tratamiento ortodoncico en pacientes con diabets mellitus Diabetes Mellitus

8/18/2019 tratamiento ortodoncico en pacientes con diabets mellitus Diabetes Mellitus

1/36

UNIVERSIDAD DE FAVAROLO

ATENEO ARGENTINO DE ODONTOLOGIA

CARRERA DE ESPECIALIDAD EN ORTODONCIA

TRATAMIENTO DE ORTODONCIA EN PACIENTE CON

DIABETES MELLITUS

MONOGRAFIA

AUTOR

Dra. Olga Rodríguez Carmoa

TUTOR

Dra. Claud!a L!"a

Bueo# A!re#$ Arge%!a

&'()

1


2/36

INDICE

(. INTRODUCCION&. *USTIFICACION+. OB*ETIVOS,. METODOLOGIA). DEFINICIONES - MARCO TEORICO. MANIFESTACIONES BUCODENTALES EN LOS PACIENTES DIABETICOS/. CONSIDERACIONES DEL TRATAMIENTO ORTODONTICO EN PACIENTES

DIABETICOS

(. INTRODUCCI0N

2


3/36

La d!a"e%e# mell!%u# e# u gru1o de e2ermedade# me%a"3l!4a# 4ara4%er!zada# 1or 5!1erglu4em!a

4r3!4a 6ue al%era el me%a"ol!#mo de lo# 5!dra%o#$ lí1!do# 7 1ro%eía# re#ul%ado del de2e4%o e la

#e4re4!3 de !#ul!a$ a44!3 de la !#ul!a$ o am"o# 8(9.

La Orga!za4!3 Mud!al de la Salud 8OMS9 1red!4e 6ue la 1re:ale4!a glo"al de la DMaume%ar; de (o &''/ 5a"ía &, m!lloe# de 1er#oa# 4o DM e el mudo 7 la e?1e4%a%!:a 1ara el

&'&) #ería de +


4/36

A4%ualme%e m;# de &'' !>o# e el mudo de#arrolla DM 4ada día$ 1aralelame%e al

aume%o de la !4!de4!a de la DM %!1o ( #e 5a 1rodu4!do u !4reme%o e la 1re:ale4!a de la

DM %!1o& a#o4!ado al e#%!lo de :!da #ede%ar!o 7 al 4o#umo de al!me%o# r!4o# e 4aloría#

8&'9$ e#%o 5a4e e:!de4!ar la e4e#!dad de 6ue lo# 1ro2e#!oale# de la #alud e4e#!%amo# e#%ar

1re1arado# 1ara la a%e4!3 de lo# 1a4!e%e# 4o DM$ 1or lo %a%o el or%odo4!#%a %!ee la

re#1o#a"!l!dad de 4a1a4!%ar#e 1ara "r!dar ua a%e4!3 ade4uada a la demada 4re4!e%e de

1a4!e%e# 4o DM.

+. OB*ETIVO

Geerar re4omeda4!oe# "a#ada# e la e:!de4!a$ 1ara 4o2e44!oar ua guía 4lí!4aor!e%ada a la 1la!2!4a4!3 del %ra%am!e%o or%od34!4o e 1a4!e%e# 4o DM$ a 2! de 1re:e!r

7 e:!%ar 4om1l!4a4!oe# e la a%e4!3 a e#%o# 1a4!e%e#.

,. METODOLOGIALa me%odología 6ue #e #!gu!3 1ara la real!za4!3 de e#%e do4ume%o$ 4o#!#%!3 e la re4o1!la4!3

7 #!#%ema%!za4!3 de !2orma4!3 de re2ere4!a# "!"l!ogr;2!4a#$ e re:!#%a# de 4ar;4%er

4!e%í2!4o e "!"l!o%e4a u!:er#!%ar!a 7 a %ra:# de !%ere%$ e #!%!o# 4omo PudMed 7

MEDLINE$ del %!1o re:!#!oe# #!#%em;%!4a#$ eleg!da# 1or #u ma7or 4al!dad de e:!de4!a. Se

4o#ul%aro %e?%o# guía 4omo re2ere%e# de "a#e# %e3r!4a#.

+. MARCO TEORICO

3. DEFINICION

4


5/36

La diabetes mellitus es un grupo de enfermedades metabólias

arateri!adas por "ipergluemia rónia #ue altera el metabolismo de los

"idratos$ l%pidos & prote%nas resultado del defeto en la sereión de

insulina$ aión de la insulina$ o ambos1.

El ontrol & la regulaión de la gluosa en el organismo dependen

sustanialmente de la interaión entre las "ormonas panre'tias gluagón

e insulina seretadas por las (lulas ) & *$ respeti+amente, sus aiones

son antagónias a ni+el del metabolismo energ(tio & son la+es para

mantener un e#uilibrio de oferta & demanda$ en espeial de la gluosa. El

gluagón aumenta sus ni+eles sangu%neos & la insulina los disminu&e al

a&udar a ingresar esta mol(ula al interior de las (lulas. La insulina tiene

omo te-idos efetores prinipales al msulo estriado$ el "%gado & el te-idograso$ e-eriendo aiones anaboli!antes de almaenamiento de gluosa en

forma de gluógeno o utili!aión de la misma en la fosforilaión o/idati+a. El

gluagón$ por el ontrario$ ata ati+ando prinipalmente la gluogenólisis

& la gluoneog(nesis en asoio on el ortisol$ una alteraión en la

produión de estas dos "ormonas puede generar diabetes mellitus.

La insulina es una "ormona polipept%dia #ue es seretada por las (lulas *

de los islotes panre'tios. Las (lulas * de los islotes panre'tiosfunionan omo un sensor energ(tio en general & de la gluemia en

partiular$ lo #ue les permite integrar simult'neamente se0ales de

nutrientes & moduladores. La llegada del alimento al tubo digesti+o & su

posterior absorión se aompa0a de numerosas se0ales #ue son aumento

de los ni+eles de gluosa & de otros metabolitos en plasma$ sereión de

algunas "ormonas gastrointestinales$ ati+aión de ner+ios parasimp'tios$

et. odas estas se0ales ontrolan la sereión de insulina.

El p'nreas endorino desempe0a un papel esenial en la regulaión del

metabolismo de "idratos$ l%pidos & prote%nas.


6/36

3. EIDE5IOLO678

La d!a"e%e# a2e4%a a !d!:!duo# de %oda# la# edade#$ 4o u 1!4o de !4!de4!a e la 6u!%a

d4ada de :!da. A1ro?!madame%e$ del ) al ('@ de %odo# lo# 1a4!e%e# d!a"%!4o# %!ee d!a"e%e#

%!1o ($ 4o u 1!4o de !4!de4!a e%re lo# (' 7 lo# (, a>o# de edad.

E Arge%!a$ #e e#%!maro &.,&.''' d!a"%!4o# e el a>o &'(( 7 #e 1re: 6ue e#%e mero :a a

du1l!4ar#e 1ara el a>o &'+'. E#%a %a#a de 4re4!m!e%o e# #!m!lar a la de EE.UU. 7 Caad; 7 mu7

#u1er!or a la de 1aí#e# euro1eo#. Seg la l%!ma E4ue#%a Na4!oal de Fa4%ore# de R!e#go del

M!!#%er!o de Salud$ de &'(($ el =$@ de la 1o"la4!3 arge%!a %!ee d!a"e%e#. Lo# e#%ud!o# de

1re:ale4!a 1ara Amr!4a La%!a 4o4lu7e 6ue la DM a2e4%a e%re el 7 el


7/36

3.2.2 DIABETES TIPO 2

Su e%!ología e# mul%!2a4%or!al$ 7a 6ue !4lu7e 2a4%ore# ge%!4o# 7 am"!e%ale#. Re#ul%a de la

4om"!a4!3 de u aume%o de la re#!#%e4!a a la !#ul!a e lo# %e!do# 1er!2r!4o# a#o4!ado al

!4reme%o del %e!do ad!1o#o :!#4eral 7 ua d!#2u4!3 1rogre#!:a de la# 4lula# 4o

4am"!o# 4ual! 7 4ua%!%a%!:o# de la #e4re4!3 de !#ul!a$ a#í 4omo de glu4ag3 1or 1ar%e de la#

4lula# . La DM %!1o & era 4o#!derada 5a#%a 5a4e 1o4o %!em1o ua e2ermedad 1ro1!a de la

edad adul%a. S! "!e e# 4!er%o 6ue 4o%!a #!edo m;# 1re:ale%e e gru1o# e%ar!o# adul%o#$

e?!#%e e:!de4!a de #u a1ar!4!3 4o ma7or 2re4ue4!a e la adole#4e4!a 7 u:e%ud$ e e#%re45a

a#o4!a4!3 4o el aume%o e la 1re:ale4!a de la o"e#!dad.

3.2.3 DIABETES GESTACIONAL

La d!a"e%e# ge#%a4!oal e# #!m!lar a la d!a"e%e# mell!%u# %!1o &$ 7a 6ue !m1l!4a la re#!#%e4!a a la

!#ul!a$ la# 5ormoa# del em"arazo 1uede 4au#ar re#!#%e4!a a la !#ul!a e muere#

ge%!4ame%e 1red!#1ue#%a# a de#arrollar e#%a 4od!4!3. La d!a"e%e# ge#%a4!oal #uele

de#a1are4er 4o el a4!m!e%o del "e"e.

3.2.4 OTROS TIPOS

Como lo# 4au#ado# 1or de2e4%o# ge%!4o# e la 2u4!3 de la# 4lula# "e%a$ de2e4%o# ge%!4o#

e la a44!3 de !#ul!a$ e2ermedad del 1;4rea# e?o4r!o 82!"ro#!# 6uí#%!4a9 o !du4!da 1or

#u#%a4!a# 6uím!4a# o med!4ame%o# 8%ra%am!e%o de HIV de#1u# de %ra#1la%e de 3rgao9.

3.3 DIAGNÓSTICO

Para el d!ago#%!4o de la d!a"e%e# mell!%u# #e 1uede u%!l!zar 4ual6u!era de lo# #!gu!e%e#

4r!%er!o# d!ago#%!4oJ

a. Sí%oma# de d!a"e%e# 81ol!ur!a$ 1ol!2ag!a$ 1ol!d!1#!a 7 1rd!da de 1e#o9 ma# ua

gl!4em!a e 4ual6u!er 5ora del día #! rela4!3 4o el %!em1o %ra#4urr!do de#de la

l%!ma 4om!da. med!da e 1la#ma :eo#o 6ue #ea !gual o ma7or a &''mgdl. ". Gl!4em!a e a7ua# 81er!odo #! !ge#%a 4al3r!4a de < 5ora#9 med!da e 1la#ma :eo#o

6ue #ea !gual o ma7or (& mgdl.4. Gl!4em!a med!da e 1la#ma 6ue #e !gual o ma7or a &''mgdl do# 5ora# de#1u# de ua

4arga de glu4o#a dura%e ua 1rue"a de %olera4!a oral a la glu4o#a 8PTOG9.

d. Hemoglo"!a A(C 8H"A(C9 #%a 5a #!do el !d!4ador m;# 2!el 1ara mo!%orear lo# 1a4!e%e# d!a"%!4o# 7 gra4!a# a la e#%adar!za4!3 al4azada e la 1rue"a e lo# l%!mo#


8/36

a>o#$ la Amer!4a D!a"e%e# A##o4!a%!o 8ADA9 la !4or1or3 re4!e%eme%e 4omo el

1r!mer 4r!%er!o de d!ag3#%!4o de d!a"e%e# e !d!:!duo# a#!%om;%!4o# o 4o #o#1e45a

4lí!4a de e#%a e2ermedad. La ADA 5a de2!!do %re# 1u%o# de 4or%e 1ara la H"A(4J K

)$@$ !:el o d!a"%!4o e%re )$/@ 7 $,@$ !:el 1red!a"%!4o 7$ $)@$ 4om1a%!"le

4o el d!ag3#%!4o de d!a"e%e#. Igualme%e$ la ADA ma%!ee 4omo la me%a e el

%ra%am!e%o del 1a4!e%e d!a"%!4o u !:el de H"A(4 K /@. Adem;# de la de2!!4!3 de

lo# 1u%o# de 4or%e$ e2a%!za e la e4e#!dad de 6ue la# 1rue"a# #e 5aga e u

la"ora%or!o 4lí!4o 6ue u%!l!4e !#%rume%o# 7 rea4%!:o# 4er%!2!4ado# 1or el NGSP

8Na%!oal Gl74o5emoglo"! S%adard!za%!o Program9 7 e#%adar!zado# de a4uerdo 4o

la# e#1e4!2!4a4!oe# del DCCT 8D!a"e%e# Co%rol ad Com1l!4a%!o# Tr!al9.

