australia
| | - AN Goss
- Oral & Maxillofacial Surgery Unit; Faculty of Health Sciences; The University of Adelaide; Adelaide South Australia Australia
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Abstract
The number of hospitalized patients receiving treatment perceived to be futile is not insignificant. Blood products are valuable resources that are donated to help others in need. We aimed to quantify the amount of blood transfused into patients who were receiving treatment that the critical care physician treating them perceived to be futile. During a 3-month period, critical care physicians in 5 adult intensive care units completed a daily questionnaire to identify patients perceived as receiving futile treatment. Of 1136 critically ill patients, physicians assessed 123 patients (11%) as receiving futile treatment. Fifty-nine (48%) of the 123 patients received blood products after they were assessed to be receiving futile treatment: 242 units of packed red blood cells (PRBCs) (7.6% of all PRBC units transfused into critical care patients during the 3-month study period); 161 (9.9%) units of plasma, 137 (12.1%) units of platelets, and 21 (10.5%) units of cryoprecipitate. Explicit guidelines on the use of blood products should be developed to ensure that the use of this precious resource achieves meaningful goals.
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Affiliation(s)
- Thanh H Neville
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
| | - Alyssa Ziman
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Neil S Wenger
- University of California Health Ethics Center, Los Angeles, California, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- RAND Health, Santa Monica, California, USA
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Diabetes and hyperglycemia as risk factors for postoperative outcome in maxillofacial surgery. J Surg Res 2017; 217:170-176. [PMID: 28602222 DOI: 10.1016/j.jss.2017.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 02/05/2017] [Accepted: 05/03/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Aim of this study was to investigate the frequency of complications in maxillofacial surgery in-patients in correlation to diabetes mellitus or a pathologically altered glucose metabolism. MATERIALS AND METHODS All patients' electronic health records were analyzed retrospectively. Diabetes mellitus anamnesis, the treatment regime, blood glucose levels, and the duration of inpatient treatment were recorded. Glucose readings ≥200 mg/dL measured at any time and fasting glucose levels of ≥110 mg/dL were defined as hyperglycemic. Noted complications were infection, dehiscence, swelling, and necrosis. RESULTS 8.7% out of 1374 patients had a known diabetes diagnosis. 13.0% had high fasting glucose and 11.4% aberrant maximum glucose readings. Complications did not occur more often in patients with a previously known diabetes but more often in patients with high maximum blood glucose levels. Of these patients, only 56.3% were known diabetics. CONCLUSIONS Diabetes mellitus does not necessarily lead to higher frequency of complications in surgical patients. Moreover, patients with well-controlled diabetes seem to have a similar outcome compared to nondiabetics. Hyperglycemia however has an important impact on treatment outcome.
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Fernandes KS, Glick M, de Souza MS, Kokron CM, Gallottini M. Association between immunologic parameters, glycemic control, and postextraction complications in patients with type 2 diabetes. J Am Dent Assoc 2017; 146:592-599. [PMID: 26227644 DOI: 10.1016/j.adaj.2015.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of this study was to assess the association between metabolic control and immune dysfunction, and postoperative complications and wound healing after dental extractions in people with type 2 diabetes and control participants. METHODS The authors performed a prospective, case-control study enrolling 53 participants with type 2 diabetes and 29 participants who did not have type 2 diabetes. Exclusion criteria included being a smoker and having teeth with periodontal pockets deeper than 4 millimeters, among others. All participants underwent an extraction of 1 erupted tooth. The investigators assessed patients' signs and symptoms at 3, 7, 21, and 60 days after surgery. The investigators measured glycemic control and immunologic profile at the time of the extraction. They compared the pattern of healing and the incidence of postextraction complications between the 2 groups. RESULTS Even in the presence of impaired neutrophil function and poor glycemic control, we found no increase in the number of postoperative complications. There was no association between delayed wound epithelialization on postoperative day 21 and level of glycemic control, and reduced neutrophil function. On postoperative day 60, all alveolar sockets were epithelialized completely and showed no signs of infection. CONCLUSIONS The study results suggest that type 2 diabetes per se or glycemic control is not a risk factor for experiencing postoperative complications in people undergoing dental extractions. Although people with type 2 diabetes may have impaired neutrophil function, the study results revealed that having this condition was not associated with an increased risk of experiencing postoperative complications. Additional research studies with larger sample sizes of patients who have diabetes are needed to confirm this study's findings. PRACTICAL IMPLICATIONS The results allow clinicians to infer that people with type 2 diabetes undergoing dental extractions of erupted teeth that do not have an acute odontogenic infection should not receive antibiotic prophylaxis simply because of their diabetic status or level of glycemic control.
