Diabetes Mellitus - Oral Health Care Considerations

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.

Medical Complexity Status - Diabetes#

See Medical Complexity Status for more information.