3.4 COMPLICACIONES DE LA DIABETES MELLITUS

Ide1ed!e%eme%e del %!1o de d!a"e%e# Mell!%u#$ u mal íd!4e de gl!4em!a 4odu4e a #u2r!r

e2ermedade# 4r3!4a# 7 aguda#.

3.4.1 COMPLICACIONES AGUDAS

+.,.(.( ESTADO HIPEROSMOLARES

Llamado de maera 4olo6u!al 4oma d!a"%!4o$ 4om1rede do# e%!dade# 4lí!4a# "!e de2!!da#J

la 4e%oa4!do#!# d!a"%!4a# 7 el 4oma 5!1ero#molar o 4e%o#!4o$ am"o# %!ee e 4om la

ele:a4!3 1a%ol3g!4a de la o#molar!dad #r!4a. E#%o e# re#ul%ado de !:ele# de glu4o#a #aguíeo

1or e4!ma de &)' mgdl$ llegado a reg!#%ra#e$ e 4a#o# e?%remo# m;# de (''' mgdl. La

ele:ada o#molar!dad #aguíea 1ro:o4a d!ure#!# o#m3%!4a 7 de#5!dra%a4!3$ la 4ual 1oe e

1el!gro la :!da del 1a4!e%e.

La 4e%oa4!do#!# #uele e:olu4!oar r;1!dame%e$ #e 1re#e%a e 1er#oa# 4o d!a"e%e# mell!%u#

%!1o ($ e 4am"!o el 4oma 5!1ero#mo%!4o e:olu4!oa e 4ue#%!3 de día#$ #e 1re#e%a e a4!ao#

4o d!a"e%e# mell!%u# %!1o &. T!ee e 4om #u gra:edad$ la 1re#e4!a de de#5!dra%a4!3

#e:era 7 al%era4!oe# ele4%rolí%!4a#$ el r!e#go de 4oma$ 4o:ul#!oe#$ !#u2!4!e4!a real aguda$

45o6ue 5!1o:ulm!4o$ 2alla org;!4a ml%!1le 7 muer%e. Lo# 2a4%ore# 6ue lo de#e4adea

#uele #er$ errore#$ om!#!oe# o au#e4!a de %ra%am!e%o$ !2e44!oe# agregada# 8ur!ar!a#$

ga#%ro!%e#%!ale#$ re#1!ra%or!a#9$ 4am"!o# e la al!me%a4!3 o e la a4%!:!dad 2í#!4a$ 4!rugía# o

%rauma%!#mo# e%re o%ro#.

+.,.(.& HIPOGLUCEMIA


9/36

D!#m!u4!3 del !:el de glu4o#a e #agre 1or de"ao de lo# )'mgdl. Puede #er 4o#e4ue4!a

de eer4!4!o 2í#!4o o 5a"!%ual o #o"re e#2uerzo$ #o"redo#!# de !#ul!a$ 4am"!o# e el lugar de

!7e44!3$ !ge#%a !#u2!4!e%e.

3.4.2 COMPLICACIONES CRÓNICAS

Puede #er m!4ro:a#4ulare# o ma4ro:a#4ulare#. La# le#!oe# m!4ro:a#4ulare# 4au#a le#!oe#

o4ulare#$ reale# 7 le#!oe# de lo# er:!o#. La# le#!oe# ma4ro:a#4ulare# #o la# e2ermedade#

4ard!o:a#4ulare#$ lo# a%a6ue# 4ard!a4o#$ lo# a44!de%e# 4ere"ro:a#4ulare# 7 la !#u2!4!e4!a

4!r4ula%or!a de m!em"ro# !2er!ore#.

+.,.&.( RETINOPATA DIABTICA

E# ua 4au#a 2re4ue%e de 4eguera 7 de d!#4a1a4!dad :!#ual. E#%a 4au#ada 1or el da>o de lo#

:a#o# #aguíeo# de la 4a1a 1o#%er!or del oo$ la re%!a$ lo 6ue o4a#!oa ua 1rd!da 1rogre#!:a

de la :!#%a. Comme%e lo# 1a4!e%e# ma!2!e#%a :!#!3 "orro#a. U "ue 4o%rol me%a"3l!4o

1uede re%ra#ar el !!4!o 7 la e:olu4!3 de la re%!o1a%ía d!a"%!4a. A#í m!#mo la de%e44!3

%em1raa 7 el %ra%am!e%o o1or%uo de la re%!o1a%ía 1uede 1re:e!r o re%ra#ar la 4eguera.

+.,.&.& NEFROPATA DIABTICA

Cau#ada 1or la le#!3 de lo# 1e6ue>o# :a#o# #aguíeo# de lo# r!>oe#$ 1uede 4au#ar

!#u2!4!e4!a real 7 llegar a la muer%e. E#%e da>o #e de%e4%a 1or al%a# 4o4e%ra4!oe# de

al"um!a e la or!a. E#%a e# ua 4au#a !m1or%a%e de d!;l!#!# 7 %ra#1la%e# reale#. Lo#

1a4!e%e# 1uede ma!2e#%ar 2a%!ga$ aem!a e !4lu#o de#e6u!l!"r!o# ele4%rolí%!4o# 1el!gro#o#.

+.,.&.+ NEUROPATAS

La d!a"e%e# 1uede le#!oar lo# er:!o# 1or d!#%!%o# me4a!#mo#$ 4omo el da>o d!re4%o 1or la

5!1erglu4em!a 7 la megua del 2luo #aguíeo 6ue llega a lo# er:!o# 4omo re#ul%ado del da>o

de lo# 1e6ue>o# :a#o#. La le#!3 e lo# er:!o# #e 1uede ma!2e#%ar 1or 1rd!da #e#or!al$

le#!oe# de lo# m!em"ro# e !m1o%e4!a #e?ual. La d!#m!u4!3 de la #e#!"!l!dad e lo# 1!e# 1uede !m1ed!r 6ue lo# d!a"%!4o# re4ooz4a a %!em1o lo# ra#gu>o# 7 4or%e# 6ue #e !2e4%a 7

agra:a$ #! e#%a# le#!oe# o #e %ra%a a %!em1o$ 1uede o"l!gar a e2e4%uar la am1u%a4!3.

+.,.&., ENFERMEDADES CARDIOVASCULARES

La 5!1erglu4em!a da>a lo# :a#o# #aguíeo# med!a%e el 1ro4e#o 4oo4!do 4omo a%ero#4lero#!#

o edure4!m!e%o u o"#%ru44!3 de la# ar%er!a#. E#%e e#%re45am!e%o de la# ar%er!a# 1uede redu4!r

el 2luo #aguíeo al mu#4ulo 4ard!a4o 8!2ar%o del m!o4ard!o9$ del e42alo 8a44!de%e

4ere"ro:a#4ulare#9.

G


10/36

+.,.&.) TRANSTORNOS OSEOS

La 5!1ergl!4em!a e la d!a"e%e# %!1o ( 4olle:a a u de#e6u!l!"r!o me%a"3l!4o 4o 1rd!da

!m1or%a%e de 4al4!o 7 mage#!o 1or la or!a$ u me%a"ol!#mo aormal de la :!%am!a D 6ue

aume%a el d2!4!% de 4al4!o$ 2a4%or !m1re#4!d!"le 1ara la 2orma4!3 de 5ue#o$ a lo 4ual #e #uma

u 1o"re e#%!mulo a la# 4lula# 4readora# de 5ue#o 1or la 2al%a de !#ul!a$ la 1rd!da 4r3!4a de

mage#!o 1or la or!a 7 u mal 2u4!oam!e%o de la# gl;dula# 1ara%!ro!de#$ !4!de e #u

4ou%o e la 2orma4!3 de 5ue#o# 4o ua ma#a 3#ea mu7 1o"re e 4a%!dad 7 4al!dad.

E la d!a"%!4o %!1o & la# al%era4!oe# 3#ea#$ :a a de1eder de la e:olu4!3 de la e2ermedad e

el %!em1o$ 4o r!e#go# 4om1ro"ado# de o#%eo1oro#!#$ o#%eomala4!a 7 e2ermedad ad!;m!4a de

lo# 5ue#o#$ 4o ua de#!dad m!eral 3#ea a1are%eme%e ormal o aume%ado 1ero 4o 2alla#

e #u e#%ru4%ura.

3.5 PERSPECTIVA GENERAL DEL TRATAMIENTO DE LA DIABETES MELLITUS

El %ra%am!e%o del 1a4!e%e 4o d!a"e%e# mell!%u# 4o#!#%e eJ edu4a4!3 #o"re 1au%a# de e#%!lo

de :!da #aluda"le#$ e:alua4!3 de la# 1o#!"le# 4om1l!4a4!oe# m!4ro 7 ma4ro :a#4ulare#$

ormal!za4!3 de glu4em!a$ redu44!3 de lo# 2a4%ore# de r!e#go 4ard!o:a#4ulare# 7 om!#!3 de

2;rma4o# 6ue 1uede agra:ar la# aomalía# del me%a"ol!#mo !#ul!!4o 7 l!1!d!4o. La d!a"e%e#

mell!%u# 1re#e%a e #u 5!#%or!a a%ural ua #er!e de %ra#2orma4!oe# e #u 2!#!o1a%ología$ 1or lo

6ue re#ul%a !m1re#4!d!"le 6ue ada1%ar el %ra%am!e%o a #u 4ur#o e:olu%!:o.

3.5.1 AÉREAS DE TRATAMIENTO

+.).(.( EDUCACION DIABETOLOGICA

Lo# 1a4!e%e# 4o d!a"e%e# mell!%u# de"e re4!"!r edu4a4!3$ a 1ar%!r del d!ago#%!4o de #u

e2ermedad 7 e#%e a1o7o edu4a4!oal$ de"e #er 1ar%e !%egral del 1rograma del %ra%am!e%o de #u

d!a"e%e# mell!%u#. La edu4a4!3 de"e !4lu!r a#1e4%o# 1#!4o#o4!ale#$ 1or6ue la 1er4e14!3 de

"!ee#%ar 1er#oal #e a#o4!a 2re4ue%eme%e a re#ul%ado# 1o#!%!:o# e el 4o%rol de la d!a"e%e#.

+.).(.& TERAPIA NUTRICIONAL - ACTIVIDAD FISICA

E# !m1or%a%e e el %ra%am!e%o de la d!a"e%e# 1au%ar re4omeda4!oe# d!e%%!4a# 7 a4%!:!dad

2í#!4a ade4uada 4o la !%e#!3 de 4om"a%!r el #o"re 1e#o ma%eer u e#%ado u%r!4!oal

ade4uado 4o%r!"u7e a meorar el 4ur#o de la# 4om1l!4a4!oe# me%a"3l!4a# e !%errum1!r la

1rogre#!3 de la 5!#%or!a a%ural de la d!a"e%e#. E#%a# re4omeda4!oe# de"e #er 1er#oal!zada#

7 ada1%ar#e a la# 1o#!"!l!dade# e4o3m!4a#$ 1re2ere4!a# 4ul%urale#$ gu#%o# 7 %ra%am!e%o md!4o

del 1a4!e%e d!a"%!4o.

1H


11/36


12/36

re#1ue#%a al %ra%am!e%o. Por lo %a%o$ la 1rd!da de%al e# m;# 1re4oz. La# "a4%er!a#

1er!odo%ale# 1uede 1a#ar a la 4!r4ula4!3 #aguíea e !2lu!r a !:el #!#%m!4o$ a2e4%ado a

d!2ere%e# 3rgao# 7 #!#%ema#. Por ello$ adem;# de :alorar a la d!a"e%e# 4omo u 2a4%or de r!e#go

1ara la a1ar!4!3 de 1er!odo%!%!#$ 5o7 e día la e:!de4!a 4!e%í2!4a d!#1o!"le %am"! 1la%ea

la rela4!3 !:er#a$ e# de4!r$ 6ue la 1er!odo%!%!# #ea u 2a4%or de r!e#go e la d!a"e%e#. A #u :ez$

la ele:ada 1rodu44!3 de med!adore# de la !2lama4!3$ u%o 4o el 1ro4e#o !2e44!o#o$

2a:ore4e ua ma7or re#!#%e4!a 1er!2r!4a a la !#ul!a 7 u !e2!4!e%e 4o%rol de la glu4em!a.

De 5e45o$ lo# 1a4!e%e# 4o 1er!odo%!%!# #uele #er lo# 6ue %!ee 1eor 4o%rol me%a"3l!4o.

