Supervisors info:
Τεντολούρης Νικόλαος, Καθηγητής, Ιατρική, ΕΚΠΑ
Τόσιος Κωνσταντίνος, Αναπληρωτής Καθηγητής, Οδοντιατρική, ΕΚΠΑ
Καρούσης Ιωάννης, Αναπληρωτής Καθηγητής, Οδοντιατρική, ΕΚΠΑ
Summary:
Introduction: Diabetes Mellitus (DM) is a metabolic disorder of carbohydrates, fatty acids and proteins, caused by deficiency of insulin with its primary expression of an increase in blood glucose levels. Patients with DM are a special category of patients for the dentist due to the possibility of wound healing problems and infections after surgical procedures in the oral cavity. As a result, many studies suggest the use of Antibiotic Prophylaxis (AP) as an appropriate preventive measure.
Purpose: The purpose of this study was to investigate the possibility of healing and post-operative infections in patients with DM after surgery in the oral cavity, as well as the necessity of administrating AP as a preventive measure.
Material and Methods: PubMed®, Scopus® και Cochrane Central Register of Controlled Trials (CENTRAL) were used as database to search for articles. All articles were initially identified and classified based on the title and subsequently on their abstract. For the next level the full scientific paper was read. The studies were then classified into one of the following categories according to their level of evidence: systematic reviews, professional association publications and official recommendations, cohort studies, case control studies, cross-sectional studies, case series-case reports, literature reviews and expert opinions. Studies consisting of professional company publications, case studies as well as literature reviews and expert opinions were used to fill the gaps resulting from the inadequate number of clinical studies.
Results: The systematic search of the bibliography led to the finding of 10,217 articles. After the removal of copies, 6846 articles remained and 208 abstracts were selected based on the title of the articles. Out of these, 83 articles were selected based on the summary and then the whole scientific text was read. Overall, 54 articles were included in the study, of which 2 were systematic reviews,8 professional association publications,3 cohort study,1 case-control studies,1 cross-sectional,1 case series,8 case reports and 30 literature reviews-expert opinion.
Conclusions: In the scientific literature, there is a wide range of recommendations and inconsistency regarding the need to administer AP prior to surgical dental operations in patients with DM and there is no scientific evidence demonstrating the effectiveness of AP as a precautionary measure. The clinical studies were heterogeneous and their number was considered inadequate for the qualitative composition of the studies and the conduction of meta-analysis, while the need for more studies became evident. Most of the existing recommendations and professional association guidelines agree on the need to administer AP in patients with poor regulation. Life-threatening and potentially fatal infections are reported after extractions in cases of uncontrolled patients. The administration of AP prior to the surgical placement of dental implants in individuals with DM may improve their survival rates. Patients with insulin dependent diabetes appear to be more likely to experience wound healing and wound infection problems than patients in per os medication; therefore, a more strict glycemic control is suggested for surgical operations without prior administration of AP.
Keywords:
Antibiotic Prophylaxis, Diabetes Mellitus, Guidelines, Dental Procedures, Prevention, Oral Surgery