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Taguchi A, Kamimura M, Nakamura Y, Sugino N, Ichinose A, Maezumi H, Fukuzawa T, Ashizawa R, Takahara K, Gushiken S, Mukaiyama K, Ikegami S, Uchiyama S, Kato H. Delayed wound healing after tooth extraction and self-reported kyphosis in Japanese men and women. Sci Rep 2016; 6:36309. [PMID: 27848958 PMCID: PMC5111072 DOI: 10.1038/srep36309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/13/2016] [Indexed: 11/09/2022] Open
Abstract
It is unclear whether osteoporosis itself is a main risk factor for delayed wound healing after tooth extraction in humans. In this study, we evaluated the association between experience of delayed wound healing after last tooth extraction and self-reported kyphosis, with the possibility of having vertebral fractures, in Japanese patients. Among the 1,504 patients who responded to the structured questionnaire survey, 518 patients (134 men and 384 women) aged 55-97 years finally participated in this study. Patients who self-reported mild-moderate kyphosis were more likely to have problematic delayed wound healing after last tooth extraction than those who reported severe kyphosis (odds ratio [OR] 4.98; 95% confidence interval [CI], 1.86-13.38 and OR 2.30; 95% CI, 0.52-10.22, respectively) (p for trend = 0.005). Japanese patients with vertebral fractures may have a higher risk of having problematic delayed wound healing after tooth extraction.
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Affiliation(s)
- Akira Taguchi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano 399-0781, Japan
| | - Mikio Kamimura
- Center of Osteoporosis and Spinal Disorders, Kamimura Orthopedic Clinic, 595-17 Ippommatsu, Kotobukitoyooka, Matsumoto, Nagano 399-0021, Japan
| | - Yukio Nakamura
- Department of Orthopedic Surgery, Showa-Inan General Hospital, Akaho 3230, Komagane 399-4117, Japan
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 33-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Noriyuki Sugino
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano 399-0781, Japan
| | - Akira Ichinose
- Department of Orthopedic Surgery, Ichise Hospital, 4824 Nishitakano-cho, Shimosuwa, Suwa-gun, Nagano 393-0087, Japan
| | - Hisayoshi Maezumi
- Maezumi Orthopedic Clinic, 8263-1 Hodaka, Azumino, Nagano 399-8303, Japan
| | - Takashi Fukuzawa
- Department of Orthopedic Surgery, Shiojiri Hospital, 6-4-36 Daimon, Shiojiri, Nagano 399-0731, Japan
| | - Ryouhei Ashizawa
- Ashizawa Orthopedic Clinic, 12205-2 Nakaminowa, Minowacho, Kamiina-gun, Nagano 399-4601 Japan
| | - Kenji Takahara
- Takahara Clinic, 5586-2, Minami-Minowa, Kamiina-gun, Nagano, 399-4511 Japan
| | - Susumu Gushiken
- Department of Surgery, Matsumoto Kyoritsu Hospital, 9-26 Habaue, Matsumoto, Nagano 390-8505, Japan
| | - Keijiro Mukaiyama
- Department of Orthopedic Surgery, North Alps Medical Center Azumi Hospital, 3207-1 Oaza-Ikeda, Ikeda, Kitaazumi-gun, Nagano 399-8695, Japan
| | - Shota Ikegami
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 33-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Shigeharu Uchiyama
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 33-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Hiroyuki Kato
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 33-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Mayard-Pons ML, Rilliard F, Libersa JC, Musset AM, Farge P. Database analysis of a French type 2 diabetic population shows a specific age pattern of tooth extractions and correlates health care utilization. J Diabetes Complications 2015; 29:993-7. [PMID: 26463898 DOI: 10.1016/j.jdiacomp.2015.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 11/26/2022]
Abstract
AIMS To assess the relationship between type 2 diabetes and tooth loss and the predictive value of health behavior and routine dental care in regard to both dental and medical follow-ups. METHODS Cross-sectional study from a national database of a French population of railways transport workers was conducted with a descriptive analysis between registered diabetic patients and non-diabetic subjects. The relationship between oral health and diabetes was measured by tooth extraction prevalence in regard to the frequency of scaling-prophylaxis sessions and the number of medical and dental appointments. RESULTS The prevalence of tooth extractions in the type 2 diabetic population is 1.88 higher than the non-diabetic population. Diabetic patients tend to undergo dental extractions earlier and more often than non-diabetic individuals. They also have more medical appointments and less dental check-ups and scaling sessions than the non-diabetic population. CONCLUSION Measured by tooth loss, type 2 diabetic patients have a significantly earlier detrimental oral status when compared to the non-diabetic population. They exhibit a different pattern in health care utilization of outpatient medical resources. Oral health surveillance is not correctly addressed by the medical and dental coverage of these diabetic patients. Emphasis should be directed on specific dental care programs aimed at preventing tooth loss.
