Long-Term Management of a Periodontal Disease Patient with Diabetes Mellitus by a Dental Hygienist

Abstract

Periodontal disease is a lifestyle-related disease as well as an infectious disease, and is often associated with various systemic diseases. In particular, periodontal disease and diabetes often coexist. Herein, we report the case of a patient with diabetes mellitus who presented with diffuse severe chronic periodontitis, in whom a stable condition has been maintained by ensuring regular management and good communication for 17 years. The patient was a 40-year-old man who was referred to our hospital in November 2001 for the treatment of periodontal disease. A year and a half ago, he had been diagnosed as having type 2 diabetes mellitus and suffered from gangrene of his right leg as a complication of diabetes.

He had been treated by below-knee amputation of the right leg, and was currently wearing an artificial limb. Examination of the oral cavity revealed gingival swelling and calculus deposition, and poor oral hygiene. Horizontal bone resorption was mainly observed in both the upper and lower jaws, and virtical severe bone resorption was also partially observed. The patient did not brush his teeth adequately. His self-care habits were established by frequent provision of instructions for maintaining good oral hygiene and he was explained the link between periodontal disease and diabetes mellitus to motivate him to clean his mouth. He was treated with tetracycline during scaling and root planing (SRP), to improve the bacterial flora in the periodontal pockets. Considering the presence of infection and poor wound healing, non-surgical treatment was performed, followed by treatment for recovery of oral function. Good improvement of periodontal tissue was observed, and about one year after the first medical examination, the patient was transitioned to SPT (supportive periodontal therapy). There were times during the course of long-term management when the serum HbA1c level became unstable, however, a stable periodontal condition has been maintained for 17 years, without the loss of teeth, through setting his visit intervals and cleaning sessions according to the prevailing situation.