Gestione Clinica del Paziente Diabetico

The Diabetes Mellitus II type is a chronic pathology typical of the third age. With the course of the illness the person affected by DM can present long term complications that aggravate the clinical picture. Systemic diseases such as the diabetes mellitus can influence very much the diet of the affected patient; and besides that the dehydration joined to the hyperglicemia, the neuropathy and the diabetic angiopathy can cause xerestomy. The saliva, important for the organization of the alimentary bolus, dissolving partly the food, makes possible a better contact with the gustatory papillas helping the taste perception, cleans and reduce the attachment of the plaque on dental surface and mucosas and makes better the attachment of the total prothesis to the mucous surface of the maxillaries. The hyposcialia makes difficult the deglutition and the mastication, reduces the prothesis retention and causes oral lesions of the mucosas given by backing lubrification. The absorption of food and its digestion as regard to a diabetic patient, can be modified by the presence of autonomic neuropathy that, even if not clinically evident, aims to increase the intestinal peristalsis up to phenomenon such as the ”diarrea diabeticorum”. A lack of metabolic compensation as we can deduce from the measurement of the HbA1c,can easily bring infections, micro and macroangiopathy, polyneuropathies,diabetic retinopathy proliferative and not, AOCAI,IRC, ulcers, phlegmous, osteomyelitis to lower limbs diabetic foot and soon. Some of these complications affect the stomatognathic apparatus with connected more frequency and aggressiveness of parodontopathies, easy gingival bleeding, microangiopathy of gingival tissue and profound paradontium, stomatodinia from neuropathy, disgeusia, xerestomy from hyperglycemia, and soon. All this can cause an untimely increase of dental mobility, evidence of loss of tissue of dental support, alveolar ligament-bone-radicul cement and consequently untimely loss of dental elements. Considering that the correct working of the masticatory apparatus is the first essential phase of a fit digestion, we can understand the importance of a proper dietetic and pharmacological diet that allows the patient to be compensated. The aim of this thesis, besides explaining the clinical pictures of DM, its long term complications and the consequences on the stomatognathic system, is to check whether or not in diabetic patients the deterioration of the chewing apparatus is bigger than in non diabetic persons. The data gathered from the clinical oral examination of 553 diabetic patients have been checked with those of 112 non diabetic patients; all the persons have been treated at the INRCA †"Ancona- or at G.Mazzini Hospital-Teramo- and have been screened during these three years.