How to Care for Diabetic Patients in a Dental Clinic?

Currently, approximately 9.5 million people (15.3% of the adult population) live with diabetes in Germany. And diabetes and dental health are closely interlinked — diabetic patients are 11x more likely to suffer from periodontitis, and vice versa. The relationship between the two diseases is bidirectional — patients with diabetes are more likely to experience periodontitis and vice versa. Since diabetic patients are at a higher risk of periodontitis, they need regular periodontal therapy and preventative dental care, ideally every three months. However, despite these grim facts, most dental clinics are hesitant about integrating diabetes consultations into their practice.

This article discusses how to care for patients with diabetes, including the information you need to obtain before dental care, tips for dental hygiene appointments, identifying and dealing with hypoglycemia, and recognizing the symptoms of undiagnosed diabetes.

List of information and details to obtain from diabetic patients prior to consultations

• History of medication usage, including vitamins and supplements.
• The frequency and usage pattern of medications.
• Food consumption habits and schedule.
• History of glycemic management, hypoglycemia, and hyperglycemia.
• A1C level, i.e., the patient’s average blood glucose levels over the past 120 days.
• Existing symptoms of diabetes.
• Detailed medical history and changes.
• History of alcohol and tobacco consumption.
• Stress levels.
• Results of other physical examinations.

Diabetic patients should always be asked about their blood glucose levels on the day of the appointment. The preprandial glucose levels should be between 70 mg/dl to 110 mg/dl, and the post-prandial glucose levels should be less than 180 mg/dl.

Dental professionals should record their patients’ recent A1C levels to identify the level of glycated hemoglobin (HbA1c) in the blood. The tests should be conducted at least twice a year because each test measures the average blood glucose level for the past 120 days. The A1C should always be less than 7% — if higher, the patient’s diabetic physician should be consulted.

If the patient can’t provide the necessary information, they should first consult a diabetic physician before dental care.

Tips for scheduling dental appointments with diabetic patients

Diabetic patients must maintain strict schedules for their meals and medications. The dental appointment shouldn’t interfere with the meal schedule. As such, the diabetic consultation should be scheduled soon after the patient’s breakfast or lunch and medications. The dental professional should ask the patient when they ate last and about their recorded blood glucose levels.

Long and stressful dental treatments should ideally be split into shorter and more manageable appointments. This is essential because stress hormones are linked to a higher incidence of diabetic symptoms due to increased blood pressure and lower insulin production in the pancreas. As such, the dental professional must make every attempt to ensure the treatments are stress-free and relaxing.

Identifying the signs and symptoms of hypoglycemia

Hypoglycemia is a severe medical emergency associated with diabetic dental patients. Dental hygienists and professionals must recognize the signs and symptoms of hypoglycemia, so they can address the issue as soon as it manifests.

The following are the most common signs of hypoglycemia:

• Confusion
• Shakiness
• Headaches
• Heightened pulse rate
• Dizziness
• Hunger pangs
• Irritability
• Pale skin
• General weakness
• Anxiety
• Trembling
• Sweating

Patients exhibiting the signs of hypoglycemia should immediately be given 15 g of carbohydrates in the form of table sugar, glucose tablets, soft drinks, corn syrup, fruit juice, or milk. Dental professionals should also have a plan for treating patients displaying signs of hypoglycemia.

Identifying the symptoms of undiagnosed diabetes

Dental professionals and hygienists should also be trained to identify the oral symptoms of diabetes, even if the patient isn’t yet diagnosed. The following are the most identifiable oral manifestations of diabetes:

• Dry mouth
• Periodontitis
• Oral thrush or candidiasis
• Burning sensations in the mouth
• Poor wound healing
• Oral infections
• Fruity acetone breath (symptomatic of diabetic ketoacidosis)

Early diagnosis can dramatically reduce life-altering and life-threatening complications of diabetes, improving the patient’s general quality of life. Dental professionals should also extend detailed education to diabetic patients, highlighting the oral and general health effects of diabetes, its causes, symptoms, and precautions.

This article was originally published in the Zircon Medical Magazine for leading dental professionals. The article was based on an interview conducted with Ms. Sona Alkozei, practicing dental hygienist, international lecturer, and nutritionist.