| Aspect | Explanation |
|---|---|
| Synopsis | – Diabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. – It is classified primarily into Type 1 diabetes (autoimmune destruction of pancreatic beta cells) and Type 2 diabetes (a result of insulin resistance and relative insulin deficiency). – Poorly managed diabetes can lead to severe complications like cardiovascular disease, neuropathy, retinopathy, and kidney damage. |
| Signs and Symptoms | – Increased thirst (polydipsia) – Frequent urination (polyuria) – Extreme hunger (polyphagia) – Unexplained weight loss – Fatigue – Blurred vision – Slow-healing sores or frequent infections – Tingling or numbness in the hands or feet |
| Appropriate Management in the Dental Clinic | – Blood Glucose Monitoring: Measure blood glucose levels before and during significant procedures. – Scheduling: Preferably schedule short, morning appointments to optimize blood glucose control and minimize stress. – Stress Reduction: Employ stress-reduction techniques such as deep breathing, short breaks during lengthy procedures, or listening to calming music. – Local Anesthesia: Ensure adequate local anesthesia to prevent pain-induced stress and spikes in blood glucose. – Oral Hygiene Instruction: Provide thorough oral hygiene instructions and stress the importance of maintaining good oral health to prevent infections. |
| Precautions | – Hypoglycemia: Be prepared to manage hypoglycemic events; keep a source of glucose such as tablets or juice available. – Infections: Diabetic patients have an increased risk of infections. Ensure meticulous aseptic techniques and consider prophylactic antibiotics if indicated. – Delayed Healing: Recognize that healing may be delayed. Plan for additional follow-ups to monitor recovery. – Position of the Chair: Avoid prolonged chair time and ensure patient comfort to prevent circulatory issues. |
| Classification of Blood Sugar Levels and Dentist Guidelines | – Normal Fasting Blood Sugar: <100 mg/dL (Treat as usual) – Prediabetes Fasting Blood Sugar: 100-125 mg/dL (Treat with caution; emphasize preventive care) – Diabetes Fasting Blood Sugar: ≥126 mg/dL (Ensure proper diabetes management before treatment) – Hypoglycemia: <70 mg/dL (Immediate glucose management, delay elective dental treatment) |
| Can They Be Seen in the Dental Clinic and When Not | – Before administering treatment ensure HBA1c is < 7% – Can be seen with caution: Patients with well-controlled diabetes (Fasting Blood Sugar < 126 mg/dL) can generally be treated safely with appropriate precautions. – Should not be seen if: Patients present with hypoglycemia (<70 mg/dL) or hyperglycemia (>240 mg/dL). Immediate medical management is required before dental treatment can proceed. |
| Drug Contraindications | – Steroids: Can elevate blood glucose levels; use cautiously, and consult with the patient’s physician. – Beta-blockers: May mask symptoms of hypoglycemia. – Certain Antibiotics: Some antibiotics can interfere with blood sugar control; always consult with the patient’s healthcare provider. |
Oral Complications Associated with Diabetes Mellitus (DM)
| Oral Complication | Description |
|---|---|
| Periodontal disease | Increased risk associated with DM due to reduced polymorphonuclear leukocyte function, formation of advanced glycation end products, and changes in collagen metabolism. |
| Salivary gland dysfunction | Hyposalivation may be related to polydipsia and polyuria, leading to xerostomia, halitosis, taste disturbance, exacerbated periodontal disturbance, dental caries, and tooth loss. |
| Halitosis | Bad breath associated with dry mouth and other metabolic syndromes in DM. |
| Burning mouth sensation | A painful and burning feeling in the mouth without an obvious cause. |
| Taste dysfunction | Altered taste perception due to salivary gland dysfunction or other DM-related factors. |
| Fungal and bacterial infections | Increased susceptibility due to impaired host defense mechanisms. |
| Oral soft tissue lesions | Compromised oral wound healing due to delayed vascularization and reduced blood flow. |
| Dental caries and tooth loss | Increased risk, particularly associated with xerostomia. |
Target Values for Diabetic Patients
| Measurement | Target Value |
|---|---|
| HbA1C | ≤ 7.0% |
| Fasting blood glucose | 4.0–7.0 mmol/L |
| Blood glucose 2 h after eating | 5.0–10.0 mmol/L (5.0–8.0 mmol/L if HbA1C targets not being met) |
Management of an Intraoperative Hypoglycemic Emergency
| Severity | Signs and Symptoms | Emergency Management |
|---|---|---|
| Mild | Hunger, fatigue, sweating, nausea, abdominal pain, headache, tachycardia, irritability | Terminate dental treatment immediately, administer 15 g oral carbohydrate, monitor blood glucose and repeat dosing if necessary |
| Moderate | Incoherence, uncooperative, belligerence, resistive behavior | Seek emergency medical assistance, administer glucagon 1 mg via subcutaneous/intramuscular injection followed by oral glucose |
| Severe | Unconscious, seizure | Seek emergency medical assistance, administer 20–50 mL of 50% dextrose solution intravenously |
Dental Management Considerations for Diabetic Patients
| Consideration | Details |
|---|---|
| Consult with patient’s physician | Assess diabetes control. |
| Update medical history and medications | Review systems at each appointment. |
| Confirm medication and food intake | Ensure patient has eaten and taken medications before initiating treatment. |
| Anticipate and manage hypoglycemia | Be prepared to handle hypoglycemic episodes. |
| Infection management | Promptly prevent, treat, and eliminate infections. |
| Avoid aspirin-containing compounds | Aspirin increases the risk of hypoglycemia. |
| Local anesthesia | Achieve profound local anesthesia. |
| Oral hygiene | Ensure excellent hygiene and provide comprehensive preventive care. |
| Scheduling | Prefer morning appointments and avoid periods of peak insulin activity. |
| Blood glucose reading | Check if patient is at high risk, on insulin, or having surgery. |
Dental Management Considerations
- 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.
- Avoid aspirin-containing compounds.
- 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 a glucometer reading if patient is high risk, on insulin, or having surgery.
