In this interview for World Diabetes Day, Dr. Dániel Végh Ph.D, research fellow and Prosthodontist at Hungary’s Semmelweis University, talks about how his status as someone with diabetes impacts his work as a dentist and explains what dentists should consider when deciding on implant treatment for patients with diabetes.

Dr. Végh, can you please tell us a bit about your dental background?

I’ve always been interested in medicine and in using manual skills. I started off in medicine, actually, and transferred to dentistry when I was diagnosed with diabetes in my second year of university. When I was diagnosed, I had to rethink my future – I’d always wanted to be a surgeon, but diabetes made this much more difficult to achieve due to the length of certain surgeries and the possibility that I would suffer from low blood sugar. With dentistry, I saw that I would still be able to perform oral surgery procedures that were of a manageable length, and that it would work with my disease. I’m very grateful that I made this transfer.

I graduated in 2015 from Semmelweis University, Hungary, at which point I began working there as a conservative dentist and prosthodontics resident while commencing my PhD studies on the topic of oral complications in diabetes. I received my PhD earlier this year and currently work in Semmelweis’ Department of Prosthodontics as a specialist.

How has diabetes impacted your professional work as a dentist?

I lead the Diabetes Dental Research Group at Semmelweis concerned with the links between diabetes and oral complications (diabetes and oral cancer1, diabetes and local anesthetics2) though we also engage with the clinical side. For example, we often organize free dental screenings for patients with diabetes at diabetes-focused events. Overall, I would say that diabetes not only shapes my personal life but my professional life as well.

What needs to be considered if a dental patient has diabetes?

If a patient has diabetes, I strongly advise scheduling the appointment at the beginning of the day. As the day progresses, their blood glucose level will change, and it will be more difficult to manage this in the afternoon. This is a risk when the patient is on intensive insulin therapy – if the patient has too much insulin or is suffering from stress due to the dental appointment, they can potentially become hypoglycemic (suffer from low blood sugar). The patient can begin to sweat, shake, and may eventually pass out, so this is dangerous if the symptoms are not recognized.

The second thing to consider for patients with diabetes is the potential for hyperglycemia, or high blood sugar. If the dentist is planning a prolonged procedure but the patient’s blood sugar is uncontrolled, this can lead to a higher likelihood of oral complications and, ultimately, treatment failure. This is more common in patients with Type 2 diabetes, which makes up ~90–95% of all diabetes cases.3

Thankfully, it is easy to detect if a patient has generally uncontrolled and high blood sugar levels – you need to look at their HbA1c level, which is their average blood sugar level for the previous three months. If it’s high, then it might be worth scheduling a consultation with a diabetologist.

Does the way you treat a patient differ if they have Type 1 or Type 2 diabetes?

For Type 1 patients, we have to be aware that every day is different, and that hypoglycemia can occur even when a patient generally has well-controlled diabetes. For Type 2 patients, it’s important to remember that long-term high blood sugar can lead to a number of issues including delayed wound healing, periodontal disease, greater tooth loss, xerostomia, and a higher likelihood of infection if they have prostheses.

In your experience, how can diabetes impact dental implant treatment?

For dental implant treatment with a patient with diabetes, the HbA1c level is very important and should be well controlled. There is no exact marker that separates well-controlled and high-risk patients; however, if the HbA1c level is above 8%, it is often recommended that a diabetologist should be consulted first to avoid long-term complications or implant failure. Implant therapy is not indicated in patients who do not have acceptable diabetes control.4

It has also been shown that dental implant treatment can be more successful with a diabetic patient if they undergo periodontal therapy first and reduce any existing inflammation.5 If the patient participates in regular professional cleaning and dental visits, their HbA1c level can decrease by between 0.27% and 0.48%,6 7 a key observation emphasized by the consensus guidelines of the International Diabetes Federation (IDF)and European Federation of Periodontology (EFP).8 This finding builds upon a prior study that also showed, although with a small sample size, a similar result with an average decrease of 0.36% in HbA1c levels after periodontal treatment.9

What can be done to maximize the potential long-term success of a dental implant in a diabetic patient?

The most important thing is for the patient to have well-controlled diabetes – one systematic review has shown that there is little to no difference in implant outcomes and complication rates between patients with well-controlled diabetes patients and those without diabetes.10 Based on this finding, if the patient’s HbA1c level is steadily below 8%, then the clinician can be confident that the diabetes will not have a negative effect on implant therapy.

In my experience, a patient with well-controlled diabetes is, in effect, no different from a patient without diabetes, and can undergo dental implant treatment with confidence.

You are currently a European representative with the IDF. What opportunities has it given you?

Working with the IDF has given me a great opportunity to represent the dental field, which can sometimes be overlooked when diabetes care is being considered. We are trying to transform the position of dental care so that it will become a focal point of general diabetes management. For instance, the IDF and the EFP held a joint workshop in Madrid, Spain in 2017 to establish links between periodontal disease and diabetes and to help create guidelines for diabetologists, dentists and patients regarding treatment protocol and possible risks when dealing with patients with diabetes.11 I was the only one in the working committee to have diabetes and so was able to inform the guidelines from a patient’s perspective as well from a clinical one.

Information and guidance for dental professionals regarding patients with diabetes is available from a wide range of sources. Just a few include:

Find out more

References

  1. Végh D, Bányai D, Hermann P, et al. Type-2 diabetes mellitus and oral tumors in Hungary: a long-term comparative epidemiological study. Anticancer Res 2017;37(4):1853-1857. Read on PubMed.
  2. Végh D, Somogyi A, Banyai D, et al. Effects of articaine on [3H]noradrenaline release from cortical and spinal cord slices prepared from normal and streptozotocin-induced diabetic rats and compared to lidocaine. Brain Res Bull 2017;135:157-162. Read on PubMed.
  3. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2009;32 (Suppl1):S62-67. Read on PubMed.
  4. Sanz M, Ceriello A, Buysschaert M, et al. Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International diabetes Federation and the European Federation of Periodontology. J Clin Periodontol 2018;45(2):138-149. Read on PubMed
  5. Madianos PN, Koromantzos PA. An update of the evidence on the potential impact of periodontal therapy on diabetes outcomes. J Clin Periodontol 2018;45(2):188-195. Read on PubMed.
  6. Sanz M, Ceriello A, Buysschaert M, et al. Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International diabetes Federation and the European Federation of Periodontology. J Clin Periodontol 2018;45(2):138-149. Read on PubMed
  7. Madianos PN, Koromantzos PA. An update of the evidence on the potential impact of periodontal therapy on diabetes outcomes. J Clin Periodontol 2018;45(2):188-195. Read on PubMed.
  8. Sanz M, Ceriello A, Buysschaert M, et al. Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International diabetes Federation and the European Federation of Periodontology. J Clin Periodontol 2018;45(2):138-149. Read on PubMed
  9. Engebretson S, Kocher T. Evidence that periodontal treatment improves diabetes outcomes: A systematic review and meta-analysis. J Clin Periodontol 2013;40(Suppl 14):S153-163. Read on PubMed.
  10. Naujokat H, Kunzendorf B, Wiltfang J. Dental implants and diabetes mellitus – a systematic review. Int J Implant Dent 2016;2(1):5. Read on PubMed.
  11. Sanz M, Ceriello A, Buysschaert M, et al. Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International diabetes Federation and the European Federation of Periodontology. J Clin Periodontol 2018;45(2):138-149. Read on PubMed

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