Dental Management of the Diabetic Patient
Providing dental treatment to diabetic patients is more complex due to the many number of parallel and co-existing problems inherent with diabetes. Modern medical treatments are making it possible for more people with diabetes to continue productive lives despite the presence of parallel, complex and complicating medical conditions. People are living longer and often have multiple risk factors co-existing which must be taken into consideration when having dental treatment.
Proper dental treatment and effective on-going maintenance of diabetics, of necessity requires a thorough working knowledge of the diabetes condition. Dentists are increasingly being called upon to take active roles as a Diabetic Team Member alongside the primary care physician.
Dentists desiring to be active parts of this team and who treat diabetic patients should become familiar with theStandards of Medical Care for Patients with Diabetes Mellitus as published by the American Diabetes Association (Diabetes Care, Vol. 26, Supplement 1, Jan 2003). Since dentists also deal with oral function, they should also become familiar with the Nutrition Principles and Recommendations in Diabetes (Diabetes Care, Vol. 27, Supplement 1, Jan 2004). Alterations in dietary habits due to changes in the oral condition (including chewing) may merit a referral to a diabetic educator or dietitian so that the diabetic dietary needs of a diabetic patient can still be met following such changes in the mouth and to the teeth.
Dentists should become familiar with how to treat diabetic complications that arise during dental treatment, such as acute raises or drops in blood sugar levels. Dental treatment should be structured and planned to reduce anxiety and stress, and to respect the needs for blood sugar control measures. Often diabetics have multiple co-existing medical conditions which must also be managed and/or taken into consideration.
Stress and infections, along with epinephrine in local anesthetics has an effect to elevate blood sugar levels. Infections and surgical procedures are also very demanding conditions which may require careful antibiotic and surgical management.
The following recommendations are basic diabetic/dental management strategies which will help assure successful dental care to people with diabetes:
1) Early and mid-morning dental appointments
2) Avoid long dental appointments
3) Reduce stress whenever and wherever possible
4) Utilize sedation procedures where appropriate and safe
5) Know blood sugar levels prior to (and perhaps during) stressful or invasive procedures
6) Modify diet with appropriate soft/liquid foods and nutritional support following dental procedures as necessary
7) Close follow up care following invasive procedures
8) Monitor and treat for Xerostomia conditions appropriately – avoid sugar lozenges
9) Move away from “wait and watch” to a more proactive preventive management approach
10) Use protective/preventive strategies such as home fluoride, anti-microbial medicaments and dentifrices, fluoride trays, etc.
11) Elevate home care to more strict standards and become “anti-microbial”
12) Recommend nutritional supplementation and good dietary practices
13) Always consult and interact with the patient’s primary care physician and other health professionals the patient is or should be working with.
Other information about dental management for the diabetic patient:
Diabetes and Oral Health: Reports from American Dental Association
http://www.ada.org/prof/resources/pubs/jada/reports/diabetes.asp
Diabetes and Oral Health: Reports from American Academy of Periodontology (type in search word “diabetes”)
http://www.perio.org/perio-bin/hypergrasp_sitesearch
Diabetes and Dental Management: University of Louisville, School of Dentistry