Podcast
Questions and Answers
What is the most common oral finding related to diabetes?
What is the most common oral finding related to diabetes?
Periodontal disease
What oral health issue can impede glycemic control and contribute to the onset of other complications in diabetes?
What oral health issue can impede glycemic control and contribute to the onset of other complications in diabetes?
Delayed tooth eruption is a recognized oral manifestation of diabetes.
Delayed tooth eruption is a recognized oral manifestation of diabetes.
True
For patients with diabetes, maintaining optimal oral hygiene and regular reviews, especially focusing on ____, should be routine.
For patients with diabetes, maintaining optimal oral hygiene and regular reviews, especially focusing on ____, should be routine.
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Match the following drug with its recommended use in diabetic patients:
Match the following drug with its recommended use in diabetic patients:
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What is the antibiotic of choice for patients with diabetes?
What is the antibiotic of choice for patients with diabetes?
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What is a common complication during dental treatment for patients with diabetes?
What is a common complication during dental treatment for patients with diabetes?
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Why should corticosteroids be avoided in patients with diabetes?
Why should corticosteroids be avoided in patients with diabetes?
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What should be done during dental treatment planning for patients with diabetes?
What should be done during dental treatment planning for patients with diabetes?
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What should be considered after an invasive procedure in patients with diabetes?
What should be considered after an invasive procedure in patients with diabetes?
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What is a significant risk associated with hyperglycaemia in a diabetic patient undergoing dental treatment?
What is a significant risk associated with hyperglycaemia in a diabetic patient undergoing dental treatment?
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What is a crucial consideration when scheduling a dental appointment for a patient with diabetes?
What is a crucial consideration when scheduling a dental appointment for a patient with diabetes?
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What is a key aspect of the dental treatment plan for a patient with diabetes?
What is a key aspect of the dental treatment plan for a patient with diabetes?
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What is a critical consideration when managing a patient with diabetes in the dental clinic?
What is a critical consideration when managing a patient with diabetes in the dental clinic?
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What is a criterion for referral to a hospital setting for a patient with diabetes?
What is a criterion for referral to a hospital setting for a patient with diabetes?
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Study Notes
General Dental Considerations for Diabetes
- Oral findings can be the initial manifestation of undiagnosed diabetes
- Periodontal disease is the most common oral finding, involving vascular changes, neutrophil dysfunction, and collagen metabolism deficiencies
- Presence of periodontitis impedes glycaemic control and contributes to the onset of other extraoral complications
- Susceptibility to bacterial and fungal infections, including oral candidiasis and mucormycosis in the sinuses
- Xerostomia, which can favour the onset of caries
- Chronic bilateral and asymptomatic inflammation of the parotid glands (sialosis) can develop as a compensatory mechanism
Clinical Presentation of Diabetes
- Classic symptoms of undiagnosed type 1 diabetes: polyuria, polydipsia, and polyphagia
- Fatigue, infections, slow wound healing, blurred vision, and weight loss
- Hypoglycaemia: early signs/symptoms include shakiness, dizziness, sweating, hunger, and piloerection
- Hyperglycaemia: early signs/symptoms include frequent urination, increased thirst, blurred vision, and fatigue
Dental Management of Diabetes
- The dental treatment plan is determined by the patient's previous oral health and degree of metabolic control
- The dental team should be aware of how to manage hypoglycaemic events in the dental clinic
- Risk assessment: hypoglycaemia, hyperglycaemia, fatigue, reduced tolerance for long treatment, increased risk of infection, poor wound healing, and increased risk of periodontal disease
Criteria for Referral
- If HbA1c levels are >9%, only emergency treatments should be conducted and surgical procedures should preferably be undertaken in a hospital setting
- With HbA1c readings >12%, all procedures should be postponed until glycaemic control has improved
Access/Position and Communication
- Schedule sessions for the morning to increase blood glucose levels and decrease the risk of hypoglycaemia
- Avoid scheduling appointments that coincide with the maximum insulin activity peak or when it may lead to a meal being missed
- Patients with signs/symptoms or oral findings suggestive of diabetes should be referred to their doctor for investigation
Consent/Capacity
- Patients should be informed that the dental treatment plan and its success will be determined by the degree of diabetic control
- Patients should be warned of the potential for local and systemic complications resulting from diabetes
- If diabetic control is poor, the patient may be confused, anxious, and/or agitated, reducing their capacity to give consent
Anaesthesia/Sedation
