Title	Risk of Alveolar Destruction Post-Operatively Following Dental Extraction is Positively Correlated to Uncontrolled Diabetes
Clinical Question	For an uncontrolled diabetic individual, is there a higher incidence of alveolar destruction after extraction, as compared to both a healthy, non-diabetic individual and a controlled diabetic individual?
Clinical Bottom Line	Uncontrolled diabetes is associated with increased risk of alveolar destruction post-operatively following dental extractions in animals.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 8811819 Devlin/1996 Streptozotocin-injected Sprague-Dawley rats. Animal Study Key results In rats with uncontrolled induced diabetes, the formation of the collagenous framework was inhibited. This led to a delayed healing and increased destruction of alveolar bone when compared with the control groups.
Evidence Search	("Dry Socket"[Mesh]) AND ( "Diabetes Mellitus"[Mesh] OR "Diabetes Insipidus"[Mesh] )
Comments on The Evidence	This was an animal study. Sprague-Dawley rats were induced to have insulin-dependent diabetes mellitus by injecting streptozotocin. For control purposes, rats were injected with citrate buffer and another group was induced with diabetes but managed with regular insulin injections. Extractions of the right maxillary molar teeth were performed. Plasma glucose levels were measured regularly and rats with uncontrolled diabetes had over 4 times higher levels than the two control groups. It was determined that uncontrolled rats exhibited an increased rate of resorption and deposition of bone, as well as delayed formation of bone in the extraction socket. Ultimately, it can be reasonably suggested that uncontrolled diabetes in humans could disrupt the formation of the collagenous framework after extraction leading to a myriad of consequences including delayed healing and alveolar bone destruction.
Applicability	The external validity for this study is low, as the test subjects were experimentally induced to have diabetes and they were animals. However, based on this evidence, when preparing for an extraction, the clinician must be cognizant that a patient whether or not a patient’s diabetes is controlled, as this can greatly delay and alter healing of the alveolar socket. They should fully brief the patient on preventative methods and what to do if a dry socket occurs.
Specialty	(General Dentistry) (Oral Surgery)
Keywords	Diabetes, alveolar osteitis, dry socket, diabetes mellitus, diabetes insipitus
ID#	2948
Date of submission	11/03/2015
E-mail	walshk@livemail.uthscsa.edu
Author	Kelly Walsh, DDS
Co-author(s)	Warrin Donowho, DDS
Co-author(s) e-mail	wittenw@livemail.uthscsa.edu
Faculty mentor	Ridley Ross, DDS
Faculty mentor e-mail	rossr@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available