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Odontología y Diabetes

La diabetes como tal no es la responsable de ninguna enfermedad bucal específica, pero  está demostrado que las complicaciones orales de la diabetes están relacionadas con la capacidad de una persona de controlar sus niveles de azúcar en sangre (control glucémico) y su salud en general.

Es por eso que el odontólogo entra a ser parte  fundamental  del equipo multidisciplinario en le manejo de la diabetes, pues los problemas bucales no solo dificultan el control metabólico adecuado si no que agravan de por si la evolución de la enfermedad como tal.

Manifestaciones orales de la diabetes

  • lesiones de los tejidos blandos: Entre las enfermedades  más comunes  de la boca se encuentran las infecciones por hongos (Candidiasis), las úlceras, la estomatitis y los cambios en la lengua (como fisuras linguales, lengua saburral, alteraciones del sentido del gusto, lengua ardiente, depapillación lingual, sensación de ardor).

El desarrollo de estas afecciones se debe a la sequedad de boca, a la lenta cicatrización de las heridas y a la alteración de las respuestas inmune (sistema de defensa) e inflamatoria.

Además, la erupción de los dientes puede estar alterada, puede haber aumento en la frecuencia  de caries y alteraciones  del esmalte.

  • Caries Dental: Afecta a todo el mundo, pero especialmente a quienes tienen diabetes. Esto se debe principalmente a los mayores niveles de glucosa de la saliva que baña los dientes. Se ha observado en diabéticos un aumento en la incidencia de caries con localizaciones atípicas, fundamentalmente, caries a nivel de los cuellos dentarios, sobre todo, en incisivos y premolares. Asimismo también son más frecuentes las consecuencias de la caries, como la celulitis, la alveolitis post extracción o el edentulismo (pérdida de los dientes).
  • La enfermedad periodontal (gingivitis y periodontitis) : es llamada la 6ª complicación de la diabetes junto con el daño en los nervios, en los riñones, los problemas visuales y el daño en los vasos sanguíneos, y es el segundo trastorno bucal en importancia tras la caries dental; constituyendo la primera causa de pérdida dentaria.

La enfermedad periodontal es una enfermedad inflamatoria, desencadenada por las bacterias de la placa dental, que producen la infección de las encías (gingivitis, que se da en una etapa temprana de la enfermedad) seguida de la destrucción del hueso (periodontitis).

Los síntomas son difíciles de notar al principio; pero con el progreso de la enfermedad, aparecen:

- Inflamación de las encías (encías rojas, hinchadas).

- Picor o rasquiña de las mismas.

- Sangrado de encías cuando se cepillan los dientes.

Cuando las enfermedades periodontales han evolucionado a periodontitis, suelen aparecer otros síntomas tales como:

- Retracción o remangamiento de las encías, sensación de dientes más largos.

- Movilidad de los dientes (dientes flojos)

- Aumento de la sensibilidad dentaria, sobre todo cuando se ingieren alimentos frios. 

- Mal aliento.

- Aparición de abscesos  la encía.

enfermedad de las encias

Para las personas con diabetes , la enfermedad de las encías es tratada por el odontólogo removiendo la placa con el fin de eliminar la infección y reducir la inflamación, además de mantener los niveles de glucosa en metas.

  • Aftas o Fuegos: Un afta es una úlcera o llaga abierta y dolorosa en la boca, de color blanco o amarillo y rodeada por un área roja y brillante. Las aftas suelen aparecer en las superficies interiores de los carrillos y los labios, la lengua, el paladar blando y la base de las encías.

 

  •  Boca Seca o Xerostomia: Es la sensación de sequedad de la boca por deficiencia persistente en el volumen de saliva necesario para mantener la boca húmeda.Las personas que tienen la boca seca generalmente tienen problemas al comer, hablar, tragar y al utilizar dentaduras postizas, asimismo presentan dolor en la lengua, incremento en la sed (por las noches) y sobre todo problemas de gusto.

    Además, las personas con diabetes pueden tener un daño grave en los dientes que puede progresar rápidamente dependiendo de la sequedad de la boca.

