Diabetes patient management in the dental practice


Management of the diabetic patient in the dental practice

Diabetes mellitus is a fairly common condition, with a large proportion of patients visiting dental practices having it.

Therefore, the success of the therapeutic act matters and is greatly influenced by the way the patient manages their underlying disease.

Diabetes mellitus is the most common endocrine pathology and acts on the whole body, producing general changes, spread throughout the body.

The three types of diabetes that can be differentiated are:

  • Type 1 diabetes – also called insulin-dependent, occurs in children and accounts for 5-10% of all cases

  • Type 2 diabetes – also called non-insulin-dependent diabetes, or adult-onset diabetes, is the most common, accounting for 85-90% of cases

  • Another type of diabetes, which is transient, is gestational diabetes.

The patient must specify both on the form on which they fill in details about their health and tell their dentist directly that they have diabetes.

In this way, the doctor will know how to manage the disease and will be more alert to complications that may arise from treatment.

The patient suffering from diabetes is a patient who often presents with chronic general complications, and the most common acute complication is hypoglycemic crisis, which can lead to hypoglycemic coma if not properly treated.

Hypoglycemic crisis is identified by the following elements:

  • Tremor, irritability

  • Drowsiness

  • Nausea and excessive hunger

  • Feeling of weakness coupled with lack of coordination of voluntary movements

If these symptoms are present, sugar, glucose, honey, sweetened fruit juice must be administered and the operation must be terminated.

If no emergency treatment is given, hypoglycemia may worsen and the patient may develop convulsions, loss of consciousness and hypoglycemic coma.

Prevention:

In order to prevent hypoglycemic seizures from occurring in the dental surgery, several preventive measures should be followed:

  • Appointments should be made at the beginning of the day, without interfering with the insulin administration schedule. It is also advisable that the patient does not wait in the room, but is picked up as soon as they arrive, so as not to allow stress to set in, which increases blood sugar levels.

  • The patient should always eat before going to the dentist

  • Because the diabetic patient has generalized neuropathy, the administration of too much vasoconstrictor should be avoided. Otherwise, local ischemia may occur, followed by necrosis.

  • For surgical maneuvers, antibiotic prophylaxis should always be applied perioperatively and for a further 5-7 days post-surgery.

  • The patient will still be followed for about 30 minutes after the end of the treatment session, in this way changes or alterations in the state of health can be observed.

  • Sugar or glucose infusion solution will always be on hand in the unfortunate event of a hypoglycemic attack.

In the case of a patient suffering from diabetes, a wide range of treatments can be carried out, provided that protective measures against local infection are observed and only if blood glucose values are constant and maintained within normal parameters.

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