Foundations in Continuing Education

The Dental Patient with Diabetes

Chapter Twelve - The Dental Patient with Diabetes


Chapter 1: Glucose Metabolism and Hormonal Regulation Review

Chapter 2: Diabetes Mellitus

Chapter 3: Diabetes Mellitus Type 1

Chapter 4: Diabetes Mellitus Type 2

Chapter 5: Gestational Diabetes Mellitus (GDM)

Chapter 6: Pre Diabetes: Impaired Glucose Homeostasis

Chapter 7: Other Specific Types of Diabetes

Chapter 8: Diagnosing Diabetes

Chapter 9: Diagnosis

Chapter 10: Glucose Monitoring

Chapter 11: Complications of Diabetes

Oral Complications
Etiology and
Pathogenesis of Factors
Affecting Periodontal
Disease Process in
Diabetics

Other Oral
Complications

Treatment of Periodontal
Disease

Dental Intervention,
Education, and
Treatment Planning

Education

Chapter 13: Successful Intervention of Diabetic Emergencies

Chapter 14: Prevention and Treatment of DM

Chapter 15: Diabetes Medications

Chapter 16: Conclusion

Glossary

Appendices

References

Post Examination

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Dental Intervention, Education, and Treatment Planning

Dental health professionals are likely to encounter many diagnosed and undiagnosed diabetic individuals. Persons with diabetes often require more emergency dental care and should have frequent routine dental visits to help control oral complications associated with diabetes. (38)

Familiarity with oral signs and symptoms of diabetes combined with a thorough health history can assist in the diagnosis and treatment of dental needs. The health history should be designed to obtain information indicative of diabetes.

A general health history including the following might help identify an undiagnosed individual:

  • Polyuria, polydypsia, polyphagia
  • Unexplained weight loss or gain
  • Tingling or numbness in hands or feet
  • Burning or tingling sensation on tongue
  • Unexplained fatigue
  • Family history of diabetes
  • Frequent infections
  • Slow healing cuts or sores
  • Blurred eyesight
  • Dry itchy skin

During the oral assessment phase of the appointment, the dental health professional should be aware of oral conditions that may represent undiagnosed diabetes.

These conditions include:

  • Periodontal disease
  • Recurrent periodontal abscesses
  • Oral candidiasis
  • Burning sensation/altered taste perception
  • Parotid gland enlargement
  • Erosive lichen planus
  • Necrotizing cellulitis
  • Sialosis
  • Sialorrhoea

If there is a question about the presence of diabetes, the dentist should request a blood glucose test. Medical consultation with the patient's physician is also suggested. Oral symptoms of diabetes may be present prior to extraoral symptoms; therefore screening for diabetes should not be delayed. (45)

In diagnosed diabetics, it might be useful to include the following supplemental information in the patient's health record:

  • Year of diagnosis
  • Type of diabetes
  • Oral hypoglycemic agent (name, dose)
  • Insulin (type, dose)
  • Glucose monitoring (type and frequency)
  • Date and result of last glycosated hemoglobin test
  • Known complications resulting from diabetes
  • Names and contact information of various specialists associated with management of patient's diabetes.
  • Previous history of diabetic emergencies (hypoglycemia, diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic coma)

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