Impact of Advances in Diabetes Care on Dental Treatment of the Diabetic Patient

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Anna Haritos Date: May 29, 2009
Article title: Impact of Advances in Diabetes Care on Dental Treatment of the Diabetic Patient
Author(s): Mealey, Brian L.
Journal: Compendium
Volume (number): 19 (1)
Month, Year: Jan 1998
Major topic: dental treatment and diabetes
Minor topic(s):
Type of Article: review
Main Purpose(s): 1) to review findings of the Diabetes Control and Complications Trial(DCCT) 2) diabetes treatment regimens that might be encountered in a dental practice 3) and potential alterations to dental treatment protocols
Findings: DCCT began in 1985 as a prospective, randomized, controlled, multi-center clinical trial; DCCT was designed to compare the effects of intensive insulin therapy with the effects of conventional insulin therapy on microvascular complications of insulin-dependent DM. The patients were followed 6.5 years on average. The results of the study found that intensive insulin treatment could lad to improved glycemic control which could then inhibit the onset and delay the progression of microvascular complications of insulin-dependent DM. The DCCT result caused physicians to intensify insulin regiments for insulin dependent DM patients.
Sulfonylureas - stimulate pancreatic beta cells to secrete insulin; patient must eat properly to avoid hypoglycemia;
Metformin, lowers blood glucose by preventing liver conversion of glycogen to glucose; rarely causes hypoglycemia.
Troglitazone, increases tissue sensitivity to insulin; hypoglycemia is rarely associated with hypoglycemia
Acarbose, an alpha-glucosidase inhibitor, slows the digestion and uptake of carbs from the gut.
Daily insulin routines encountered by dental practitioner include (1) single injection of intermediate acting insulin; (2) single injection of intermediate acting insulin mixed with regular or lispro insulin (3) twice daily injection of intermediate acting insulin or (4) twice daily injections of intermediate-acting insulin mixed with regular or lispro insulin
Dentist should ask patients to bring their glucometer to the dental office to check their blood glucose prior to starting the appointment. Patients on intensive treatment plans may test their blood glucose 4 or more times daily; a low reading indicates the need for a snack, a high reading indicates a need for insulin injection. If patient has a low or at the low end of normal blood glucose reading (below 60 mg/dl), it might be important for them to have a carbohydrate before starting, especially if the appointment will be lengthy.
Signs and symptoms of hypoglycemia: confusion, shakiness, tremors, agitation, sweating, tachycardia
Treatment for hypoglycemia: 15 g of oral carbohydrate (4-6 oz of juice or soda), tube of icing;
Hyperglycemic crisis is much less common in dental office – prolonged hyperglycemia may result in diabetic ketoacidosis in insulin dependent patients or hyperosmolar nonketotic diabetic acidosis.
Key points/Summary: : Healthy persons have blood glucose levels within range of 60 mg/dl to 150 mg/dl. Five complications classically associated with DM include retinopathy, nephropathy, neuropathy, macrovascular disease, and impaired wound healing. Primary assay of long term DM control is HbA1c, which reflects blood glucose concentrations over the past 6-8 weeks. Most common complication of DM insulin regimens: hypoglycemia. Most common causes of hypoglycemia: excess insulin injection, skipping meals/snacks, increasing exercise without adjusting food or insulin, consuming alcohol and confusing hypoglycemia signs with intoxication and stress.
Assessment of article: very good resource article