Fudame%alme%e$ #e 5a demo#%rado 6ue la #e:er!dad 7 la 1rogre#!3 de la 1er!odo%!%!#

!2lu7e e el grado de 4o%rol me%a"3l!4o de la d!a"e%e#$ %a%o 6ue 4o u %ra%am!e%o

1er!odo%al ade4uado$ #e 1uede 1rodu4!r ua "aa e lo# !:ele# de glu4o#a #r!4a e e#%o#

1a4!e%e#. E de2!!%!:a$ el e#%ado de 5!1erglu4em!a ma%e!da 1o%e4!a la# 4om1l!4a4!oe# de la

d!a"e%e#$ e%re ella# la 1er!odo%!%!#. E#%a$ a #u :ez$ 4!erra u 4ír4ulo :!4!o#o 1or lo# me4a!#mo#

de#4r!%o# a%er!orme%e$ 1ro:o4ado u aume%o e la re#!#%e4!a 1er!2r!4a a la !#ul!a 7 u

de2!4!e%e 4o%rol me%a"3l!4o del 1a4!e%e. E 2u4!3 de e#%o$ #ería re4omeda"le 6ue el

4o%rol de la e2ermedad 1er!odo%al 2ormara 1ar%e del 1la de %ra%am!e%o e lo# 1a4!e%e#

d!a"%!4o# 7 6ue #u# re:!#!oe# 1er!3d!4a# !4lu7era ua :alora4!3 "u4ode%al.

3.6.2 CARIES/ÍNDICE CAOD

Alguo# au%ore# o 5a e4o%rado d!2ere4!a #!g!2!4a%!:a e la 1re:ale4!a de 4ar!e# ! e el

íd!4e CAOD al 4om1ararlo# 4o la 1o"la4!3 #aa$ #! "!e e#%e l%!mo e# l!gerame%e m;# al%o7 1re#e%a u ma7or mero de au#e4!a# e lo# 1a4!e%e# d!a"%!4o#. E lo# !>o# d!a"%!4o#$ la

#!%ua4!3 e# d!#%!%a 7 #uele %eer u meor mero de 4ar!e# 6ue lo# !>o# #ao# de la m!#ma

edad. Lo# e#%ud!o# demue#%ra re#ul%ado# 4o%rar!o#J uo# re2!ere meor íd!4e de 4ar!e#$

a%r!"u!"le a la e?4lu#!3 de az4ar de la d!e%a$ m!e%ra# o%ro#$ e4o%raro u íd!4e ma7or de

Car!e# De%al$ rela4!oado 4o el grado de 4o%rol me%a"3l!4o

3.6.3. HIPOSIALIA

A2e4%a a u %er4!o de lo# 1a4!e%e# d!a"%!4o#$ 6ue ma!2!e#%a #e6uedad oral. Su 1a%oge!a e#4o%ro:er%!daJ #e a%r!"u7e a la de#5!dra%a4!3 der!:ada de la 5!1erglu4em!a 7 al !4reme%o de la

d!ure#!# 8a ma7or de#4om1e#a4!3 me%a"3l!4a$ meor 2luo #al!:al9. E%re la le#!3 de %e!do#

"lado# de la 4a:!dad "u4al #e e4ue%ra la# !2e44!oe# 1or 5ogo# 84ad!d!a#!#9$ la# l4era# 7

lo# 4am"!o# e la legua 82!#ura# l!guale#$ legua #a"urral$ al%era4!oe# del #e%!do del gu#%o$

legua ard!e%e$ de1a1!la4!3 l!gual$ #e#a4!3 de ardor9. El de#arrollo de e#%a# a2e44!oe# #e

de"e a la 5!1o#!al!a 7 la al%era4!3 de re#1ue#%a !mue e !2lama%or!a.

12


13/36

3.6.4. HIPERTROFIA PAROTÍDEA BILATERAL

Se 1re#e%a e 2orma !dolora 7 #e e?%!ede e o4a#!oe# a la# gl;dula# #u"ma?!lare#. Su

or!ge #e a%r!"u7e a la euro1a%ía 1er!2r!4a del #!#%ema er:!o#o :ege%a%!:o 6ue !er:a la

gl;dula. E#%a 1a%ología %am"! 2a:ore4e la !4!de4!a de l!6ue 1lao. Se 5a e4o%rado e u

am1l!o rago de :alore# e #u de%e44!3 e lo# 1a4!e%e# d!a"%!4o#.

3. CON9IDEJ8CIONE9 ODONOL:6IC89 EN EL 58NEKO DEL 8CIENE

DI8;ICO

Lo# odo%3logo# 1uede redu4!r la mor"!l!dad 7 la mor%al!dad a#o4!ada a la DM med!a%e el

ma%e!m!e%o de la #alud oral de #u# 1a4!e%e# 7 1or der!:a4!3 md!4a de 1a4!e%e# 4o #!go#

7 #í%oma# de la# 4om1l!4a4!oe# orale# #uge#%!:a# de la DM 1ara ua e:alua4!3 ad!4!oal.

E la 4o#ul%a odo%ol3g!4a #e 1uede 1re#e%ar 1a4!e%e# 6ue de#4oo4e #u 1a%ología. El

odo%3logo de"e real!zar la 5!#%or!a 4lí!4a 4o ua 4orre4%a aame#!# 7 ua e?5au#%!:a

e?1lora4!3 4lí!4a de la 4a:!dad "u4al$ e:aluado la 1o#!"!l!dad de 6ue #u 1a4!e%e 1adez4a

DM. Por el re4oo4!m!e%o %em1rao de lo# #!go# 7 #í%oma# de la e2ermedad$ el odo%3logo

1uede #er el 1r!mero e de%e4%ar a u 1a4!e%e d!a"%!4o o d!ago#%!4ado.

A#!m!#mo$ el odo%3logo uega u 1a1el !m1or%a%e 4omo m!em"ro del e6u!1o de #alud 1ara

a7udar a lo# 1a4!e%e# d!ago#%!4ado# a ma%eer el 4o%rol de la glu4em!a med!a%e el

%ra%am!e%o 4orre4%o de la# !2e44!oe# orale# 7 la !#%ru44!3 de med!da# de 5!g!ee oral. Para

m!!m!zar el r!e#go de emerge4!a# e el 4o#ul%or!o odo%ol3g!4o e 1a4!e%e# 4o DM$ el

odo%3logo e4e#!%a %eer 1re#e%e u mero de 4o#!dera4!oe# a%e# de !!4!ar el %ra%am!e%o

de%al.

3..1 HISTORIA CLÍNICA

La 5!#%or!a 4lí!4a de 4ual6u!er 1a4!e%e a%e la 4o#ul%a odo%ol3g!4a de"e 4o%em1lar alguo#

a#1e4%o# 6ue #o 4a1a4e# de aler%ar #o"re la 1o#!"!l!dad de e#%ar a%e u 1a4!e%e d!a"%!4o.

El odo%3logo de"e real!zar el de#1!#%ae de 1a4!e%e# 6ue de#4oo4e %eer la 1a%ología

med!a%e la a%e4!3 4o#%a%e a la #em!ología de la e2ermedad 7 #u# #í%oma# 4ard!ale#J

1ol!d!1#!a$ 1ol!2ag!a$ 1ol!ur!a$ 1rd!da de 1e#o 7 de"!l!dad geeral. El odo%3logo de"e 1re#%ar

a%e4!3 de 1a4!e%e# de m;# de ,' a>o# 4o a%e4ede%e# 2am!l!are# de d!a"e%e#$ 1are#%e#!a$

!2e44!oe# 4u%;ea#$ :!#!3 "orro#a$ !rr!%a"!l!dad o muere# 6ue 5a7a dado a luz !>o#

1rema%uro# o 4o 1e#o ele:ado.

La aame#!# rela4!oada 4o la 4a:!dad oral de"e !4lu!r 1regu%a# rela4!oada# a la d!2!4ul%ad

e la 4!4a%r!za4!3$ la 1re#e4!a de ?ero#%omía$ el #agrado 7 la 5!1er1la#!a g!g!:al$ la 5al!%o#!#$

13


14/36

la 1re#e4!a de mal #a"or e la "o4a$ 7 a la #e#a4!3 de 6uemaz3 e la legua u o%ro# #!%!o# de

la mu4o#a oral. Lo# #!go# 7 #í%oma# 6ue #e 1re#e%a e la 4a:!dad oral de 1a4!e%e# !>o#$

3:ee# o adul%o#$ #o !d!4!o de la 1rd!da e?4e#!:a de 2lu!do# 1or la 1ol!ur!a$ la al%era4!3 de

la re#1ue#%a !mue a la# !2e44!oe# 7 la 4!4a%r!za4!3$ lo# 4am"!o# :a#4ulare# 7 el !4reme%o

de la glu4o#a e #al!:a.

S! el odo%3logo de%e4%a alguo# de e#%o# #í%oma#$ de"e rem!%!r al 1a4!e%e a la !%er4o#ul%a

md!4a 1ara 4o2!rmar el d!ag3#%!4o 4o lo# e?;mee# de la"ora%or!o. De#1u# de e#%a"le4er el

d!ag3#%!4o 7 e#%a"!l!zar al 1a4!e%e$ #e de"e real!zar ua 4o%rarem!#!3 a odo%ología.

Cuado el odo%3logo a%!ede a u 1a4!e%e 4o d!ag3#%!4o de DM$ de"e real!zar la aame#!#

6ue le 1erm!%a e#%a"le4er el grado de 4o%rol 7 1rogre#o de la e2ermedad. La aame#!# de"e

e#%a"le4er %!1o de d!a"e%e#$ 2e45a de #u 4o%rol 4o e?ame de la"ora%or!o$ 4om1re#!3

4om1le%a de #u %ra%am!e%o md!4o 8!4lu7edo med!4ame%o#$ do#!# 7 mome%o del día e 6ue

#e adm!!#%ra$ e%4.9. E el 4a#o de la# 4om1l!4a4!oe# #!#%m!4a# de la DM 81or eem1lo$ la

5!1er%e#!3$ la e2ermedad 4ard!o:a#4ular$ la re%!o1a%ía$ la !#u2!4!e4!a real9 el odo%3logo

de"e 4o#ul%ar 4o el md!4o del 1a4!e%e 1ara d!#4u%!r la# mod!2!4a4!oe# e el 1la de

%ra%am!e%o de%al$ #o"re %odo 4uado #e 1re: 1ro4ed!m!e%o# 6u!rrg!4o#.

El odo%3logo de"e real!zar u e?ame 4lí!4o m!u4!o#o de la 4a:!dad oral del 1a4!e%e 1ara

e#%a"le4er 7 4orro"orar el e#%ado de #alud oral 4o e:!de4!a rad!ogr;2!4a.

3..2 CONSIDERACIONES FARMACOLÓGICAS A TENER EN CUENTA PARA EL

TRATAMIENTO ODONTOLÓGICO DE PACIENTES DIABÉTICOS

Co "a#e e la 5!#%or!a 4lí!4a$ el odo%3logo de"e re4oo4er lo# med!4ame%o# a%!d!a"%!4o#

6ue e#%; %omado el 1a4!e%e$ 4o #u# re#1e4%!:a# do#!# 7 %!em1o de adm!!#%ra4!3$ lo 4ual le

1erm!%e re:!#ar la# 1o#!"le# !%era44!oe# med!4ame%o#a#.

E#%e %!1o de 1a4!e%e e#%ar; #ome%!do a d!#%!%o# %!1o# de 2;rma4o# %a%o 1ara la aalge#!a oae#%e#!a.

Lo# 1a4!e%e# 6ue :a7a a #ome%er#e a 1ro4ed!m!e%o# 6u!rrg!4o# 1uede re6uer!r au#%e de la#

do#!# de !#ul!a o del rg!me de la# droga# a%!d!a"%!4a# orale#. Para ello$ el odo%3logo de"e

4o#ul%ar 4o #u md!4o %ra%a%e.

Se re4om!eda u%!l!zar ae#%#!4o# #! :a#o4o#%r!4%or e %odo# lo# 1a4!e%e# d!a"%!4o#$ de"!do

a 6ue 1uede 1re#e%ar e2ermedad 4ard!o:a#4ular 4o4om!%a%e.

14


15/36

+./.&.( INTERACIONES MEDICAMENTOSAS

La e1!e2r!a a%ago!za la a44!3 de la !#ul!a 7 e grade# do#!# 1uede 4au#ar 5!1erglu4em!a.

