Impact of DM on healing and complications in post dental surgical procedures: a simple narrative review

Diabetes mellitus is defined as a condition that is characterized by certain disorders in sugar metabolism along with neuropathy and micro-vascular disorders. Furthermore, it is among the complicated diseases that affect the process of dental and oral surgeries. In spite of the fact that the surgical techniques have undergone remarkable improvement in the last years, it remains a current issue implying a certain effect of diabetes on postoperative recovery and complications in surgery. Methods: The present narrative review was based on a targeted literature search of MEDLINE, Google Scholar and EMBASE. All relevant papers published during the last two decades on the relationship between diabetes and wound healing in oral surgery were reviewed. Findings: Diabetes has a negative impact on wound healing due to numerous factors. High concentration of pro-inflammatory cytokines, low concentration of growth factors (VEGF, TGF_β) along with low levels of angiogenesis/collagen synthesis, low tissues' tensile strength, may serve as examples of important pathophysiological factors associated with the problem in question. Patients suffering from diabetes are exposed to higher risks of complications, such as slow epithelialization, developing of infections and dry socket which usually occurs after extraction of lower molars, osteomyelitis, etc. Additionally, prolonged periods of hyperglycemia minimize cellular and humoral immune responses, thus making it possible to develop opportunistic infections and suppress wound healing processes in case of the presence of oral fistulae. Conclusion: Poorly managed cases of diabetes mellitus are an independent and important risk factor for developing more complications as well as poor healing in the wound of surgery in the oral cavity. To reduce the number of complications in such patients, a multimodal approach including pre-operative optimization of blood glucose level, proper dietary advice, antiseptic rinses and post-operative follow-ups should be undertaken. Success of the treatment depends on the surgeon’s awareness of the metabolic state of the patient and modification of the surgical technique according to the degree of diabetes control.

Keywords:

Diabetes mellitus , Dental surgery , Wound healing , Postoperative complications , Dry socket , Metabolic control