- Local anaesthesia: any local anaesthetic may be employed by following routine precautions
- Sedation: controlling the patient's stress is important, and sedation should be performed in a hospital setting for patients with poor metabolic control and comorbidities
- General anaesthesia: the use of general anaesthesia is determined by the severity of the comorbidities
Dental Treatment
- Before: confirm that the patient has eaten normally and has taken the scheduled medication, and assess the need for antibiotic prophylaxis
- During: dental implants can be placed successfully in patients with well-controlled diabetes, and the main complication is hypoglycaemia
- After: slow healing of the surgical wound is common, and consider the need for postoperative antibiotics, especially for patients with poor disease control
Drug Prescription
- Antibiotic of choice: amoxicillin
- Avoid using metronidazole, azithromycin, ciprofloxacin, and corticosteroids
- Analgesic of choice: paracetamol
- Avoid using aspirin, ibuprofen, diclofenac, and naproxen
Education/Prevention
- Patients with diabetes usually recognize the signs and symptoms of hypoglycaemia, and dentists should know how to identify and manage urgent episodes
- Maintaining optimal oral hygiene and regular reviews, with a focus on periodontal disease, should be routine for patients with diabetes
- Removing any removable prosthesis at night and renewing them periodically are essential for preventing denture-induced stomatitis
Diabetic Patients in Dental Care
General Considerations
- Oral findings can be an initial manifestation of undiagnosed diabetes
- Periodontal disease is the most common oral finding, involving vascular changes, neutrophil dysfunction, and collagen metabolism deficiencies
- Diabetes susceptibility to bacterial and fungal infections, including odontogenic abscesses and oral candidiasis
- Xerostomia can favor the onset of caries
- Chronic bilateral and asymptomatic inflammation of the parotid glands (sialosis) can develop as a compensatory mechanism
- Burning mouth syndrome, circumoral paraesthesia, glossitis, loss of filiform papillae, and dysgeusia can occur
- High prevalence of oral lichen planus, mucosal lichenoid reactions, and facial flushing as secondary effects of antidiabetic drugs
- Delayed tooth eruption is common
Dental Management
- Dental treatment plan is determined by the patient's previous oral health and degree of metabolic control
- Dental team should know how to manage hypoglycemic events in the dental clinic
Clinical Presentation of Diabetes
- Classic symptoms of undiagnosed type 1 diabetes: polyuria, polydipsia, polyphagia, fatigue, infections, slow wound healing, blurred vision, and weight loss
Hypoglycaemia
- Early signs/symptoms: shakiness, dizziness, sweating, hunger, piloerection, tachycardia, inability to concentrate, confusion, irritability, anxiety, headache
- Later signs/symptoms: clumsiness, jerky movements, muscle weakness, difficulty speaking, blurry or double vision, drowsiness, convulsions, unconsciousness, death
Hyperglycaemia
- Early signs/symptoms: frequent urination, increased thirst, blurred vision, fatigue, headache
- Later signs/symptoms: fruity-smelling breath, nausea, vomiting, shortness of breath, weakness, confusion, abdominal pain, coma
Risk Assessment
- Hypoglycaemia is the main risk and must be managed urgently
- Hyperglycaemia, fatigue, reduced tolerance for long treatment, increased risk of infection, poor wound healing, and increased risk of periodontal disease are also risks
Criteria for Referral
- If HbA1c levels are ≥9%, only emergency treatments should be conducted and surgical procedures should preferably be undertaken in a hospital setting
- If HbA1c readings >12%, all procedures should be postponed until glycaemic control has improved
Access/Positioning
- Schedule sessions in the morning to minimize risk of hypoglycaemia
- Avoid scheduling appointments during maximum insulin activity peak or when a meal may be missed
Communication
- Patients may be unaware of their diabetes diagnosis
- Patients with signs/symptoms or oral findings suggestive of diabetes should be referred to their doctor for investigation
- Impaired communication may occur due to uncontrolled blood glucose levels (slurred speech, confusion)
Consent/Capacity
- Patients should be informed that the dental treatment plan and its success will be determined by the degree of diabetic control
- Patients should be warned of potential local and systemic complications resulting from diabetes
- If diabetic control is poor, the patient may be confused, anxious, and/or agitated, reducing their capacity to give consent
Anaesthesia/Sedation
- Local anaesthesia: follow routine precautions
- Sedation: control patient's stress, and consider hospital setting for patients with poor metabolic control and comorbidities
- General anaesthesia: determined by the severity of comorbidities
Dental Treatment
- Before: confirm patient has eaten normally, taken scheduled medication, and consider antibiotic prophylaxis
- During: dental implants can be placed successfully in patients with well-controlled diabetes, but hypoglycaemia is a main complication
- After: slow healing of the surgical wound is common, and consider postoperative antibiotics, especially for patients with poor disease control
Drug Prescription
- Antibiotic of choice: amoxicillin
- Avoid metronidazole, azithromycin, ciprofloxacin, aspirin, ibuprofen, diclofenac, naproxen, and corticosteroids due to interactions with oral hypoglycaemic agents
- Analgesic of choice: paracetamol
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Description
This quiz covers the relationship between diabetes and oral health, including periodontal disease and its impact on glycaemic control and other complications.