O%ro# med!4ame%o#$ 4omo 4or%!4o!de#$ %!az!da#$ a%!4o4e1%!:o# orale#$ 2e!%o!a#$ 1rodu4%o#

%!ro!deo# 7 droga# 6ue "lo6uea lo# 4aale# de 4al4!o %!ee e2e4%o# 5!1erglu4em!a%e#.

Lo# #al!4!la%o#$ el d!4umarol$ lo# "lo6ueadore# "e%aadrerg!4o#$ lo# !5!"!dore# de la

mooam!oo?!da#a 8MAO9$ la# #ul2oam!da#$ lo# "ar"!%r!4o#$ la 2e!"u%azoa 7 el

a4e%am!o2 1o%e4!a la a44!3 5!1oglu4em!a%e de la# #ul2o!lurea#.

3..3

HORARIO DE CONSULTA

E geeral$ la# 4!%a# e la ma>aa #o re4omeda"le#$ 7a 6ue lo# !:ele# ed3geo# de 4or%!#ol

#o geeralme%e m;# al%o# e e#e 5orar!o 8el 4or%!#ol aume%a lo# !:ele# de az4ar e #agre9.

E el 4a#o de 6ue el 1a4!e%e #ea !#ul!ode1ed!e%e$ de"emo# %eer e 4ue%a el %!1o de

!#ul!a 1re#4r!%a 7 la 2re4ue4!a de #u a1l!4a4!3 8e# e4e#ar!o leer la# e#1e4!2!4a4!oe# del

la"ora%or!o o 2a"r!4a%e$ 7 e 4a#o de duda$ #ol!4!%ar u !2orme al md!4o %ra%a%e9$ 7a 6ue

e?!#%e 1!4o# de al%a a4%!:!dad !#ulí!4a dura%e lo# 4uale# e# 1re2er!"le o e2e4%uar !g

%ra%am!e%o odo%ol3g!4o e# de4!r$ la# 4!%a# de"ería #er e u 5orar!o 6ue o 4o!4!da 4o lo#

1

CLASE DE DROGANOMBRES GENÉRICOS

DE LAS DROGASMECANISMO DE ACCIÓN

Sul2o!lurea#

Clor1ro1am!da

Gl!1!z!de

Gl7"ur!de

Gl!me1!r!de

E#%!mula la #e4re4!3 de !#ul!a

Megl!%!!de# Re1agl!!de E#%!mula la #e4re4!3 de !#ul!a

B!gua!de# Me%2orm! D!#m!u7e la glu4oge3l!#!# 7 1rodu44!3 de glu4o#a 5e1;%!4a

I5!"!dore# de la Al2aGlu4o#!da#aA4ar"o#e

M!gl!%ol

D!#m!u7e la a"#or4!3

ga#%ro!%e#%!al de 4ar"o5!dra%o#

T5!azol!d!ad!oe#Ro#!gl!%azoe

P!ogl!%azoe

Aume%a la #e#!"!l!dad de lo# %e!do#

a la !#ul!a


16/36

1!4o# de la a4%!:!dad !#ulí!4a$ 7a 6ue e#e e# el 1eríodo de m;?!mo r!e#go de de#arrollo de u

e1!#od!o de 5!1oglu4em!a.

La !#ul!a m;# 2re4ue%eme%e u%!l!zada e# la de a44!3 !%ermed!a$ 6ue #e 5a4e a4%!:a

a1ro?!madame%e & 5ora# de#1u# de la !7e44!3 7 al4aza el 1!4o de a4%!:!dad m;?!ma e%re <7 (& 5ora# de#1u#. Se adm!!#%ra e ua !4a do#!# 1or la ma>aa. Por lo %a%o$ e e#%o#

1a4!e%e# e# a4o#ea"le 6ue lo# %ra%am!e%o# #ea ma%!ale#$ 7a 6ue 1or la %arde el !:el de

glu4o#a e #agre e# "ao 7 la a4%!:!dad de la !#ul!a$ al%a$ 1or lo 6ue el r!e#go de 1re#e%ar

rea44!oe# 5!1oglu4m!4a# e# m;# al%o.

PREPARACIONES DE INSULINA

TIPO DEPREPARACIÓN

INICIO DE LAACTIVIDAD

PICO DEACTIVIDAD

DURACIÓNEFECTIVA

A44!3 r;1!da Q () m!u%o# ,)=' m!u%o# +, 5ora#

A44!3 4or%a +' m!u%o# &) 5ora# )< 5ora#

A44!3 !%ermed!a (+ 5ora# (& 5ora# (&&, 5ora#

Larga a44!3 , 5ora#


17/36

8%omado# a 4ual6u!er 5ora del día9 1or e4!ma de &'' mgdl 8(($( mmoll9 7 e a7ua# 1or

e4!ma de (& mgdl 8/$' mmoll9.

+./.). COMPLICACION DURANTE EL TRATAMIENTO ODNTOLOGICO.

La 4om1l!4a4!3 m;# 4om 6ue 1uede o4urr!r dura%e el %ra%am!e%o odo%ol3g!4o a lo#

1a4!e%e# 4o d!a"e%e# mell!%u# e# u e1!#od!o de 5!1ogl!4em!a. S! lo# !:ele# de !#ul!a o de

med!4ame%o# a%!d!a"%!4o# e?4ede lo# !:ele# 2!#!ol3g!4o# e4e#ar!o#$ lo# 1a4!e%e# 1uede

e?1er!me%ar u #e:ero de4l!:e e #u# !:ele# de glu4o#a e #agre. El r!e#go m;?!mo de

de#arrollar 5!1ogl!4em!a geeralme%e o4urre dura%e el 1!4o de a4%!:!dad !#ul!!4a. Lo#

e#%ado# de 5!1ogl!4em!a le:e# #e 4ara4%er!za 1or !rr!%a"!l!dad$ %em"lor$ #udora4!3 2ría 7

1ro2u#a$ !%e#a$ %a6u!4ard!a 7 4o2u#!3 me%al. E#%o# #í%oma#$ e 1ar%e$ #e de"e a la

#e4re4!3 de adreal!a$ u med!ador de la re#1ue#%a 4o%rarreguladora a la 4aída de la glu4o#a.

El 4oma 5!1ogl!4m!4o gra:e 4om!eza 4o la# ma!2e#%a4!oe# a%e# de#4r!%a# 7 r;1!dame%e

#e !#%ala la# 4o:ul#!oe#$ e#%u1or$ 4oma o #!go# eurol3g!4o# 2o4ale#.

U 4uadro de 5!1ogl!4em!a gra:e 1rodu4e la muer%e$ e m!u%o# u 5ora#. El d!ag3#%!4o$

au6ue 1uede %eer 4om1ro"a4!3 de la"ora%or!o$ e# em!e%eme%e 4lí!4o$ 1ue# #! #e e#1era el

4om1leme%ar!o 1ara de4!d!r #u a4%ua4!3$ de #eguro #ería %arde 1ara re4u1erar la :!da de #u 1a4!e%e. El %ra%am!e%o de1eder; del e#%ado de 4o4!e4!a del 1a4!e%e 7 la e:olu4!3 4lí!4a

1re:!#%a.

S! el 1a4!e%e %!ee u e#%ado de 5!1ogl!4em!a le:e 7 el e#%ado de 4o4!e4!a #e lo 1erm!%e$

de"er; !%errum1!r el %ra%am!e%o de%al e !med!a%ame%e adm!!#%rar () gr. de 4ar"o5!dra%o#

de a44!3 r;1!da 1or :ía oral$ 4ada () m!u%o#$ 5a#%a llegar a lo# !:ele# ormale# de az4ar e

#agre.

A!"#$%&' ( $)*+&,-(' &

%0*$ $##*, C$,-*$ $ -(+$%

Glu4o#a 8gel o %a"le%a#9

U 1a6ue%e de & o + %a"le%a#

8#!gu!edo la# !#%ru44!oe# del

1a6ue%e9.

*ugo de araa o mazaa (


18/36

Caramelo# duro# <

Le45e de#4remada ( Va#o

E# !m1or%a%e #e>alar 6ue #! el 1a4!e%e %oma !5!"!dore# Glu4o#!da#a$ e#%o# !m1!de la

5!dr3l!#!# de lo# azu4are# de 2ru4%o#a e glu4o#a$ 4o lo 4ual e e#%o# 1a4!e%e# la 5!1ogl!4em!a

de"ería %ra%ar#e 4o ua 2ue%e d!re4%a de glu4o#a 7 o 2ru4%o#a o #u4ro#a.

S! el 1a4!e%e e# !4a1az de %ragar 1or6ue 1or eem1lo 5a 1erd!do la 4o4!e4!a$ e%o4e# el

odo%3logo de"er; #ol!4!%ar a#!#%e4!a md!4a 1or6ue de"ería adm!!#%r;r#ele al 1a4!e%e &) a +'

ml de ua #olu4!3 de de?%ro#a al )'@ o "!e ( mg de glu4ag3 1or :ía !%ra:eo#a. Au6ue el

glu4ag3 %am"! 1uede #er adm!!#%rado 1or :ía #u"4u%;ea o !%ramu#4ular.

La 5!1ergl!4em!a #e:era a#o4!ada 4o d!a"e%e# mell!%u# %!1o ( 84e%oa4!do#!#9$ o d!a"e%e# mell!%u#

%!1o & 8e#%ado 5!1ero#molar o 4e%3%!4o9$ u#ualme%e %!ee u !!4!o 1rologado. Por lo %a%o$ el

r!e#go de ua 4r!#!# de 5!1ergl!4em!a e# mu45o m;# "ao 6ue el de ua 4r!#!# de 5!1ogl!4em!a e

el mar4o de ua 4o#ul%a odo%ol3g!4a. La# ma!2e#%a4!oe# del e#%ado de 5!1ergl!4em!a #o

2udame%alme%e male#%ar geeral$ dolor a"dom!al$ ;u#ea#$ :3m!%o#$ %a6u!1ea e !4lu#o

1uede llegar al 4oma$ de o %ra%ar#e ade4uadame%e. De2!!%!:ame%e el maeo de ua

5!1ergl!4em!a re6u!ere !%er:e4!3 md!4a 7 adm!!#%ra4!3 de !#ul!a. S! em"argo$ "a#ado##olame%e e lo# #í%oma#$ 1uede #er d!2!4ul%o#o d!2ere4!ar e%re 5!1ogl!4em!a e 5!1ergl!4em!a.

Por lo %a%o el Odo%3logo de"ería adm!!#%rar ua 2ue%e de 4ar"o5!dra%o 1ara u 1a4!e%e a

6u!e #e le 5a real!zado u d!ag3#%!4o 1re#u%!:o. A #! el 1a4!e%e e#%; e?1er!me%ado u

e1!#od!o de 5!1ergl!4em!a$ la 1o4a 4a%!dad de az4ar ad!4!oal e# !m1ro"a"le 6ue 4au#e da>o

#!g!2!4a%!:o. El 4lí!4o de"ería med!r lo# !:ele# de glu4o#a !med!a%ame%e de#1u# del

%ra%am!e%o. E#%o# 1a4!e%e# de"e #er %ra#ladado# de urge4!a a u 4uer1o de guard!a de u

4e%ro md!4o u 5o#1!%al m;# 4er4ao.

+./. COMPLICACIONES DESPUS DEL TRATAMIENTO ODONTOLOGICO

Tra# el %ra%am!e%o de%al$ de"emo# %eer e 4ue%a algua# 4o#!dera4!oe# 1o#%o1era%or!a#

4omo 6ue$ lo# 1a4!e%e# d!a"%!4o# 4o u 1o"re 4o%rol me%a"3l!4o %!ee u ma7or r!e#go de

de#arrollar !2e44!oe# 7 1uede %eer ua 4!4a%r!za4!3 le%a de la# 5er!da#. A #u :ez$ ua

!2e44!3 aguda 1uede aume%ar la re#!#%e4!a a la !#ul!a 7 a2e4%ar ega%!:ame%e el 4o%rol de

la gl!4em!a 6ue a #u :ez 1uede al%erar la 4a1a4!dad de 4!4a%r!za4!3$ e#%a"le4!do#e a#í u4ír4ulo :!4!o#o. Por %a%o$ ua 4o"er%ura a%!"!3%!4a 1uede #er e4e#ar!a e lo# 1a4!e%e# 4o

1


19/36

grade# !2e44!oe# orale# o e a6uello# 6ue :a7a a #er #ome%!do# a !%er:e4!oe# 6u!rrg!4a#

!m1or%a%e#. E%o4e#$ #! lo# 1a4!e%e# d!a"%!4o# %!ee ua ma7or #u#4e1%!"!l!dad a la#

!2e44!oe#$ e# 2;4!l 1e#ar 6ue la 4a:!dad oral e# u 4am1o 6ue 1uede :er#e 2re4ue%eme%e

a2e4%ado.

