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Shakiness
Sweating
Fast or irregular heartbeat
Dizziness or lightheadedness
Hunger
Nervousness
Change in behavior or personality
Tingling or numbness of the lips or tongue
Diabetes can arise in individuals at any age. As with all patients, it is recommended that dentists review the patient’s medical history, take vital signs, and evaluate for oral signs and symptoms of inadequately controlled diabetes, which may be common.42 Oral manifestations of uncontrolled diabetes can include xerostomia, burning sensation in the mouth (which may possibly be related to neuropathy), impaired/delayed wound healing, increased incidence and severity of infections, secondary infection with candidiasis; parotid salivary gland enlargement; gingivitis and/or periodontitis.22, 42
A dentist may want to ask a patient with diabetes questions such as:42
In general, morning appointments are advisable for patients with diabetes since endogenous cortisol levels are typically higher at this time; because cortisol increases blood sugar levels, the risk of hypoglycemia is less.43, 44 For patients using short- and/or long-acting insulin therapy, appointments should be scheduled so they do not coincide with peak insulin activity, which increases the risk of hypoglycemia.43 It is important to confirm that the patient has eaten normally prior to the appointment and has taken all scheduled medications.43 If a procedure is planned with the expectation that the patient will alter normal eating habits ahead of time (e.g., conscious sedation), diabetes medication dosing may need to be modified in consultation with the patient’s physician.43 Patients with well-controlled diabetes can usually be managed conventionally for most surgical procedures.42 If the patient’s food consumption will be affected after oral or dental surgery, a plan to balance the patient’s diabetes medications and food intake should be established in advance.42
When treating patients with marginally or poorly controlled diabetes, elective dental treatment may need to be delayed until the patient’s diabetes is considered stable or better controlled.42
Dental implant placement is generally safe and reliable in patients with properly controlled diabetes, and possibly in those with moderately controlled disease. Two recent systematic reviews concluded that implants in patients with diabetes have predictably high survival rate at least within the first three years, provided that the patients maintain good glycemic control,45 and that implant procedures are safe and predictable in patients with well-controlled diabetes.46 However, systematic reviews have also advised that clinicians consider HbA1c values for risk assessment of patients with diabetes prior to implant placement (and throughout the implant’s lifespan), and to consider hyperglycemia as a significant risk factor associated with peri-implant inflammation.45, 47 In patients with poorly controlled diabetes, implant placement may have an unpredictable prognosis, delayed osseointegration and higher risk of failure.42, 46
Coordination with the patient’s physician may be necessary to determine the patient’s health status and whether planned dental treatment can be safely and effectively accomplished.42 Physicians should make laboratory test results available to the dentist upon request, and inform the dentist of any diabetic complications of relevance to the individual patient prior to dental procedures.42 The physician may need to adjust the patient’s diabetes medication to help ensure sustained metabolic control, before, during, and after surgical procedures.42 Patients with diabetes should obtain regular medical and dental care, including regular dental visits for full evaluation of their dental and periodontal condition.28
Emergency Management. Although patients with diabetes often recognize signs and symptoms of hypoglycemia and self-intervene before changes in or loss of consciousness occurs, they may not be fully cognizant of such signs.2 As a result, a hypoglycemic event may arise in a clinical setting without any initial signs or visible indications from the patient with diabetes. Training staff to recognize signs of hypoglycemia (e.g., mood changes, unusual behavior or profuse sweating), and to use a glucometer to test a diabetic patient’s blood glucose levels can help prevent hypoglycemic episodes.2, 44 Every dental office is advised to have a protocol for managing hypoglycemia in conscious and unconscious patients.2 Having snack foods or oral glucose tablets or gels available, especially in practices where a large number of surgical procedures are performed, is also prudent.2
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ADA Oral Health Topics: Oral-Systemic Health
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Last Updated: January 24, 2022
Prepared by:
Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Institute, LLC.
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