3. OBJECTIVES
Diabetes?
Types
Signs
Diagnostic Criteria
Dental treatment and protocol of a
diabetic patient
Dental office complication and
Management
Emergency
Caution
4. DEFINITION
Diabetes mellitus is a clinical syndrome characterized by
hyperglycemia caused by absolute or relative deficiency
of insulin
TYPES
Type I (IDDM)
Type II (NIDDM)
5. SIGNS
Thorough history should be taken from patient by
clinician if he detects intraoral signs of poorly controlled
diabetes.
6. SIGNS AND SYMPTOMS
Polyuria
Polydipsia
Polyphagia
Sudden weight loss
Wound that won’t heal
Blurry vision
Numb or tingling hands or feet
If a patient has any of these symptoms or if
a clinician’s index of suspicion is high, lab
investigation and physician consultation is
indicated.
8. DENTAL TREATMENT AND PROTOCOL OF A
DIABETIC PATIENT
IF A PATIENT IS SUSPECTED OF
HAVING UNDIAGNOSED DIABETES:
Consult the patient’s physician
Analyze lab tests both fasting and
casual blood glucose.
Rule out acute orofacial infection or
severe dental infection; if
present, provide emergency care
immediately.
Establish best possible oral health through
non surgical debridement of plaque and
calculus, institute oral hygiene
instruction, limit more advanced care until
diagnosis has been established and good
glycemic control obtained.
9. IF A PATIENT IS A KNOWN DIABETIC
Ask patient to bring his glucometer to dental office on each
appointment.
Check blood glucose to obtain a baseline level ;
Pt with levels at or below the lower end of normal- give
carbohydrates before strating procedure
High pretreatment glucose levels- consider the recent glycemic
control of patient by thorough questioning and recent HbA1c
values.
If glycemic control has been poor-postponed the procedure until
better glycemic control achieved.
10. IF A PATIENT IS A KNOWN DIABETIC
Check blood glucose to obtain a baseline level ;
If procedure is long, check glucose level during
procedure to prevent hypoglycemia.
Check blood glucose after treatment procedure.
Anytime during procedure if patient feels symptoms of
hypoglycemia, blood glucose should be checked
immediately to prevent severe hypoglycemia , a medical
emergency
11. DENTAL OFFICE COMPLICATION
, PROTOCOL AND MANAGEMENT
HYPOGLYCEMIA!!... Most common in patients with better
glycemic control
12. PROTOCOL
When planning a dental treatment, it is best to
schedule appointments before or after periods of
peak insulin activity.
Check blood glucose before, during and after
procedure.
13. MANAGEMENT
Stop procedure !
Check blood glucose
Treatment guidelines
Provide 15g oral carbohydrate
If patient is unable to take food / drink or if
sedated
Give 25- 30 ml of 50%dextrose IV
OR
Give 1 mg of glucagon IV ( causes rapid
release of stored glucose from liver)
OR
Give 1mg of glucagon IM or subcutaneous
14. EMERGENCIES
Emergencies from
hypoglycemia are rare and
usually takes weeks to develop.
Glucometer may b used to rule
out hyperglycemic emergencies
such as diabetic ketoacidosis, a
life threatening condition.
15. CAUTIONS
Taking insulin without eating is primary
cause of hypoglycemia.
It is critical that the pt eat their normal
meal before dental treatment cz the
treatment may render the pt unable to eat
for sometime.
General guideline “well controlled
diabetic pt having routine periodontal
therapy may take their normal insulin
doses as they also eat their normal
meal”.
If pt is restricted from eating before
treatment or if during long
procedures, normal insulin doses will
need to b reduced.
16. CAUTIONS
Likewise if pt is restricted from
treatment after treatment , insulin or
sulfonyl urea dosages may be
reduced.
Consult patient’s physician.
If PDL surgery is indicated, it is best
to limit size of surgical fields so that
pt will be comfortable to resume
normal diet immediately.