  • Alteraciones en el gusto: Se ha descrito en pacientes diabéticos mayort sensibilidad  en la punta de la lengua que en los bordes laterales así como sensación de gusto metálico.
  •  Síndrome de la boca ardiente (Estomatodinia esencial, Estomatopirosis): Aunque puede estar causada por muchos factores, ha sido relacionada con desequilibrios hormonales y metabólicos incluyendo la diabetes mal controlada. Los factores sicológicos como la depresión, la ansiedad, la estabilidad y adaptabilidad emocional, también serían muy importantes en el desencadenamiento de la patología. Se manifiesta con una sensación extraña que el paciente define como una quemazón comenzando primero por los  labios,  luego en la lengua, los carrillos y el paladar (también existe sequedad bucal).

 Las molestias son de intensidad variable, en algunas ocasiones insoportables, aunque a veces aparece dolor intenso que suele ser permanente con crisis durante el día. En el examen fisico  se encuentran los tejidos normales con el mismo color que la mucosa que los rodea y sin ningún signo evidente de lesión. Algunos autores consideran que la Estomatopirosis es una enfermedad psicosomática, y como tal, los pacientes deben realizarse una evaluación psicológica.

  • Candidiasis Oral: Infección por levaduras como es la Cándida Albicans: hongo oportunista, presente en la mayoría de las personas pero cuando se produce un desequilibro en el organismo causante de la baja en las defensas como diabetes en especial cuando está descompensada, cancer, tratamientos con corticoesteroides y otros, éste hongo causa  la Candidiasis. Pero en la diabetes en general existe una predisposición a padecer candidiasis, independiente de los niveles de glucosa sanguínea.

Clínicamente da una sintomatología leve, generalmente en forma de quemazón en la faringe y mucosa oral que además están enrojecidas y en algunos casos presentan formaciones blanquecinas.

 

Para mantener sus encías y dientes sanos, he aquí algunos consejos:

- Mantenga su nivel de glucosa sanguínea en niveles adecuados. Esto es una de las cosas más importantes que puede hacer para  mantener la salud de su boca.

- Visite a su odontólogo  cada 6 meses para un examen completo, en caso de ser necesario visítelo con mayor frecuencia.

- Hable con el odontólogo  sobre cómo mantener una buena salud bucal.

Recuérdele al odontólogo que tiene diabetes antes de cada procedimiento que le  vaya a hacer.

- Consulte lo antes posible en caso de que presente llagas, fuegos, heridas, sangrado de encías, ulceras, pérdida de dientes, dolor en la boca, parches blancos o mal aliento.

- Examine regularmente su boca para detectar los problemas a tiempo.

- Cepille los dientes después de comer y antes de acostarse. Use el cepillo de dientes adecuado y seda dental.

Informe a su odontólogo  si la dentadura postiza no se ajusta apropiadamente o si las encías le duelen.

- Mantenga limpios su dentadura postiza o puentes móviles.

- Antes de iniciar cualquier procedimiento odontológico asista a su médico del control para que le de las recomendaciones que debe tener en cuenta antes, durante y después (premedicación, mediciones de glucosa, manejo del dolor).

- Evite el cigarrillo o deje de fumar. El tabaco agrava las enfermedades de las encias.

 

Referencias Bibliográficas

 

-Leonardo Berini Aytés, Cosme Gay Escoda,. “Cirugía Bucal”: 3.2.8. ENFERMEDADES ENDOCRINAS.

- Livia Escovich, José Luis Novelli. “Glándulas Salivales”, Patologías, diagnóstico y tratamientos. Cap. 2: Trastornos funcionales: Xerostomía, Estomatodinias.

-“Tratamiento dental en el paciente diabético”: Sitio: Salud Dental Para Todos.“Manifestaciones-bucales-de-la-diabetes”: Diabetes and Hormone Center of the Pacific.

- “La atención estomatológica de las personas con necesidades especiales”: Marketing dental, Adminstración de consultorio dental y Gestión en Odontología.

-“Consideraciones a tomar en cuenta en el manejo odontológico del paciente con Diabetes Mellitus”: http://www.actaodontologica.com

-“La Odontología en el control y el diagnóstico de la diabetes” Atención sanitaria. Martin Gillis y Steven-Saxon.

 

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