S! el odo%3logo 1re: 6ue la !ge#%a ormal del 1a4!e%e #e :a a :er al%erada %ra# el %ra%am!e%o$

la do#!# de !#ul!a o de lo# a%!d!a"%!4o# orale# %edr; 6ue #er au#%ada 1or el md!4o del

1a4!e%e.

El e#%r# agudo aume%a la l!"era4!3 de adreal!a 7 d!#m!u7e la #e4re4!3 de !#ul!a$ 1or lo

6ue el 4o%rol del dolor e el 1a4!e%e d!a"%!4o$ e# 2udame%al$ 7a 6ue la adreal!a %!ee

e2e4%o 4o%rar!o a la !#ul!a.

E# !m1or%a%e 4o#!derar 6ue lo# #al!4!la%o# aume%a la #e4re4!3 de la !#ul!a 7 la#e#!"!l!dad a #%a$ 7 1uede 1o%e4!ar la a44!3 de la# #ul2o!lurea#$ 1or lo 6ue e geeral$ la

a#1!r!a de"er; #er e:!%ada e lo# 1a4!e%e# d!a"%!4o#. Sal!4!la%o# 7 o%ro# AINE# 1or #u

4om1e%e4!a 4o lo# 5!1ogl!4em!e%e# orale# 1or la# 1ro%eía# 1la#m;%!4a#$ e4e#!%a ua

!d!4a4!3 mu7 1re4!#a.

El aalg#!4o a !d!4ar e u 1a4!e%e d!a"%!4o e#J Para4e%amol$ o Para4e%amol 4odeía.&

3. L8 DI8;EE9 5ELLI


20/36

1er#oa# !d!4a ua d!#m!u4!3 e %oda# la# med!4!oe# l!eale# 7 4am"!o# e algua#

med!4!oe# agulare#. La d!#m!u4!3 o"#er:ada e el ;gulo SNA 1uede #er !%er1re%ada 4omo

!%er2ere4!a de la d!a"e%e# e el 4re4!m!e%o del ma?!lar. La e2ermedad 1are4e a2e4%ar la

mor2ología 4raeo2a4!al 7 la madura4!3 e#6uel%!4a$ 1r!4!1alme%e 4uado #e ma!2!e#%a a%e#

o dura%e el e#%!r3 1u"eral. La !:e#%!ga4!3 e ra%a# d!a"%!4a# mo#%r3 de%er!oro e el

4re4!m!e%o 4raeo2a4!al de e#%o# a!male#. El #e%e%a 1or 4!e%o de lo# e#6uele%o# mad!"ulare#

e:aluado# 81ar%e "a#al$ 4od!lar$ 4or3!de#$ agular$ al:eolar 7 #!2!4!al9 #e :!ero a2e4%ada#$ lo

6ue re#ul%a e ua redu44!3 del 4re4!m!e%o 7 la de2orm!dad de la e#%ru4%ura mad!"ular. La#

med!4!oe# l!eale# de la reg!3 4raeo2a4!al 7 mad!"ular de ra%a# d!a"%!4a#$ 5e45a# a 1ar%!r de

rad!ogra2ía# 4e2alom%r!4a#$ #e reduero e %oda# la# d!me#!oe# e#1a4!ale# e 4om1ara4!3

4o la# med!4!oe# real!zada# e ra%a# #aluda"le#. Se e4e#!%a m;# e#%ud!o# 1ara 4o2!rmar 7

d!lu4!dar el me4a!#mo e?a4%o 1or el 6ue la d!a"e%e# 1rodu4e 4am"!o# e la# madí"ula#

5umaa#. S! em"argo$ lo# 1o#!"le# e2e4%o# o4!:o# de la d!a"e%e# #o"re el 4re4!m!e%o del

ma?!lar 7 la madí"ula 6ue 7a #e 5a !2ormado de"e #er %e!do# e 4ue%a dura%e el

d!ag3#%!4o 7 la 1la!2!4a4!3 de lo# %ra%am!e%o# or%od34!4o# 7 or%o1d!4o# e 1a4!e%e#

d!a"%!4o# e e%a1a de 4re4!m!e%o.

3..2 ERUPCIÓN DENTAL

La# al%era4!oe# e el de#arrollo de la o4lu#!3 1uede o4urr!r 4omo re#ul%ado de la eru14!3

de%ar!a a4elerada$ %ardía o 1or la al%era4!3 de la #e4ue4!a de eru14!3. Do# e#%ud!o#

demo#%raro 6ue lo# !>o# 4o d!a"e%e# 1re#e%a"a ua eru14!3 de%al #!g!2!4a%!:ame%e

a4elerada$ 1ero e d!2ere%e# 1eríodo# de de%!4!3. Lal 7 4ola"oradore# o"#er:aro 6ue lo#

!>o# 4o DM e el l%!mo 1eríodo de de%!4!3 m!?%a 8('(, a>o# de edad9 %eía ua ma7or

1ro1e#!3 a la eru14!3 de%al a:azada. S! em"argo$ o #e o"#er:aro 4am"!o# e el gru1o

de 1a4!e%e# d!a"%!4o# 4o de%!4!3 m!?%a %em1raa 8(' a>o# de edad9. No 5u"o 4orrela4!3

e%re la# al%era4!oe# de la eru14!3 7 lo# !:ele# de H"A(4$ au6ue ua d"!l a#o4!a4!3 #e

o"#er:3 e%re la eru14!3 de%al a4elerada 7 la o"e#!dad. Por o%ro lado$ Or"a 7 4ola"oradore#o"#er:aro 6ue el de#arrollo de%al #e a4eler3 5a#%a lo# (' a>o# 7 5u"o u re%ra#o de#1u# de

e#a edad. U do"le 4om1leme%o de me4a!#mo 6ue !2lu7e la# 2a#e# !%ra 7 e?%raal:eolare#

de eru14!3 #e #ug!ere$ #!edo e#%e l%!mo mod!2!4ado 1or la e2ermedad me%a"3l!4a. M!e%ra#

la 2a#e !%raal:eolar de eru14!3 #e r!ge 1r!4!1alme%e 1or #e>ale# mole4ulare# geerada# 1or

el 2olí4ulo de%al$ la eru14!3 e?%raal:eolar 1are4e de1eder m;# del de#arrollo de la raíz 7 la

a1o#!4!3 3#ea e la reg!3 a1!4al del d!e%e e eru14!3.

2H


21/36

3..3 MOVIMIENTO DENTARIO

M;# all; de la# al%era4!oe# e el me%a"ol!#mo 3#eo e geeral$ el 5ue#o al:eolar e 1ar%!4ular

%am"! 1are4e e#%ar a2e4%ado 1or la degeera4!3 1ro:o4ada 1or la DM. Lo# 4am"!o# e el

1a%r3 mor2ol3g!4o de la m!eral!za4!3 del 5ue#o al:eolar 7 la# 2!"ra# de S5ar1e7 #e 5a

re1or%ado e alguo# e#%ud!o# 4o a!male# d!a"%!4o#. El de%er!oro 4odu4e a u de"!l!%am!e%o

de la u!3 e%re el d!e%e 7 el 5ue#o al:eolar 7$ adem;#$ 1ro:o4a el e:ee4!m!e%o 1rema%uro

de e#%a# e#%ru4%ura#. A largo 1lazo$ #e e#%!ma 6ue 5a7 ua d!#m!u4!3 e la d!#%r!"u4!3 de la#

2uerza# ma#%!4a%or!a# 4au#ada 1or el edure4!m!e%o del l!game%o 1er!odo%al$ 1are4!do al 6ue

o4urre e la #ee4%ud. La remodela4!3 del l!game%o 1er!odo%al de#1u# de la a1l!4a4!3 de la

2uerza 1uede a%r!"u!r#e e 1ar%e a la modula4!3 de la e?1re#!3 g!4a de 1ro%ea#a# de lo#

2!"ro"la#%o#$ 1or eem1lo$ me%alo1ro%e!a#a de %!1o ( 8MMP(9 7 lo# !5!"!dore# %!#ulare# de la#

MMP 8TIMP9. Adem;#$ 4omo el mo:!m!e%o de%al e# u 2e3meo %o%alme%e de1ed!e%e del

l!game%o 1er!odo%al$ #e 1uede #u1oer 6ue #u 4orre4%o 2u4!oam!e%o de1ede de$ e%re o%ro#

2a4%ore#$ la !%egr!dad mor2ol3g!4a 7 2u4!oal de e#%a e#%ru4%ura 7 #u rela4!3 4o la#

e#%ru4%ura# ad7a4e%e#.

E la DM #e o"#er:3 u aume%o de la a4%!:!dad e la# 4lula# !2lama%or!a#$ 6ue 1romue:e u

e6u!l!"r!o !ade4uado e%re la rea"#or4!3 7 la 2orma4!3 de 5ue#o al:eolar. La 1re#e4!a de ua

!%e#a !2!l%ra4!3 de 4lula# !2lama%or!a#$ %ale# 4omo eu%r32!lo#$ l!2o4!%o# 7 ma4r32ago#

de#1u# de mo:!m!e%o de lo# d!e%e# e la# ra%a# d!a"%!4a# 7 ua ma7or !4!de4!a de la

re#or4!3 rad!4ular e?%era #e 1udo o"#er:ar e lo# d!e%e# 6ue %eía mo:!l!dad.

Ua al%era4!3 del e#%ado me%a"3l!4o 6ue !%er2!ere 4o la remodela4!3 3#ea 1uede re#ul%ar e

ua %a#a d!2ere%e de mo:!m!e%o de%al. E 4ua%o a la !2lue4!a de la DM e la 4a%!dad de

mo:!m!e%o de%al 4lí!4o$ la l!%era%ura mue#%ra re#ul%ado# 4o%ro:er#!ale#. E #u e#%ud!o 4o

ra%a# d!a"%!4a#$ amo e4o%r3 6ue la 4a%!dad de mo:!m!e%o 4o ua 2uerza de or%odo4!a e

el gru1o e?1er!me%al 2ue )'@ m;# "ao 6ue e el gru1o de 4o%rol. El re%ra#o e la

remodela4!3 3#ea 7 la el!m!a4!3 del %e!do 5!al!o$ e u e#%ado d!a"%!4o$ 1uede 4au#ar

re%ra#o e el mo:!m!e%o de%al. Del m!#mo modo$ la a1l!4a4!3 de 2uerza# 1e#ada# 1rodu4egrade# 4a%!dade# de %e!do 5!al!o$ m!ado la re#or4!3 7 re%ra#ado el mo:!m!e%o de%al.

E la d!a"e%e#$ #e e#%!ma 6ue 5a7 u re%ra#o de"!do a la d!2!4ul%ad e la el!m!a4!3 de e#%e

%e!do e4r3%!4o. E?!#%e la 5!13%e#!# de 6ue lo# 1ro"lema# e el #!#%ema :a#4ular 7 4o la

remodela4!3 3#ea e la d!a"e%e# 4o%r!"u7e ega%!:ame%e al 1ro4e#o de mo:!m!e%o de%al.

Por o%ro lado$ el mo:!m!e%o del d!e%e 1uede e#%ar aume%ado e 1re#e4!a de la e2ermedad.

E e?1er!me%o# 6ue u%!l!zaro 2uerza# l!gera#$ H!raoa 7 Braga o"#er:aro u ma7or

mo:!m!e%o de d!e%e# e u gru1o de ra%a# d!a"%!4a# e 4om1ara4!3 4o la# ra%a# de 4o%rol.

E#%o 1uede e?1l!4ar#e 1or la !2lue4!a ega%!:a de 2a4%ore# !%rí#e4o# 7 e?%rí#e4o# 1re#e%e#

21


22/36

e la d!a"e%e#$ 7 #u# a44!oe# a4umulada# %a%o e el %e!do 3#eo 4omo e el e1!%el!al 7 el

4oe4%!:o. La 1re#e4!a de u mal e#%ado 1er!odo%al 1uede 1romo:er u ma7or mo:!m!e%o

del d!e%e$ !de1ed!e%eme%e de la 4a%!dad de 2uerza u#ada. Lo# 4am"!o# e la mor2ología 7

la d!#%r!"u4!3 de la# 2!"ra# de S5ar1e7$ o"#er:ado# e la d!a"e%e#$ %am"! 1uede 2a:ore4er la

1rd!da de a4lae de%al.

