Association between immunologic parameters, glycemic control, and postextraction complications in patients with type 2 diabetes

• Published in: The Journal of the American Dental Association (1939) Vol. 146; no. 8; pp. 592 - 599
• Main Authors: Fernandes, Karin Sá, DDS, PhD, Glick, Michael, DMD, de Souza, Mario Sérgio, DDS, Kokron, Cristina Maria, MD, PhD, Gallottini, Marina, DMD, PhD
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-08-2015; American Dental Association
• Subjects: Adult; Aged; Aged, 80 and over; Case-Control Studies; Dental care; Dentistry; Diabetes; diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - immunology; Diabetes Mellitus, Type 2 - therapy; Female; Glycated Hemoglobin A - analysis; Humans; Hyperglycemia; Immune system; infection; Male; Metabolism; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative period; Prospective Studies; Tooth extraction; Tooth Extraction - adverse effects; Wound healing; hyperglycemia; infection; wound healing; USP; HbA 1c; University of São Paulo; Tooth extraction; diabetes mellitus; Immunoglobulin; Glycated hemoglobin; Ig; HbA1c
• ISSN: 0002-8177; 1943-4723
• DOI: 10.1016/j.adaj.2015.02.014

Abstract Background The purpose of this study was to assess the association between metabolic control and immune dysfunction, and postoperative complications and wound healing after dental extractions in people with type 2 diabetes and control participants. Methods The authors performed a prospective, case-control study enrolling 53 participants with type 2 diabetes and 29 participants who did not have type 2 diabetes. Exclusion criteria included being a smoker and having teeth with periodontal pockets deeper than 4 millimeters, among others. All participants underwent an extraction of 1 erupted tooth. The investigators assessed patients’ signs and symptoms at 3, 7, 21, and 60 days after surgery. The investigators measured glycemic control and immunologic profile at the time of the extraction. They compared the pattern of healing and the incidence of postextraction complications between the 2 groups. Results Even in the presence of impaired neutrophil function and poor glycemic control, we found no increase in the number of postoperative complications. There was no association between delayed wound epithelialization on postoperative day 21 and level of glycemic control, and reduced neutrophil function. On postoperative day 60, all alveolar sockets were epithelialized completely and showed no signs of infection. Conclusions The study results suggest that type 2 diabetes per se or glycemic control is not a risk factor for experiencing postoperative complications in people undergoing dental extractions. Although people with type 2 diabetes may have impaired neutrophil function, the study results revealed that having this condition was not associated with an increased risk of experiencing postoperative complications. Additional research studies with larger sample sizes of patients who have diabetes are needed to confirm this study’s findings. Practical Implications The results allow clinicians to infer that people with type 2 diabetes undergoing dental extractions of erupted teeth that do not have an acute odontogenic infection should not receive antibiotic prophylaxis simply because of their diabetic status or level of glycemic control.