Patients with poor glycemic control are more prone to oral manifestations of diabetes, including periodontal disease, salivary gland dysfunction, halitosis, burning mouth sensation, delayed wound healing and increased susceptibility to infections. Diabetic patients are also at risk of experiencing an intraoperative diabetic emergency in the dental office. People with DM are also more prone to fungal and bacterial infections, oral soft tissue lesions, compromised oral wound healing processes, dental caries and tooth loss. Therefore, it is important that dentists take an active role in educating patients about DM control and the potential impact of lack of control on their oral well-being.
Diagnosis
Several diagnostic tools are available to clinicians to assess their patient’s blood glucose control. The fasting plasma glucose (FPG) test measures blood glucose level following a period of zero caloric intake for at least 8hours. An FPG level of about 5.6 mmol/L or less is considered normal. The hemoglobin A1C (HbA1c) test provides information about average blood glucose levels over the past 3 months. This test, which is reported as a percentage, is used by clinicians to assess control and management of DM. In a healthy, non-diabetic patient, an HbA1C level of 5.7% or lower is considered normal.
Current diagnostic criteria for diabetes. Test
| Fasting plasma glucose test | Measures blood glucose following zero caloric intake for at least 8 h | ≤ 5.6 mmol/ |
| Hemoglobin A1C test | Provides information about glycemic control over the past 3 months | ≤ 5.7% |
Management
At the core of every DM management or treatment plan is an attempt to restore blood glucose levels to as close to normal as possible. Notably, if blood glucose levels can be adequately managed and controlled, progression to complications can be delayed or even prevented. In many cases, DM management becomes quite complex with intensive treatment plans; therefore, patient compliance is an important factor in predicting success. Thorough patient education, compliance with medication, adherence to lifestyle changes (i.e., diet, exercise) and at-home blood glucose monitoring are all essential in achieving adequate glycemic control. The dentist should be aware of their patients’ treatment plans and should reinforce the importance of compliance.
Dental Management Considerations
Before initiating treatment of a diabetic patient, dentists must appreciate important dental management considerations. In doing so, dentists can help to minimize the risk of an intraoperative diabetic emergency and reduce the likelihood of an oral complication of the disease.
Dental management considerations for the diabetic patient
- Consult with patient’s physician to assess diabetes control
- Update medical history and medications and review systems at each appointment
- Confirm that patient has eaten and taken medications before initiating treatment
- Anticipate and be prepared to manage hypoglycemia
- Prevent, treat and eliminate infections promptly
- Do not use or recommend aspirin-containing co
- Achieve profound local anesthesia Ensure excellent oral hygiene and provide profound preventive care
- Reinforce regular diet and medication regimen before and after dental appointments
- Take glucometer reading if patient is high risk, on insulin or having surgery
- morning appointments are advisable in patients with diabetes since endogenous cortisol levels are typically higher because cortisol increases blood sugar levels, the risk of hypoglycemia is less.
- For patients using short- and/or long-acting insulin therapy, appointments should be scheduled so they do not insulin activity, which increases the risk of hypoglycemia.
Management of an intraoperative hypoglycemic emergency.
| Signs and symptoms | Emergency management |
|---|---|
Mild
Moderate
Severe |
Awake/alert patient
Uncooperative patient
Unconscious patient
|