DIABETES MELLITUS

Hypoglycemia Compared with Hyperglycemia

Signs and Symptoms	Hypoglycemia (40-50 mg/dL)	Hyperglycemia (400-600 mg/dL)
Onset	Rapid (minutes)	Slow (days/weeks)
Thirst	Absent	Increased
Nausea and vomiting	Absent	Frequent
Vision	Double	Dim
Respirations	Normal	Difficult, hyperventilation
Skin	Moist, pale	Hot, dry, flushed
Tremors	Frequent	Absent
Blood pressure	Normal	Hypotension

Features of Severe Diabetic Ketoacidosis

Features	Possible Causes
Symptoms
Thirst	Dehydration
Polyuria	Hyperglycemia, osmotic dieresis
Fatigue	Dehydration, protein loss
Weight loss	Dehydration, protein loss, catabolism∗
Anorexia	∗
Nausea, vomiting	Ketones,∗ gastric stasis, ileus
Abdominal pain	Gastric stasis,∗ ileus, electrolyte deficiency∗
Muscle cramps	Potassium deficiency∗
Signs
Hyperventilation	Acidemia
Dehydration	Osmotic diuresis, vomiting
Tachycardia	Dehydration
Hypotension	Dehydration, acidemia
Warm, dry skin	Acidemia (peripheral vasodilation)
Hypothermia	Acidemia-induced peripheral vasodilation (when infection is present)
Impaired consciousness or coma	Hyperosmolality
Ketotic breath	Hyperketonemia (acetone)

∗ Indicates speculated or unknown cause.

Oral Complications of Diabetes Mellitus

Clinical Signs and Symptoms	Pathophysiology
Salivary and Oral Changes
Xerostomia	Increased fluid loss
Bilateral, asymptomatic parotid gland swelling with increased salivary viscosity	Increased fatty acid deposition Increased salivary glucose levels Compensatory hypertrophy due to a decrease in saliva production

Increased dental caries, especially in cervical region Secondary to xerostomia and salivary glucose levels Unexplained odontalgia and percussion sensitivity (acute pulpitis) Pulpal arteritis from microangiopathies Lingual erosion of anterior teeth∗ Complications of anorexia nervosa and bulimia Periodontal Changes Periodontal disease^† Induction and accumulation of AGEs Tooth mobility   Rapidly progressive pocket formation Degenerative vascular changes Gingival bleeding Subgingival polyps Cause unknown Infection and Wound Healing Slow wound healing (including periapical lesions after endodontics) and increased susceptibility to infection Oral ulcers refractory to therapy, especially in association with a prosthesis Irritation fibromas Altered wound healing Increased incidence and prolonged healing of dry socket Tongue Changes Glossodynia Median rhomboid glossitis (glossal central papillary atrophy) Candida albicans Other Changes Opportunistic infections: Candida albicans and mucormycosis Acetone or diabetic breath (seen when the person is close to a diabetic coma) Ketoacidotic state Increased incidence of lichen planus (as high as 30%) Compromised immune system

AGE, Advanced glycation end product.

∗ Although not a complication of diabetes per se, this pattern is seen when the person wants to maintain the weight-loss aspect of diabetes while ignoring or tolerating the hyperglycemic side effects. Client may not be taking proper insulin doses and may not be truthful when asked about this.

† Periodontal disease is seen in up to 40% of diabetic patients. Adequate periodontal therapy may result in decreased insulin requirements.

Adapted from Lalla RV, D’Ambrosio JA: Dental management considerations for the patient with diabetes mellitus, J Am Dent Assoc 132:1425, 2001.

CANCER

HUMAN IMMUNODEFICIENCY VIRUS

AIDS-Defining Conditions and Diagnostic Criteria

Condition	Signs and Symptoms
Candidiasis	Of the bronchi, trachea, lungs, or esophagus
Cervical cancer	Invasive
Coccidioidomycosis	Disseminated or extrapulmonary
Cryptococcosis	Extrapulmonary
Cryptosporidiosis	Chronic intestinal (>1 month duration)
Cytomegalovirus disease	Other than liver, spleen, or nodes
Cytomegalovirus retinitis	With loss of vision
Encephalopathy	HIV-related
Herpes simplex	Chronic ulcer(s) (>1 month duration), or bronchitis, pneumonitis, or esophagitis
Histoplasmosis	Disseminated or extrapulmonary
Isosporiasis	Chronic intestinal (>1 month duration)
Kaposi’s sarcoma	Intraoral or extraoral
Lymphoma	Burkitt’s lymphoma Immunoblastic Primary, in the brain

Mycobacterium avium complex or Mycobacterium kansasii Disseminated or extrapulmonary Mycobacterium tuberculosis Any site (pulmonary or extrapulmonary) Pneumocystis carinii Pneumonia