Nurse the dental implants

With a large number of people using dental implants, it has become extremely important to take care of oral hygiene — keeping the implants from infection and also ensuring that they do not harbour bacteria. Diabetics, in particular, need to take extra care as high or low blood sugar levels affect the implants too. Prosthodontist and implantologist, Dr Prasad M answers some queries about implants.

How does an implant affect a person? Is it prone to infections and fluid retention? Can it have bacteria growing inside if it is badly fitted?
Dental implants function just like natural teeth and they can become infected just like natural teeth. Yes, they are prone to infections and bacteria build-up. Poor oral hygiene may lead to infection and inflammation in the area surrounding the implant which occurs more often in diabetics and smokers.

If you suffer from receding gums and reduced bone levels, you may be able to see the implant’s rough surface, which in addition may allow bacteria to collect and cause infection. In several cases, you may end up in losing the implant.

How are patients with controlled diabetes affected with diseases in implants?
In diabetics, when the blood sugar level increases, the immunity of the patient decreases which in turn leads to increased risk of gum infections. The risk is lesser in controlled diabetics.

How are patients with uncontrolled diabetes affected by diseases in implants? What are the cases seen at the clinical level?
There is a two-way relation between gum infection and diabetes. Gum infection leads to deactivation of the tyrosine phosphatase enzyme on insulin receptors, which leads to reduced intake of insulin, which in turn leads to increased blood sugar levels (hyperglycemia). Diabetes leads to the thickening of blood vessels which leads to a decrease in blood supply to the gums and mouth .The decreased blood supply causes a decrease in nutrient supply to that area and slows down removal of harmful wastage. This in turn leads to decrease of immunity which increases gum infection around the implant. Therefore, patients with uncontrolled diabetic levels are more prone to get gum infections around implants.

Do these people require second implants after cleaning? Is it a very risky exercise?
Because of improper blood sugar levels, placing implants a second time is a risky practice. In such patients, smooth surface bi-cortical implants are the only remedy.

Do diabetic patients require regular screening sessions when they have oral cavity implants for metabolic control. What is the metabolic change seen in them?
Regular screening is required once every six months to a year in diabetic patients. Patients with poor blood sugar control may present an elevated risk of post-operative complications such as infection and delayed wound healing. Dental implant success has been dependent on direct bone to implant contact but bone and mineral metabolism are altered in diabetics.

What happens once an implant is infected in both diabetic and non-diabetic patients?
Once the infection sets in the implant, it might become a failure because the implant does not have its own immunity.

What is the treatment schedule for an infected implant and how can it be cured?
Depending on the severity of infection, the dentist may prescribe mouth rinses, antibiotics, surgery or laser therapy with surface decontamination.

Look out for these
Once the infection sets in the implant, it might become a failure because the implant does not have its own immunity. Here are a few signs to look out for when the implant is infected
Red or puffy gums around the implant
The implant will become loose
If your implant is infected you may experience bad breath
The patient will suffer from throbbing pain or discomfort in the implant area
The pus accumulate will be visible in the implant area