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Education
Educating patients about diabetes and its complications is the responsibility of the entire dental team. Information as to risk factors, screening methods and potential complications should be readily available during the dental visit. Dental education should include the importance of glucose control, good oral hygiene, diet/exercise and regular dental visits.
Controlled Type 1 and Type 2 diabetics receive regular dental treatment. It is important, however, that the patient and doctor communicate about the patient's current condition and make sure that the diabetes is, in fact, controlled. Make sure the patient has taken their insulin that day. Inquiring as to recent blood glucose numbers may help in this regard. Appointments should be kept as short and a stress free as possible. Knowledge of the type, duration and peak of the insulin being taken is useful to the dentist and hygienist in planning dental treatment. (27,35)
In persons with uncontrolled diabetes, dental procedures should not be initiated except for the immediate relief of pain or other emergency. If emergency surgery is necessary, the patient should be treated in a facility where they can easily be monitored, such as a hospital. Consultation with the physician prior to providing any dental therapy for these individuals is recommended. (27,35,38)
The amount of stress the individual feels during the dental appointment can greatly affect the patient's ability to tolerate the procedure. Therefore, patients should not be kept waiting. Thorough explanations of dental procedures to be performed may also help to reduce stress.
It is better to plan for dental treatment during a time of high glucose and low insulin activity. Individuals with Type 1 generally do better if appointed in the morning after consuming a normal breakfast. This is due to something known as the Dawn Phenomenon. There is an elevation in circulating blood glucose in the morning due to breakdown of stored energy supplies in the pre-dawn hours. This is thought to be a response to the prolonged fasting that occurs overnight.(56)
Patients should be instructed to maintain their currently prescribed drug regimen. Adjustments in diet and insulin therapy may be necessary if the patient undergoes significant dental treatment. It is important to maintain proper nutritional balance and patients should be instructed to eat following their dental appointment. Understanding the patient's drug regimen assists the dental professional in planning and scheduling dental treatment. (27,38)
The use of local anesthesia is not contraindicated in diabetic patients. Local anesthesia should contain no more than 1:100,000 epinephrine. Avoidance of excessive amounts of epinephrine is necessary in order to prevent increased blood glucose levels. (27,35)
Alterations in food and drug intake should be considered when conscious sedation is necessary during dental treatment. Consultation with the physician is suggested prior to initiating dental treatment involving IV sedation.
If diabetic patients are to undergo emergency oral surgery or periodontal treatment, the use of prophylactic antibiotics should be considered. In controlled and uncontrolled diabetics, poor host response and delayed wound healing may prompt the use of antibiotics. However, the use of antibiotics is not generally necessary in controlled diabetic patients for routine procedures. Use of antibiotics in conjunction with dental treatment of diabetics is highly variable according to the patient's glycemic control. Administration, dose and selection of an antibiotic are usually the same as in nondiabetic patients. Doxycycline may be considered for use instead of tetracycline (if tetracycline is indicated). Doxycycline is not metabolized in the kidney, which may be important if nephropathy is present. Avoid prescribing glucocorticosteroids (used to reduce post-surgical swelling) because they may cause undesirable elevations in blood glucose. (3,27,35)
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Pathogenesis of Factors
