- No modifications needed for controlled diabetics. (For additional information, see glucose testing and interpretation).
- Consider antibiotic prophylaxis for poorly controlled diabetics with recurrent bacterial infections.
- Schedule appointments when the risk of developing hypoglycemia is diminished, i.e., not during the peak of the effect of insulin.
- Be aware of the risk for hypoglycemic episodes with specific oral hypoglycemic medications, such as sulfonureas.
- Consider avoiding nonemergency dental care for patients with a plasma glucose level above 400 mg/dL.
- Recognize signs of hypoglycemia and hyperglycemia.
- Inquire about “hypoglycemic unawareness” where patients may not exhibit any of the classic signs and symptoms of hypoglycemia when they become hypoglycemic.
- Have a source of glucose available.
- Adjust insulin dosage only in consultation with the patient’s physician.
- Do not prescribe glucocorticosteroids.
- Avoid aspirin in patients taking sulfonylureas.
- Although still controversal (see Fernandes KS et al.) there may be impaired wound healing in poorly controlled diabetics.
- Be aware of aggressive periodontal disease in poorly controlled diabetics.
- Address oral complaints of oral burning (possibly due to oral candidiasis and oral dryness) and xerostomia.
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- Classification and Definitions
- Fernandes KS, et al. Association between immunologic parameters, glycemic control, and postextraction complications in patients with type 2 diabetes. JADA. 2015;146(8):592-99.
- Power DJ, et al. The healing of dental extraction sockets in insulin-dependent diabetic patients: a prospective controlled observational study. Aust Dent J. 2019:64:111-116..
- Ko KI, et al. Diabetic wound healing in soft and hard oral tissues. Trans Res 2021;May 13.
- Borgnakke WS. IDF Diabetes Atlas: Diabetes and oral health - A two-way relationship of clinical importance. Diabetes Res Clin Pract. 2019 Nov;157:107839.
- Borgnakke WS, et al. Oral health and diabetes. In: Diabetes in America. 3rd Edition. Cowie CC, et al. Eds. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (US); 2018:31-1 to 31-51.
- American Diabetes Association. Standards of Medical Care in Diabetes—2021 Abridged for Primary Care Providers. Clinical Diabetes 2021 Jan; 39(1): 14-43.