E# !m1or%a%e de#%a4ar 6ue %odo# e#%o# re#ul%ado# ega%!:o# 6ue a4a"amo# de me4!oar #e

o"#er:aro e ra%a# d!a"%!4a# !du4!da# #! %ra%am!e%o. El modelo e?1er!me%al de d!a"e%e#

4r3!4a u%!l!zado e e#%ud!o# 4o a!male# e# u modelo 6ue #e 1are4e mu45o a la #!%ua4!3

4lí!4a o"#er:ada e 1a4!e%e# 4o d!a"e%e# %!1o ( #! %ra%am!e%o.

E #u e#%ud!o e?1er!me%al 4o ra%a# d!a"%!4a#$ V!llar!o 7 4ol. 1ro1or4!oa e:!de4!a 4!e%í2!4a

6ue a1o7a la 5!13%e#!# de 6ue la re#1ue#%a del 5ue#o a la 2uerza de or%odo4!a e #ue%o#

d!a"%!4o# %ra%ado# 4o !#ul!a o d!2!ere #!g!2!4a%!:ame%e de la o"#er:ada e #ue%o#

#aluda"le#.

Te!edo e 4ue%a e#%o# e?1er!me%o# e a!male#$ #e 1uede re4omedar al or%odo4!#%a 6ue

lo# 1a4!e%e# d!a"%!4o# 6ue o e#% e#%r!4%ame%e 4o%rolado# o 1uede re4!"!r %ra%am!e%o de

or%odo4!a 5a#%a 6ue #u e#%ado me%a"3l!4o e#% ormal!zado. E 1a4!e%e# 4o 4o%rol

me%a"3l!4o #e de"e e#%ar a%e%o de 4ual6u!er #e>al de al%era4!3 1er!odo%al dura%e el

%ra%am!e%o de or%odo4!a$ 6ue a meudo e# de larga dura4!3. E 4a#o de #o#1e45a de u

de#e6u!l!"r!o me%a"3l!4o$ el %ra%am!e%o de or%odo4!a de"e #er #u#1ed!do 7 el 1a4!e%e #er;

rem!%!do a #u md!4o de !med!a%o.

3..4 PLANIFICACIÓN DEL TRATAMIENTO ORTODÓNCICO

Al !gual 6ue 4o 4ual6u!er o%ra e2ermedad #!#%m!4a$ la DM o 4o%rolada re1re#e%a ua

4o%ra!d!4a4!3 1ara %ra%am!e%o de or%odo4!a. S! em"argo$ #! e?!#%e u "ue 4o%rol

glu4m!4o$ el %ra%am!e%o de or%odo4!a #e 1uede real!zar 4o ua e#%r!4%a :!g!la4!a 1er!odo%al

7 4o%rol rad!ogr;2!4o 1ara de%erm!ar la 1rd!da de 5ue#o 7 la rea"#or4!3 rad!4ular. Dado 6ue

5o7 o 5a7 lím!%e de edad 1ara el %ra%am!e%o de or%odo4!a$ el or%odo4!#%a :er; 1a4!e%e# 4o

DM %!1o ( 7 &. La 4la:e 1ara 4ual6u!er %ra%am!e%o de or%odo4!a e# u "ue 4o%rol md!4o.

S!em1re 6ue #e lle:e a 4a"o de a4uerdo a u "ue 4o%rol me%a"3l!4o 8H"A(4 =@9$ !g

%ra%am!e%o de%al$ md!4o o !4lu#o 6u!rrg!4o e#%; 4o%ra!d!4ado.

P!%5o 7 Re!45er%$ u%o a #u# 4ola"oradore#$ re1or%aro e la l!%era%ura %ra%am!e%o de

or%odo4!a e 1a4!e%e# 4o DM %!1o ($ e geeral l!"re# de 4om1l!4a4!oe#. E am"a#

#!%ua4!oe#$ lo# !:ele# de glu4o#a e la #agre e#%a"a "ao 4o%rol 7 5a"ía ua "uea 5!g!ee "u4al.

22


23/36

A%e# de 4omezar la %era1!a de or%odo4!a$ el 1a4!e%e o u adul%o re#1o#a"le de"e #er

!2ormado# de la 1o#!"!l!dad de aume%o de la !2lama4!3 g!g!:al de"!do a la u%!l!za4!3 de

a1ara%o# 2!o#$ de#%a4ado la !m1or%a4!a de la 5!g!ee oral. E 1r!mer lugar$ la 4od!4!3

1er!odo%al de"e meorar#e a%e# de 6ue 4ual6u!er %ra%am!e%o de or%odo4!a 1ueda %eer lugar.

El 1a4!e%e d!a"%!4o 6ue e# 4ad!da%o a %ra%am!e%o de or%odo4!a$ #o"re %odo e el 4a#o de u

adul%o$ de"e #ome%er#e a ua e:alua4!3 1er!odo%al 4om1le%a 4o #odeo 7 med!4!3 de lo#

íd!4e# g!g!:al 7 de 1la4a "a4%er!aa. No 1are4e 5a"er !gua 1re2ere4!a 1or a1ara%o# 2!o# o

remo:!"le#$ 1ero a d!2ere4!a de lo# a44e#or!o# 2!o#$ la 2lora "a4%er!aa o #e al%era o4!:ame%e

al u%!l!zar a1ara%o# m3:!le#.

Dura%e %ra%am!e%o$ el or%odo4!#%a de"e #u1er:!#ar la 4od!4!3 1er!odo%al de lo# 1a4!e%e#

4o d!a"e%e# 7 ma%eer 4o%rol #o"re la !2lama4!3. Al !gual 6ue 4o %odo# lo# 1a4!e%e# de

or%odo4!a$ ma%eer ua e#%r!4%a 5!g!ee oral e# mu7 !m1or%a%e. S! el 4o%rol de la 1la4a e#d!2í4!l de lograr 4o a7uda# me4;!4a# %ale# 4omo 4e1!llo de d!e%e# 7 el 4e1!llo !%erde%al$ el

u#o de u euague "u4al del %!1o de 4lor5e?!d!a$ 4omo u 4oad7u:a%e e el 4o%rol 6uím!4o

de la 1la4a$ #e 1uede 4o#!derar. Para m!!m!zar la eu%ral!za4!3 de la 1a#%a de d!e%e# e la

mol4ula de 4lor5e?!d!a$ de"e 5a"er al meo# u !%er:alo de +' m!u%o# e%re el 4e1!llado de

d!e%e# 7 u euague de 4lor5e?!d!a.

E# 1re2er!"le d!#1oer 4!%a# e la ma>aa %em1rao e 1eríodo# 4or%o#. S! u 1a4!e%e e#%;

1rogramado 1ara ua #e#!3 de %ra%am!e%o largo$ 1or eem1lo$ a1ro?!madame%e =' m!u%o#$ #e

le de"e a4o#ear 4omer ua 4om!da ormal 7 %omar lo# med!4ame%o# 4omo #!em1re. E 4ada

4!%a$ a%e# de 6ue 4om!e4e el 1ro4ed!m!e%o de%al$ el e6u!1o de%al de"e de%erm!ar #! el

1a4!e%e 5a 4um1l!do e#%a# re4omeda4!oe#$ 1ara e:!%ar ua rea44!3 5!1ogl!4m!4a e el

4o#ul%or!o.

De a4uerdo 4o la# d!re4%r!4e# re:!#ada# de la A#o4!a4!3 Amer!4a del Coraz3 8AHA$ 1or #u#

#!gla# e !gl#9 #o"re la 1ro2!la?!# a%!"!3%!4a e odo%ología$ lo# 1ro4ed!m!e%o# or%od34!4o#

4omo la 4olo4a4!3 7 au#%e de lo# a1ara%o# remo:!"le#$ "ra4e%# 7o "ada# o re6u!ere

4o"er%ura a%!"!3%!4a.

E# re4omeda"le 4om1ro"ar regularme%e la :!%al!dad 1ul1ar de lo# d!e%e#. El 2e3meo de la

m!4roag!o1a%ía d!a"%!4a 1uede a2e4%ar el #um!!#%ro :a#4ular 1er!2r!4o$ lo 6ue 4odu4e a

odo%alg!a !e?1l!4a"le$ #e#!"!l!dad a la 1er4u#!3$ 1ul1!%!# e !4lu#o a la 1rd!da de la :!%al!dad

e d!e%e# #ao#. E#%o# #í%oma# 1uede agra:ar#e 4o la a1l!4a4!3 de 2uerza# 6ue mue:a lo#

d!e%e# e ua d!#%a4!a #!g!2!4a%!:a. Se re4om!eda el u#o de la# 2uerza# 2!#!ol3g!4a# e el

%ra%am!e%o de or%odo4!a. E 4o#e4ue4!a$ la 4a%!dad de 2uerza u%!l!zada 1ara el mo:!m!e%o

de%al e 1a4!e%e# d!a"%!4o# o 1uede #er la m!#ma 6ue #e u%!l!z3 e 1a4!e%e# #aluda"le#.

23


24/36

La a1l!4a4!3 de 2uerza# e?4e#!:a# aume%a la 5!al!!za4!3 7 la e4ro#!# 4elular$ 6ue 1uede

4au#ar la rea"#or4!3 rad!4ular. E la# 4od!4!oe# a%er!ore#$ #! 4ual6u!er e2ermedad #!#%m!4a

e#%; 1re#e%e$ !2lu7e #!g!2!4a%!:ame%e e la e:olu4!3 de e#%o# e:e%o#. La 2!#!ología del

mo:!m!e%o de lo# d!e%e# 1uede :er#e a2e4%ada 7 mo#%rar 4am"!o# 1erud!4!ale#. Alguo#

e#%ud!o# 5a re:elado 6ue u e#%r!4%o 4o%rol de la !%e#!dad de la 2uerza dura%e la %era1!a

me4;!4a de or%odo4!a e 1a4!e%e# d!a"%!4o# 4o%rolado# 2ue uo de lo# 2a4%ore# re#1o#a"le#

de la au#e4!a de rea"#or4!3 rad!4ular 7 da>o #!g!2!4a%!:o a lo# %e!do# 1er!odo%ale# de#1u#

del %ra%am!e%o de or%odo4!a. Hol%gra:e 7 Doa%5 e#%ud!aro la# rea44!oe# 1er!odo%ale# a la#

2uerza# de or%odo4!a. E4o%raro regeera4!3 3#ea re%ra#ada$ de"!l!%am!e%o del l!game%o

1er!odo%al 7 m!4roag!o1a%ía e el ;rea g!g!:al. Llegaro a la 4o4lu#!3 de 6ue lo# 4am"!o#

d!a"%!4o# e#1e4í2!4o# e el 1er!odo%o #o m;# 1rou4!ado# de#1u# del mo:!m!e%o de%al

or%od34!4o. Dado 6ue lo# 1a4!e%e# 4o DM$ 7 e e#1e4!al a6uello# o 4o%rolado# o mal

4o%rolado#$ %!ee ua %ede4!a ma7or a la e2ermedad 1er!odo%al$ de"e #er 4o#!derado#

e el 1la de %ra%am!e%o de or%odo4!a 4omo 1a4!e%e# 1er!odo%ale#.

Se de"e %eer 4u!dado 1ara e:!%ar la !rr!%a4!3 de la mu4o#a oral 4o a1ara%o# de or%odo4!a 6ue

1uede agra:ar alguo# #!go# 7 #í%oma# de DM$ 4omo glo#o1!ro#!#$ ?ero#%omía e !2e44!oe#

orale# re4urre%e#. La# !2e44!oe# o1or%u!#%a#$ 4omo la 4ad!d!a#!# oral$ %am"! de"e #er

4o%rolada#.

Saa%4! 7 4ola"oradore# demo#%raro e #u e#%ud!o 6ue la# 4om1l!4a4!oe# de la d!a"e%e# a2e4%a

la 4al!dad de :!da e 1a4!e%e# 4o DM %!1o &$ lo 6ue 4odu4e al de#arrollo de %ra#%oro#

1#!4ol3g!4o#. Lo# 1a4!e%e# de"e re4!"!r a1o7o 1#!4o#o4!al$ 7a 6ue 4od!4!oe#

1#!4o1a%ol3g!4a# 4omo la de1re#!3 7 la a#!edad de"e #er %ra%ada# 1ara d!#m!u!r #u# e2e4%o#

ega%!:o# #o"re el 4o%rol me%a"3l!4o. Lo# au%ore# 4o4lu7ero 6ue la a%e4!3 !d!:!dual!zada

de lo# 1a4!e%e# 4o d!a"e%e# de"e meorar #u 4al!dad de :!da. Por e#%o$ #e 1uede 1la%ear la

5!13%e#!# de 6ue la al!ea4!3 de lo# d!e%e# 1uede %raer ua meora e la au%oe#%!ma de lo#

1a4!e%e# d!a"%!4o#$ lo 6ue aume%aría #u 4al!dad de :!da. E 4o%ra1ar%e$ lo# 1a4!e%e# 4o

5!#%or!al 4lí!4o 4r3!4o #uele e4o%rar#e ago%ado# de la# :!#!%a# a 4o#ul%or!o# md!4o#$ lo6ue 1uede re#ul%ar e u 1eru!4!o al 4um1l!m!e%o del %ra%am!e%o de or%odo4!a.

