1. MANAGEMENT OF A
DIABETIC PATIENT IN
DENTAL OFFICE
KAMRAN MASOOD MIRZA

2. Diabetes Mellitus
• A chronic metabolic disorder caused by
deficiency of insulin,the primary
feature is increase in blood glucose level
(hyperglycemia)

3. Global Prevalence
• 171 million (people having diabetes,
worldwide) in the year 2000 is expected
to increase to at least 366 million in
2030

4. Patient with cardinal features of
diabetes
• polydipsia, polyuria, polyphagia, weight
loss, poor wound healing, weakness,
frequent and severe infections, obesity
and having family history of diabetes

5. Patient with cardinal features of
diabetes
• oral conditions includes xerostomia,
burning sensations, overgrowth of gum
tissue, tooth decay, periodontal disease,
and fungal infections, fruity (acetone)
breath, dry mouth, thickness of saliva

6. Patient with cardinal features of
diabetes
• Such patients are more prone to
diabetes so should be referred to a
physician for diagnosis of diabetes

7. Known diabetic patients
• inquire about the medication, the type,
severity and control of diabetes, the
physician treating the patient and the
date of last visit

8. Known diabetic patients
• The dentist should be aware of the
patient’s recent glycated hemoglobin
values. HbA1c values of less than 8%
indicate relatively good glycemic
control; greater than 10% indicate poor
control

9. Known diabetic patients
• When the level of control of diabetes is
not known, consult patients physician
and the treatment should be just
limited to palliation

10. Known diabetic patients
• In patients with good glycemic control
before starting any procedure, verify
that the patient has taken medication
and diet as usual

11. Known diabetic patients
• Patients, receiving good medical
management without serious
complications such as renal disease,
hypertension, or coronary
atherosclerotic heart disease, can
receive any indicated dental treatment

12. Known diabetic patients
• Local anesthesia is preferred, but such
patients can even be safely treated in
general anesthesia

13. Known diabetic patients
• Patients with complications require
different treatment plan
• Morning appointments should be
preferred because this is the time of
high glucose and low insulin activity
• This reduces the risk of hypoglycemic
episodes during the dental procedures

14. Known diabetic patients
• Appointments should be of short
duration
• a source of glucose such as an orange
juice must be available in the dental
office to avoid hypoglycemic attacks

15. Known diabetic patients
• Prophylactic antibiotics for patients
taking high doses of insulin to prevent
post-operative infection are
recommended
• It's best to do surgery when blood
sugar levels are within normal range

16. Known diabetic patients
• to avoid hyperglycemia use anxiety
reduction protocol,emotional stresses
and painful conditions increase the
amount of cortisol and epinephrine
secretion which induce hyperglycemia so
– pre-treatment anxiety should be reduced
by sedation
– pain during procedures can be avoided by a
potent anesthesia

17. Known diabetic patients
• If the dental needs are urgent and
blood sugar is poorly controlled,
treatment should be provided in a
hospital or other setting where more
medical professionals can monitor
patient

18. Management of Insulin Shock
• The most common diabetic emergency
which a dentist encounters is
hypoglycemia
• it can lead to life-threatening
consequences
• it occurs when the concentration of
blood glucose drops below 60 mg/dL

19. Management of Insulin Shock
• confusion, sweating, tremors, agitation,
anxiety, dizziness, tingling or numbness,
and tachycardia. Severe hypoglycemia
may result in seizures or loss of
consciousness

20. Management of Insulin Shock
• As soon as such signs or symptoms are
present the dentist should check the
blood glucose with a glucometer,, the
“Golden Rule” is that manage the
patients as if they are hypoglycemic
until proven otherwise

21. Management of Insulin Shock
• Establish adequate airway, breathing &
circulation by loosening dress near the
neck, switching on the fan/air
conditioners, and placing the patient in
the head-low-feet-up position

22. Management of Insulin Shock
• If patient is conscious and able to take
food by mouth, give 15g of oral
carbohydrate in one of the following
forms;
– 4-6 ounce fruit juice or soda,
– 3-4 teaspoon sugar,
– a hard candy.
– Small amount of honey/sweet syrup can also
be placed in the buccal fold

23. Management of Insulin Shock
• In unconscious patients, give 50ml of
dextrose in 50% concentration or 1mg
glucagon intaravenously, or give 1ml
glucagon intramuscularly at almost any
body site.

24. Management of Insulin Shock
• Following treatment, the signs and
symptoms of hypoglycemia should
resolve in 10 to 15 minutes
• The patient should be observed for 30
to 60 minutes after recovery. Normal
blood glucose level is confirmed by a
glucometer before the patient is
allowed to leave

25. Post-operative Period
• Eating the right diet is a critical part of
diabetes therapy, if the patient is
expected to have difficulty in eating
solid food after dental procedure; diet
should be modified to soft solids or
liquids
• Even the use of blender to blend food
before eating is recommended

26. Post-operative Period
• Consult the patient’s physician for post-
operative period diet plan
• It is necessary that the total caloric
content and
proteins/carbohydrates/fats ratio of
the diet remain same

27. Instructions to be given to a
diabetic
• diabetic patients should be strongly
motivated to maintain a good oral
hygiene by
– brushing after every meal
– using floss daily
– keeping their dentures clean

28. Instructions to be given to a
diabetic
• patients should be frequently recalled
for
– dental examinations
– prophylactic measures, such as topical
fluorides should be applied

29. Instructions to be given to a
diabetic
• Cavities should be treated as quickly as
possible.The dryness of mouth can be
relieved by providing salivary
substitutes or asking the patient to
suck sugar-free candy or gums and
frequently drink water

30. Instructions to be given to a
diabetic
• Because their good oral health can help
in maintaining good glycemic control,
they should be taught that if there is a
problem like a bleeding, swollen or
tender gums, continuous bad taste or
white patches, they should immediately
contact a dentist

31. Instructions to be given to a
diabetic
• The patients should be encouraged to
quit smoking as it greatly increases the
risk of periodontal disease in diabetic
patients

32. Instructions to be given to a
diabetic
• Diabetics should be informed that they
are more likely to catch dental diseases
than the normal ones because awareness
and knowledge increases the tendency
to seek preventive dental care, and
improves chances of maintaining healthy
mouth

33. THANK YOU