Orthdontic Treatment Considerations in Patients with Diabetes

The demand for orthodontic treatment among adults has been steadily rising, and it's likely that the adult population will present with more complex dental issues, potentially including chronic conditions like diabetes mellitus. Diabetes mellitus (DM) is a chronic metabolic disorder characterized by insulin deficiency or insulin resistance or both, subsequently leading to a disruption in carbohydrate, fat and protein metabolism. Type I DM or insulin dependent DM (IDDM) is a result of insulin deficiency owing to an autoimmune destruction of pancreatic β cells, more common in younger patients, below 19 years of age; and Type II DM or non-insulin dependent DM (NIDDM) is owing to a resistance in insulin uptake more common in adult patients. Orthodontic tooth movement is a result of complex mechanical loading patterns with consecutive reactions to the periodontal tissues. The orthodontic force applied stimulates the release of multiple biological agents into the local microenvironment ultimately triggering an aseptic inflammatory response leading to local periodontal tissue remodeling. Orthodontic compressive strains on the periodontal ligament and alveolar bone stimulate osteoclastogenesis, and tensile strains on the other side of the tooth, increases the differentiation rate of osteogenic progenitor cells into mature osteoblasts resulting in osteoid deposition. Therefore, for progressive tooth movement to occur in orthodontics, osteoclast-mediated bone resorption occurs in the compressive zone and osteoblast-mediated bone formation takes place in the tension zone. Diabetes mellitus alters the process of bone remodeling that will have an impact on orthodontic tooth movement and ultimately affect treatment goals set out by the orthodontist. The aim of this narrative review is to highlight the mechanisms that DM may have on orthodontic treatment and considerations in managing adult and children orthodontic patients with diabetes.