24


25/36

3. CONCL


26/36

Por l%!mo$ %eemo# u 4om1rom!#o 4omo 1ro2e#!oale# de ele:ar el !:el de ue#%rae#1e4!al!dad a #u 4od!4!3 de 4!e4!a "!ol3g!4a$ 1re#%ado a%e4!3 a lo# a#1e4%o# "!ol3g!4o#del %ra%am!e%o %a%o 4omo a #u# a#1e4%o# me4;!4o#.

4. JEFEJENCI89;I;LIO6JFIC8

.(. Amer!4a D!a"e%e# A##o4!a%!o. Re1or% o2 %5e E?1er% Comm!%%ee o %5e D!ago#!# ad

Cla##!2!4a%!o o2 D!a"e%e# Mell!%u#. D!a"e%e# Care &''= #u11l +&$ & /.&. A""a##7 MA$ Wa%ar! L$ Soma . E22e4% o2 e?1er!me%al d!a"e%e# o 4ra!o2a4!al groX%5

! ra%#. Ar45 Oral B!ol &''


27/36

d!a"%!4o e odo%ología. Re:!#%a de la 2a4ul%ad de 4!e4!a# de la #alud &'')$ :ol. &J (&,

(&=.=. Braga SM$ Tadde! SR$ Adrade I *r$ Yue!roz*u!or CM$ Garle% GP$ Re1ee CE$ Te!?e!ra

MM$ da S!l:a TA. E22e4% o2 d!a"e%e# o or%5odo%!4 %oo%5 mo:eme% ! a mou#e model.

Euro1ea *oural Oral S4!. &'(( ((=8(9J/(,.('. Burde D$ Mullall7 B$ Sadler *. or%5odo%!4 %rea%me% o2 1a%!e%# X!%5 med!4al d!#order#.

Euro1ea * or%5odo%!4 &''($ :ol. &+J +++/&.((. Cardozo E$ Parod! G. Co#!dera4!oe# a %omar e 4ue%a e el maeo odo%ol3g!4o del

1a4!e%e 4o d!a"e%e# mell!%u#. A4%a Odo%ol3g!4a Veezolaa &''+$ :ol. ,( (.(&. Co5e V!:!aa. Tra%am!e%o de or%odo4!a e 1a4!e%e# 4o %ra#%oro# #!#%m!4o#. Re:!#%a

de or%odo4!a SAO &'('$ :ol. /+ (,


28/36

&,. NamHee O5$ IlS! C5o$ Eu-oug !m$ Gerald Nel#o$ DoM! *eog. E:alua%!o o2

S%a"!l!%7 o2 Sur2a4eTrea%ed M!!Im1la%# ! D!a"e%!4 Ra""!%#. I%era%!oal *oural o2

De%!#%r7 &'(,$ :ol. &'(,J (/.&). N!4olo#! L. Edo4ard!%!# !2e44!o#a. Nue:a# re4omeda4!oe# 1ara #u 1re:e4!3. Guía de

la Amer!4a Hear% A##o4!a%!o &''/.re:!#%a de la 2a4ul%ad de odo%ología 8UBA9 &''/$:ol. && )+J =(,.

&. Or"a R$ S!m#e S$ Or"a c$ a:ru% F$ Cola M. T5e I2lue4e o2 T71e( D!a"e%e#

Mell!%u# o De%!%!o ad Oral Heal%5 ! C5!ldre ad Adole#4e%#. -o#e! Med!4al

*oural &''


29/36

Diabetes mellitus, A Dilemma in Orthodontics

Syed Omar Aziz Rizvi, Vinod Pattabiraman, Sandesh Pai, Sharanya Sabrish

Department of Orthodontics and Dentofacial Orthopedics, Vydehi Institute of Dental Sciences and Research

Center, en!aluru, "arnata#a, India

Date of $eb Publication %&'Sep'&(%)

Correspondence Address*

Syed Omar Aziz Rizvi

Department of Orthodontics and Dentofacial Orthopedics, Vydehi Institute of Dental Sciences and ResearchCenter, +& -PIP Area, $hite field, en!aluru, "arnata#a

2G

http://www.jorthodr.org/searchresult.asp?search=&author=Syed+Omar+Aziz+Rizvi&journal=Y&but_search=Search&entries=10&pg=1&s=0http://www.jorthodr.org/searchresult.asp?search=&author=Vinod+Pattabiraman&journal=Y&but_search=Search&entries=10&pg=1&s=0http://www.jorthodr.org/searchresult.asp?search=&author=Sandesh+Pai&journal=Y&but_search=Search&entries=10&pg=1&s=0http://www.jorthodr.org/searchresult.asp?search=&author=Sandesh+Pai&journal=Y&but_search=Search&entries=10&pg=1&s=0http://www.jorthodr.org/searchresult.asp?search=&author=Sharanya+Sabrish&journal=Y&but_search=Search&entries=10&pg=1&s=0http://www.jorthodr.org/searchresult.asp?search=&author=Sharanya+Sabrish&journal=Y&but_search=Search&entries=10&pg=1&s=0http://www.jorthodr.org/searchresult.asp?search=&author=Syed+Omar+Aziz+Rizvi&journal=Y&but_search=Search&entries=10&pg=1&s=0http://www.jorthodr.org/searchresult.asp?search=&author=Vinod+Pattabiraman&journal=Y&but_search=Search&entries=10&pg=1&s=0http://www.jorthodr.org/searchresult.asp?search=&author=Sandesh+Pai&journal=Y&but_search=Search&entries=10&pg=1&s=0http://www.jorthodr.org/searchresult.asp?search=&author=Sharanya+Sabrish&journal=Y&but_search=Search&entries=10&pg=1&s=0


30/36

India

Source of Support: .one, Conflict of Interest: .one

DOI: %(/)%(01&0&%'0&2/%)(3&(

Abstract

Diabetes mellitus 4D56 is a chronic disorder of carbohydrate, fat and protein metabolism/ 7he prevalence

of D5 is !ro8in! rapidly 8orld8ide and is reachin! epidemic proportions/ 7raditionally, orthodontic

treatment 8as considered to be a treatment modality for healthy youn! people/ 9o8ever, 8ith increasin!

patient a8areness the trend has chan!ed 8ith adults no8 see#in! orthodontic treatment/ Appro:imately,

half of the patients 8ith diabetes are undia!nosed and a dental e:amination may provide the first

indication of the disease, and therefore a clinician must have a basic #no8led!e of the oral manifestations

of D5/ 7his article briefly deals 8ith the medical aspects of D5, its oral manifestations and orthodontic

treatment considerations/

Keywords: Diabetes mellitus, deficient insulin secretory response, hyperglycemia

How to cite this article:

Rizvi SO, Pattabiraman V, Pai S, Sabrish S/ Diabetes mellitus, A Dilemma in Orthodontics/ ; Orthod Res&(%)%? A persistently raised blood !lucose level

3H

http://www.jorthodr.org/text.asp?2014/2/3/113/140620http://www.jorthodr.org/text.asp?2014/2/3/113/140620http://www.jorthodr.org/text.asp?2014/2/3/113/140620http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref1http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref1http://www.jorthodr.org/text.asp?2014/2/3/113/140620http://www.jorthodr.org/text.asp?2014/2/3/113/140620http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref1


31/36

4hyper!lycemia6 is also a characteristic feature, resultin! from deficiency in insulin secretion, insulin action,or both/ 7he classic symptoms of mar#ed hyper!lycemia include polyuria, polydipsia, 8ei!ht loss, andsusceptibility to infections/ on!term complications include retinopathy, nephropathy, peripheral andautonomic neuropathy, cardiovascular disease and in addition, increased tendency for periodontal diseaseis often found/ >&?

Classification of Diabetes #ellitus

7he t8o broad cate!ories of D5 are desi!nated 7ype % and 7ype &/ In 7ype % diabetes, the cause is anabsolute deficiency of insulin secretion/ It is often dia!nosed in adolescence and therefore 8as called@uvenile'onset diabetes/ >0?

7ype & D5 is a hetero!eneous !roup of disorders/ Distinct !enetic and metabolic defects in insulin actionand1or secretion !ive rise to the common phenotype of hyper!lycemia in 7ype & D5/ >0?

In addition to these types, there are other specific types of D5 >7able %?/ >=?

7able %* Recent classification of D5 based on the etiolo!y of the disease

Clic' here to (iew

Incidence and %re(alence

Pea# incidence of 7ype & D5 is in the fifth decade of life due to increasin! obesity and reduced activitylevels/

7he prevalence of D5 is !ro8in! rapidly 8orld8ide and is reachin! epidemic proportions/ >)? It is estimatedthat there are currently &2 million people 8ith diabetes 8orld8ide and this number is set to increase to)0 million by the year &(0(/

Accordin! to the $orld Diabetes Atlas 5ore Details, India is pro@ected to have around 2% million people 8ith

diabetes/

Diagnosis and #onitoring of Diabetes

7he primary methods used to dia!nose diabetes are fastin! venous plasma !lucose levels and oral

!lucose tolerance tests/ Oral !lucose tolerance tests used in the past tended to !ive false positive resultsbecause of stress'induced adrenaline release that impairs the response to !lucose loadin!/ >2? Dia!nosiscan be made from a simple fastin! venous plasma !lucose level/ 5easurement is ta#en from a fastin!sample of blood and provides information on the level of control of diabetes throu!hout the 0('E( dayshalf'life of red blood cells/

%athogenesis

Some of the patho!enetic processes involved in the development of diabetes are*

• Fenetic defects,

• Primary destruction of Islet cells by inflammation, cancer, sur!ery, and trauma,

31

http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref2http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref2http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/viewimage.asp?img=JOrthodRes_2014_2_3_113_140620_b1.jpghttp://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref7http://www.jorthodr.org/viewimage.asp?img=JOrthodRes_2014_2_3_113_140620_b1.jpghttp://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref4http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref4http://openwin%28%27speciallinks.asp/?id=2161%27)http://openwin%28%27speciallinks.asp/?id=2161%27)http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref5http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref5http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref2http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/viewimage.asp?img=JOrthodRes_2014_2_3_113_140620_b1.jpghttp://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref7http://www.jorthodr.org/viewimage.asp?img=JOrthodRes_2014_2_3_113_140620_b1.jpghttp://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref4http://openwin%28%27speciallinks.asp/?id=2161%27)http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref5


32/36

• A complication of endocrine disorders such as anterior pituitary hyper function 4overproduction of

!ro8th hormone, acrome!aly6, Cushin!Gs disease, and pheochromocytoma,

• Iatro!enic after the administration of corticosteroids/

In addition to these, there are many other factors involved/

7ype % D5 develops as a result of the syner!istic effects of !enetic, environmental, and immunolo!icfactors that ultimately destroy the pancreatic beta cells/ Individuals 8ith a !enetic susceptibility havenormal beta cell mass at birth but be!in to lose beta cells secondary to autoimmune destruction thatoccurs over months to years/ >0?

In 7ype & diabetes, the cause is a combination of resistance to insulin action and an inadeBuatecompensatory insulin secretor response/ In this type of diabetes, the hyper!lycemia develops !raduallyand starts usually at the a!e of )( or later/ >0?

A stri#in! feature of 7ype & diabetes is the stren!th of its !enetic component, 8hich is much !reater than in7ype % diabetes/ 7ype & diabetes is hi!hly concordant, bein! 3(H to E(H concordant in monozy!otic

t8ins, but less so in nonidentical t8ins 4%='0=H6/ or e:ample, if one of t8o identical t8ins develops 7ype% diabetes, the other t8in has only about a 2(H chance of developin! diabetes< but if one t8in develops7ype & diabetes, the other t8in has about a %((H chance of also becomin! diabetic/ >3?

