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THE IMPORTANCE OF DIABETES

MELLITUS IN DENTAL PRACTICE

Nina Dimitrijević Jovanović Introduction
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Hristina Ugrinović Diabetes mellitus (DM) is a metabolic disorder caused by
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Radomir Mitić insufficient insulin production in the pancreas (Type 1 DM),
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Nevena Kalezić 4, 5 inadequate insulin utilization in the periphery (Type 2 DM),
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1 Faculty of Dentistry, University of Belgrade, Belgrade, Serbia or a combination of both mechanisms . Many substances
2 Clinic for Cardiac Surgery, University Clinical Center of Serbia, Belgrade, have different effects on insulin secretion, which can lead
Serbia to significant imbalances in blood glucose levels, even to
3 General Hospital of Leskovac, Leskovac, Serbia hypo- or hyperglycemic crises. The main stimulators of
4 Faculty of Medicine, University of Belgrade, Serbia insulin secretion are glucose and fructose, while other sti-
5 Clinic for Endocrine Surgery, University Clinical Center of Serbia, Belgrade mulators include amino acids, gastrointestinal hormones
Serbia (gastrin, cholecystokinin, secretin, incretins), acetylcholine,
and certain medications (β-adrenergic receptor agonists).
Corresponding author: The most important inhibitors of secretion are stress hor-
mones (known as counterregulatory hormones), including
Ass. dr sci. Nina Dimitrijević Jovanović
catecholamines (epinephrine and norepinephrine), cortisol,
Stomatološki fakultet Univerziteta u Beogradu, Rankeova 4, growth hormone, and glucagon. Cytokines, as well as some
Beograd, Srbija medications (such as α-adrenergic receptor agonists, gluco-
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dr.nina.dimitrijevic@gmail.com corticoids, etc.), also inhibit insulin secretion .
The normal range for fasting blood glucose levels is 3.5-
6.0 mmol/L, and for glycosylated hemoglobin (HbA1c) it is
Abstract 3.5-6%. The diagnosis of diabetes mellitus (DM) is establi-
shed based on elevated blood glucose levels, specifically
This paper presents the basic characteristics of ≥ 7.0 mmol/L or ≥ 11.1 mmol/L, 120 minutes after an Oral
diabetes mellitus, a disease that affects about 10% of Glucose Tolerance Test (OGTT). Since 2009, the criteria for
the population, with a tendency to further increase diagnosing DM have also included an elevated level of gly-
in frequency. There is a special focus on the oral cosylated hemoglobin (HbA1c ≥ 6.5%) as an indicator of
long-term metabolic control (around three months, or 6-8
manifestations of diabetes and the specifics of diabetic weeks in pregnant women) .
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patients undergoing various dental procedures and
interventions. In this context, hyper and hypoglycemic The prevalence of diabetes mellitus is high in all deve-
crises, which can quickly progress to coma, if not loped countries worldwide, with a tendency for further
recognized and treated promptly, are especially growth. While in 2000 there were 6.4% of affected individu-
apostrophized. With the goal of timely diagnosis, als, by 2014 the number increased to 8.3% of the world's
population, with a forecast for further growth. According
clinical manifestations and laboratory parameters of to the World Health Organization (WHO), this could exceed
acute diabetic complications are presented, as well as 12% by 2040 . Diabetes mellitus occurs in all age groups,
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risk factors that contribute to the occurrence of these with the highest prevalence observed after the age of forty,
complications. The recommendations of the American especially in underdeveloped and developing countries
and European Diabetes Associations, as well as the where there is a higher number of undiagnosed cases of
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Serbian National Guide for the Diagnosis and Treatment DM, reaching over 40% . In the geriatric population, the pre-
of Diabetes mellitus, are given regarding the necessary valence of DM is highest (>20%), with diabetes being more
commonly associated with chronic complications and other
pre-procedural evaluation of these patients and the comorbidities in older age, whether related to diabetes or
equipment of dental offices, to successfully prevent and independent of it . According to WHO data, there are cu-
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treat acute complications of diabetes. rrently around 400 million registered diabetics worldwide,
and in Serbia, according to the Institute of Public Health of
Keywords: diabetes mellitus, oral manifestations of Serbia, there are approximately 700,000 cases.
diabetes, dental interventions, acute complications of
diabetes, therapy of acute complications of diabetes Diabetes also has oral manifestations that are signifi-
cant in dental practice . However, even without oral mani-
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festations, patients with diabetes deserve special attention

REVIEW PAPER Galenika Medical Journal, 2024; 3(9):69-75. 69