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Affiliation(s)
- M L Mayard-Pons
- Medical and Dental Department, CPRP SNCF, 18 rue de Budapest, 75009 Paris, France.
| | - F Rilliard
- Medical and Dental Department, CPRP SNCF, 18 rue de Budapest, 75009 Paris, France; Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, 75013 Paris, France
| | - J C Libersa
- Medical and Dental Department, CPRP SNCF, 18 rue de Budapest, 75009 Paris, France
| | - A M Musset
- Medical and Dental Department, CPRP SNCF, 18 rue de Budapest, 75009 Paris, France; Université de Strasbourg, Hôpitaux Universitaires de Strasbourg, Faculté de Chirurgie Dentaire, Department of Oral Health, 67000 Strasbourg, France
| | - P Farge
- Medical and Dental Department, CPRP SNCF, 18 rue de Budapest, 75009 Paris, France; Université Lyon 1, Faculté d'Odontologie, Hospices Civils de Lyon, 69008 Lyon, France
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Goss AN, Sambrook PJ. Diabetes, wound healing and complications: authors' reply. Aust Dent J 2014; 58:536-7. [PMID: 24320917 DOI: 10.1111/adj.12117_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Alastair N Goss
- Oral and Maxillofacial Surgery, The University of Adelaide, Emeritus Consultant Surgeon, The Royal Adelaide Hospital, Adelaide, South Australia
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Affiliation(s)
- Arun Chandu
- Oral and Maxillofacial Surgeon, Western Health, The Royal Dental Hospital of Melbourne, Melbourne, Victoria
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Hutcheson A, Cheng A, Kunchar R, Stein B, Sambrook P, Goss A. A C-terminal crosslinking telopeptide test-based protocol for patients on oral bisphosphonates requiring extraction: a prospective single-center controlled study. J Oral Maxillofac Surg 2014; 72:1456-62. [PMID: 24793621 DOI: 10.1016/j.joms.2014.02.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/21/2014] [Accepted: 02/23/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Patients undergoing extraction are at risk for bisphosphonate-related osteonecrosis of the jaws (BRONJ). A C-terminal crosslinking telopeptide (CTX) level lower than 150 pg/mL has been suggested as a predictor of BRONJ risk. The authors aimed to increase the precision of estimates of the risk of BRONJ in osteoporosis after extraction and to assess value of CTX testing at extraction time in cases of BRONJ in a large prospective cohort. PATIENTS AND METHODS All patients on oral bisphosphonates for osteoporosis referred for extractions over a period of 6.5 years were included in a standard protocol. Pre-extraction fasted CTX levels were obtained. All patients were followed until healing. If the CTX level was lower than 150 pg/mL, they were offered a drug holiday. If they declined, if the CTX level was above 150 pg/mL at baseline, or after the drug holiday, they had extractions performed under local anesthesia. Age-matched controls not on bisphosphonates were identified. RESULTS Nine hundred fifty patients had 2,461 extractions. One hundred eighty-one patients had a CTX level lower than 150 pg/mL. Four patients developed BRONJ; all had a CTX level lower than 150 pg/mL. All were on alendronate. The case-control comparison approached significance (<150 pg/mL; P = .073). Alendronate was associated with a low CTX level (P < .05). A CTX level lower than 150 pg/mL had a sensitivity of 100% and specificity of 81%. Bayesian analysis yielded a population expected risk of BRONJ of 0.29% (95% confidence interval, 0.12-0.52); the expected risk was 0.42% for a CTX level lower than 150 pg/mL and 0.13% for a CTX level higher than 150 pg/mL. CONCLUSION The risk of BRONJ for patients with osteoporosis on bisphosphonates having extractions is approximately 0.2%. A CTX level lower than 150 pg/mL is sensitive and is associated with an approximately 3-fold greater risk of BRONJ.
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Affiliation(s)
- April Hutcheson
- Honor Student, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew Cheng
- Consultant, formerly Registrar for Oral and Maxillofacial Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ranjit Kunchar
- Registrar for Oral and Maxillofacial Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - Brian Stein
- Medical Oncologist, Adelaide Cancer Centre, The University of Adelaide, Adelaide, South Australia, Australia
| | - Paul Sambrook
- Director, Oral and Maxillofacial Surgical Unit, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alastair Goss
- Professor and Emeritus Consultant, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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