Oral #anifestations of Diabetes #ellitus

Appro:imately, half of the patients 8ith diabetes are undia!nosed and a dental e:amination may providethe first indication of the disease, and therefore a clinician must have a basic #no8led!e of the oralmanifestations of D5/

7hese include dry mucous membranes 4:erostomia6, oral candidiasis, burnin! mouth or ton!ue

4!lossopyrosis6, impaired 8ound healin!, recurrent oral infections, #etone breath, cheilosis, mucosal dryin!and crac#in!, diminished salivary flo8, alterations in the flora of the oral cavity, 8ith !reater predominanceof Candida albicans, hemolytic streptococci, and staphylococci and an increased rate of dental caries/

Occasionally, enlar!ement of the parotid salivary !land can be noticed/ >=,?

Diabetic patients on hypo!lycemic a!ents have :erostomia, 8hich may predispose to opportunisticinfections 8ith C. albicans/

Oral manifestations associated 8ith diabetes are in most cases restricted to the uncontrolled or poorlycontrolled patient/ actors that may contribute to the oral complications in diabetes include decreasedpolymorphonuclear leu#ocyte function 4leads to impaired resistance to infections6 and abnormal colla!enmetabolism/ >? Altered protein metabolism resultin! from impaired utilization of !lucose can contribute toincreased brea#do8n of colla!en in the connective tissues/ In addition, impaired neutrophil chemota:isand macropha!e function may add to the impaired 8ound healin! responses in diabetic patients/ >E?

9ealin! is impaired in diabetics due to decreased synthesis of colla!en by fibroblasts, increasedde!radation by colla!enase, !lycosylation of e:istin! colla!en at 8ound mar!ins, defective remodelin!rapid de!radation of ne8ly synthesized poorly cross'lin#ed colla!en and reduced vascularity of tissues dueto defective colla!en in the vessel 8all/ >E?

Diabetes mellitus patients have more !in!ival inflammation, probably because of impaired neutrophilfunction/ >E? Vascular chan!es, such as D5'related microan!iopathies, have been sho8n to encoura!eperiodontal disease/ 7his 8as also confirmed by Rylander et al /, >%(?8ho compared the periodontalconditions of )3 youn! insulin'controlled D5 patients 8ith )% healthy youn! adults/ 7hey reportedsi!nificantly more !in!ival inflammation in the youn! D5 patients 8ith retinopathy and nephropathycompared 8ith those 8ithout complications/ ecause periodontal disease tends to be more common andmore e:tensive in patients 8ith uncontrolled or poorly controlled D5, one could hypothesize thatnormalizin! the blood !lucose levels should stop the pro!ression of periodontal disease/ 7his is, ho8ever,

not true/ Sastro8i@oto et al />%%?

demonstrated that better metabolic control in 7ype % patients did not improvethe clinical periodontal condition< it ameliorates only 8hen local oral hy!iene measures are used/ 7heperiodontal condition 8ill continue to deteriorate 8hen the blood !lucose level is not 8ell controlled/

32

http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref6http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref6http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref7http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref7http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref7http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref8http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref8http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref8http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref8http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref9http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref9http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref9http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref9http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref9http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref10http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref11http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref6http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref7http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref8http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref8http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref9http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref9http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref9http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref10http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref11


33/36

Hypoglycemia)#anagement in a Dental Office

9ypo!lycemia is most commonly the result of ta#in! dru!s used to treat D5 or other dru!s, includin!

alcohol/ An important frame8or# for ma#in! the dia!nosis of hypo!lycemia is $hippleGs triad*

%/ Symptoms consistent 8ith hypo!lycemia,

&/ A lo8 plasma !lucose concentration, and

0/ Relief of symptoms after the plasma !lucose level is raised/ 9ypo!lycemia can cause si!nificant

morbidity and can be lethal, if severe and prolon!ed/ >0?

$hen a hypo!lycemic reaction occurs in the dental office, the dentist should reco!nize the symptoms andact in an appropriate 8ay/ oss of consciousness in insulin shoc# can occur Buite rapidly, 8ithin minutesafter the appearance of the first symptoms/ At the onset, patients appear 8ea#, nervous, and confused/7heir s#in is moist and pale, and they e:hibit e:cessive flo8 of saliva/ Respiration is normal, the pulse isfull and poundin!, and blood pressure is usually normal/ reBuently, a tremor may be noted/ 7he stillcooperative and conscious patient 8ith these clinical symptoms should be administered a hi!h'carbohydrate bevera!e such as oran!e @uice or cola 4not diet6/ $hen treatin! a diabetic patient, it isadvised to have a source of su!ar available in the office that is handy for Buic# and easy use/ 7he patient8ill respond 8ithin a fe8 minutes and should then remain under observation until all si!ns and symptomshave disappeared/ If the state of hypo!lycemia continues, the patient 8ill soon become unconsciousunless a 2(H de:trose solution 42( m6 is administered intravenously at once/ 5ana!ement of theunconscious patient also includes air8ay maintenance, o:y!en administration, and monitorin! of vitalsi!ns/ Another dru! that can be administered is !luca!on 4% m! intramuscularly6, 8hich is also preferable if the patient is conscious but uncooperative to ta#e carbohydrates orally/ >%&?

Orthodontic Considerations

7he #ey to any orthodontic treatment is !ood medical control/ Orthodontic treatment on uncontrolleddiabetics should be avoided/ If the patient is not in !ood metabolic control 49bA%c JEH6, every effortshould be made to improve blood !lucose control/

7here is no treatment preference 8ith re!ard to fi:ed or removable appliances/ It is important to stress!ood oral hy!iene, especially 8hen fi:ed appliances are used/ 7hese appliances may !ive rise toincreased plaBue retention, 8hich could more easily cause tooth decay and periodontal brea#do8n inthese patients/ 7he blood !lucose levels should be monitored to rule out deterioration of the D5 control/Diabetes'related microan!iopathy can occasionally occur in the periapical vascular supply, resultin! inune:plained odontal!ia, percussion sensitivity, pulpitis, or even loss of vitality in sound teeth/ >%0? -specially8ith orthodontic treatment 8hen forces are applied to move teeth over a si!nificant distance, thepractitioner should re!ularly chec# the vitality of the teeth involved/ It is advisable to apply li!ht forces andnot to overload the teeth/

9olt!rave and Donath >%)? studied periodontal reactions to orthodontic forces/ 7hey found retarded osseousre!eneration, 8ea#enin! of the periodontal li!ament, and microan!iopathies in the !in!ival area/ 7heyconcluded that the specific diabetic chan!es in the periodontium are more pronounced after orthodontictooth movement/ ecause D5 patients, and especially those 8ho are uncontrolled or poorly controlled,have a hi!her tendency for periodontal brea#do8n, they must be considered in the orthodontic treatmentplan as periodontal patients, and treatment considerations must accordin!ly be made/

If plaBue control is difficult to achieve 8ith mechanical aids such as toothbrush and interdental brush, thenusin! a disinfectant mouthrinse such as chlorhe:idine as an ad@uvant chemical plaBue control can beconsidered/ 7o minimize the neutralizin! effect of the toothpaste on the chlorhe:idine molecule, there

33

http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref12http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref12http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref12http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref13http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref13http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref13http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref14http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref14http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref14http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref3http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref12http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref13http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref14


34/36

should be at least a 0( min interval bet8een tooth brushin! and the chlorhe:idine rinse/ >%2?

ecause today there is no upper a!e limit for orthodontic treatment, the practitioner 8ill see both 7ype %and 7ype & D5 patients/ 7ype & patients can be considered more stable than 7ype % patients, 8ho can bepresumed to be brittle/ 5ornin! appointments are preferable/ If a patient is scheduled for a lon!treatment session, e/!/, about E( min, he or she should be advised to eat a usual meal and ta#e themedication as usual/ At each appointment, before the dental procedure starts, the dental team should

determine 8hether the patient has fulfilled these recommendations, to avoid a hypo!lycemic reaction inthe office/

Orthodontic *ooth #o(ement

Diabetes may also affect bone turnover, resultin! in diminished bone'mineral density, osteopenia,osteoporosis, >%3? and an increased prevalence and severity of periodontal disease/ >%=? Several mechanismshave been reported to e:plain the altered bone remodelin! in diabetes, one of 8hich is diminished boneformation as a result of decreased osteoblastic activity >%=? or enhanced apoptosis of osteoblastic cells/

Another contributin! factor may be increased bone resorptive activity/ >%=? 9o8ever, it is still controversial8hether osteoclastic recruitment and function are altered in diabetes, because no chan!e or decrease inthe activity of osteoclasts has been reported/ >%?

Chemo#ine, cyto#ines, and bone'remodelin! re!ulators >%E?

influence the recruitment and activity ofosteoclasts and osteoblasts/ Recent reports demonstrated increased e:pression of messen!er ribonucleic

acid 4mR.A6 for Ccl & , Ccl 2 , tumor necrosis factor'alpha 47.'alpha6, and receptor activator of nuclear

factor'# li!and 4Ran#l6 that are associated 8ith osteoclast recruitment and activity durin! orthodonticmovement/ >&(? Previous investi!ators have reported that diabetes is associated 8ith prolon!ed e:pression

of mR.A for 7.'alpha, Ccl & ,>&%? Ran#l, and colony'stimulatin! factor %, 8hich may lead to more

persistent inflammation and tissue dama!e/ >&%?9o8ever, the cellular and molecular mechanismsassociated 8ith the diabetic state that may influence orthodontic movement are not #no8n/

Antibiotic %rophyla+is

Orthodontic bands placement and separator placement may produce si!nificant bacteremia 8heresi!nificant oral bleedin! and1or e:posure to potentially contaminated tissue is anticipated, and this 8ould

typically reBuire antibiotic prophyla:is in patients at ris#/ >&&,&0?Simple ad@ustment of orthodontic appliances,

do not reBuire antibiotic prophyla:is/

#ini Screws

7he mini'implant retention results from the mechanical interloc#in! of its metal structure in cortical anddense bone and is not based on the concept of osseointe!ration/ One of the #ey success factors are boneBuality and1or density/ >&)? $ell'controlled diabetic patients can under!o mini'scre8 placement underantibiotic prophyla:is/

Conclusion

Due to the hi!h prevalence of D5, the probability of the orthodontist treatin! such patients is also veryhi!h/ 7herefore, it is the responsibility of an orthodontist as 8ell as of the dentist to have a basic#no8led!e of the si!ns and symptoms of D5/ Patients havin! !ood !lycemic control can under!oorthodontic treatment 8hereas treatment of uncontrolled diabetics is not indicated/ Stress should be laidon !ood oral hy!iene, re!ular chec# of the periodontium as 8ell as vitality chec# of the teeth/ i!ht forcesshould be applied/ -mphasis should also be on re!ular !lycemic tests/

As orthodontists, 8e must strive to improve the treatment of our patients and elevate the standard of ourspecialty to its biolo!ic science status by payin! attention to the biolo!ic aspects of treatment as much asto its mechanical aspects/

!eferences

34

http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref15http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref15http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref15http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref16http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref16http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref17http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref17http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref17http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref17http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref17http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref17http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref18http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref19http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref19http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref19http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref20http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref20http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref20http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref21http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref21http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref21http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref22http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref22http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref23http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref24http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref24http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref24http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref15http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref16http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref17http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref17http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref17http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref18http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref19http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref20http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref21http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref21http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref22http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref23http://www.jorthodr.org/article.asp?issn=2321-3825;year=2014;volume=2;issue=3;spage=113;epage=117;aulast=Rizvi#ref24


35/36

%/ Cotran RS, "umar V, Collins 7/ Robbins'Patholo!ic asis of Disease/ 3 th ed/ Pennsylvania* -lsevier<

&(((/ p/ E%0/

&/ inney S, inney 5O, Fonzalez'Campoy ;5/ $hat the mouth has to say about diabetes/ Diabetes

%EE=PL5-D?

%%/ Sastro8i@oto S9, van der Velden L, van Steenber!en 7;, 9illemans P, 9art AA, de Fraaff ;, et al /

Improved metabolic control, clinical periodontal status and sub!in!ival microbiolo!y in insulin'

dependent diabetes mellitus/ A prospective study/ ; Clin Periodontol %EE(


36/36

%/ o8l#es ;, unn RC, iu , $ahl -C, Coleman 9., Coc#rell F-, et al / Runt'related transcription

factor & 4RL.&6 and RL.&'related osteo!enic !enes are do8n're!ulated throu!hout

osteo!enesis in type % diabetes mellitus/ -ndocrinolo!y &((

tratamiento ortodoncico en pacientes con diabets mellitus Diabetes Mellitus

Documents

Transcript of tratamiento ortodoncico en pacientes con diabets mellitus Diabetes Mellitus