Ms. Wu, a 32-year-old woman from Zhuzhou, sought treatment for unbearable dental pain at a local dental clinic and underwent root canal therapy. However, two days later, she began experiencing pain in her right cheek as well. Upon looking in the mirror, she discovered that her right face was swollen, her mouth corner had become asymmetrical, and air was leaking from her cheek; her right eye could no longer close.
At a local hospital, Ms. Wu was diagnosed with facial neuritis accompanied by facial cellulitis. However, despite receiving antimicrobial therapy, her symptoms did not improve significantly. She then visited several provincial hospitals, but the treatments were ineffective. The intense pain made it difficult for Ms. Wu to eat or sleep. In her distress, a friend suggested she visit a hospital in Changsha.
Upon admission, examinations revealed that in addition to the maxillofacial infection, Ms. Wu had elevated blood ketones at 0.56 mmol/L (normal value ≤0.3 mmol/L) and reduced carbon dioxide binding capacity, with a blood glucose level of 19.74 mmol/L (normal fasting blood glucose is 3.9–6.1 mmol/L), indicating diabetic ketoacidosis.
Ms. Wu indicated that she had been diagnosed with diabetes ten years ago and had taken metformin for a while. Due to a lack of noticeable symptoms, she gradually became complacent, stopped taking her medication, and did not monitor her blood glucose levels thereafter.
“How could my face swell and be in so much pain after dental treatment, even with diabetes?” Ms. Wu was perplexed.
The director of the endocrinology department explained that her facial neuritis and cellulitis following root canal treatment were ultimately related to her long-term hyperglycemic state. Individuals with elevated blood glucose levels tend to have compromised immune systems. Once pulpitis develops, bacteria can easily enter the body through the apex or periodontal tissues, allowing the infection to spread to the maxillary bone and surrounding cellulitis, leading to oral and maxillofacial infections that result in symptoms of redness, swelling, heat, and pain, as well as severe, persistent neuropathic pain. The presence of infection in the maxillofacial spaces can lead to facial neuritis, causing asymmetrical mouth corners and an inability to close the eye. Effective blood glucose control is essential for antimicrobial treatment to be effective.
Given that Ms. Wu was concurrently suffering from maxillofacial infection, type 2 diabetic ketoacidosis, facial neuritis, and chronic pulpitis—and faced the risk of the facial infection spreading intracranially, potentially causing headaches, fever, vomiting, altered consciousness, psychiatric disorders, seizures, coma, or even life-threatening situations—the endocrinology department convened a multidisciplinary team (MDT) discussion involving experts from oral surgery, otorhinolaryngology, neurology, and clinical pharmacy. They decided to administer intensive antimicrobial treatment along with glucose-lowering therapy, fluid replacement, and nutritional support until the inflammation subsided, after which targeted treatment for oral and facial neuritis could proceed.
After a week of adjusted treatment, Ms. Wu showed a decrease in inflammatory markers and some improvement in facial swelling. Once the infection was fully controlled, she would receive targeted treatment for her facial neuritis.
“I thought I could ignore my high blood sugar because I was young, but this experience has made me suffer tremendously. High blood sugar poses many risks, and I’m determined to follow the doctor’s advice and strictly manage my blood sugar!” Ms. Wu resolved.
The doctor stated that typical symptoms of diabetes include “three increases and one decrease”: increased eating, increased drinking, increased urination, and weight loss. However, by the time these symptoms appear, the patient’s blood sugar is often extremely high. Most individuals with diabetes do not exhibit obvious symptoms and may not experience significant discomfort. Prolonged periods of elevated blood sugar can lead to various complications, including multiple infections. If treatment is not timely, it can result in sepsis, septic shock, and even life-threatening conditions.
Therefore, individuals with diabetes must adhere to medical advice regarding glucose-lowering treatment and regularly monitor fasting blood glucose levels and postprandial blood sugar levels at two hours after meals. They should only undergo root canal therapy, tooth extractions, or other dental procedures once their blood glucose levels are within the target range.
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