Dental implications of altered hemostasis in patients with diabetes mellitus: A narrative review

The current study examines the effects of altered hemostasis on various dental issues related to patients with diabetes mellitus (DM). Chronic hyperglycemia causes substantial changes to the hemostatic status, producing a state of platelet hyper-reactivity and reducing the vascular response. The underlying pathophysiology involves the non-enzymatic glycation of the coagulation proteins and the development of microangiopathy, both of which diminish the efficacy of local vasoconstriction during surgical manipulation. Furthermore, the presence of hypo fibrinolysis, caused by increased levels of PAI-1, creates a dense yet fragile clot that does not undergo appropriate remodeling. The result is that these systems expose the patient to increased clinical risk for prolonged postoperative bleeding and inadequate socket healing, thus requiring increased vigilance when performing dental procedures on patients with DM. To effectively manage these patients in the dental setting, it is essential to have a thorough understanding of the relationship between metabolic control and local tissue repair. This study used a literature review approach with a descriptive narrative to synthesized the most current findings on biomarkers and surgical outcomes in dental procedures. Overall, the findings from this study demonstrate that some common postoperative complications, such as osteitis alveolaris and delayed healing of the surgical site, are directly related to the microvascular and hematological impairments that characterized DM. Therefore, in order to provide safe dental care, dentists should develop and implement multidisciplinary treatment strategies, including the use of local hemostatic agents (e.g., tranexamic acid) and perform preoperative glycemic assessments. Finally, the need for customization of dental interventions to meet the unique characteristics of individual patients with DM was also stressed.