This document discusses diabetes and its relationship to periodontitis. It defines diabetes as a clinical syndrome characterized by hyperglycemia caused by insulin deficiency. There are two main types of diabetes: type 1 (insulin dependent) and type 2 (non-insulin dependent). Signs of poorly controlled diabetes include intraoral signs detected by a clinician. Diagnosis is based on blood glucose levels from casual, fasting, and post-prandial tests as well as glycated hemoglobin levels. The dental treatment protocol for diabetic patients involves checking blood glucose levels before, during, and after procedures to monitor for hypoglycemia. Hypoglycemia is the most common complication and is treated by providing carbohydrates or glucagon.

1. DIABETES
AND
PERIODONTITIS
By
Sunia Gul

2. DIABETES AND PERIODONTITIS

3. OBJECTIVES
 Diabetes?
 Types
 Signs
 Diagnostic Criteria
 Dental treatment and protocol of a
diabetic patient
 Dental office complication and
Management
 Emergency
 Caution

4. DEFINITION
Diabetes mellitus is a clinical syndrome characterized by
hyperglycemia caused by absolute or relative deficiency
of insulin
TYPES
 Type I (IDDM)
 Type II (NIDDM)

5. SIGNS
 Thorough history should be taken from patient by
clinician if he detects intraoral signs of poorly controlled
diabetes.

6. SIGNS AND SYMPTOMS
Polyuria
Polydipsia
Polyphagia
Sudden weight loss
Wound that won’t heal
Blurry vision
Numb or tingling hands or feet
If a patient has any of these symptoms or if
a clinician’s index of suspicion is high, lab
investigation and physician consultation is
indicated.

7. DIAGNOSTIC CRITERA
1. BLOOD GLUCOSE LEVELS
 Casual/non fasting….… > 200 mg/dl
 Fasting …………….. > 126 mg/dl (N..70-100)
 2 hr.post prandial .….. > 200 mg/dl (N..<140)
2. GLUCOSYLATED Hb ASSAY
 HbA1
 HbA1c a) <8 % (well controlled diabetes)
b) >10%(poorly controlled diabetes)

8. DENTAL TREATMENT AND PROTOCOL OF A
DIABETIC PATIENT
 IF A PATIENT IS SUSPECTED OF
HAVING UNDIAGNOSED DIABETES:
 Consult the patient’s physician
 Analyze lab tests both fasting and
casual blood glucose.
 Rule out acute orofacial infection or
severe dental infection; if
present, provide emergency care
immediately.
 Establish best possible oral health through
non surgical debridement of plaque and
calculus, institute oral hygiene
instruction, limit more advanced care until
diagnosis has been established and good
glycemic control obtained.

9. IF A PATIENT IS A KNOWN DIABETIC
 Ask patient to bring his glucometer to dental office on each
appointment.
 Check blood glucose to obtain a baseline level ;
 Pt with levels at or below the lower end of normal- give
carbohydrates before strating procedure
 High pretreatment glucose levels- consider the recent glycemic
control of patient by thorough questioning and recent HbA1c
values.
 If glycemic control has been poor-postponed the procedure until
better glycemic control achieved.

10. IF A PATIENT IS A KNOWN DIABETIC
 Check blood glucose to obtain a baseline level ;
 If procedure is long, check glucose level during
procedure to prevent hypoglycemia.
 Check blood glucose after treatment procedure.
 Anytime during procedure if patient feels symptoms of
hypoglycemia, blood glucose should be checked
immediately to prevent severe hypoglycemia , a medical
emergency

11. DENTAL OFFICE COMPLICATION
, PROTOCOL AND MANAGEMENT
 HYPOGLYCEMIA!!... Most common in patients with better
glycemic control

12. PROTOCOL
 When planning a dental treatment, it is best to
schedule appointments before or after periods of
peak insulin activity.
 Check blood glucose before, during and after
procedure.

13. MANAGEMENT
 Stop procedure !
 Check blood glucose
 Treatment guidelines
 Provide 15g oral carbohydrate
 If patient is unable to take food / drink or if
sedated
 Give 25- 30 ml of 50%dextrose IV
 OR
 Give 1 mg of glucagon IV ( causes rapid
release of stored glucose from liver)
 OR
 Give 1mg of glucagon IM or subcutaneous

14. EMERGENCIES
 Emergencies from
hypoglycemia are rare and
usually takes weeks to develop.
 Glucometer may b used to rule
out hyperglycemic emergencies
such as diabetic ketoacidosis, a
life threatening condition.

15. CAUTIONS
 Taking insulin without eating is primary
cause of hypoglycemia.
 It is critical that the pt eat their normal
meal before dental treatment cz the
treatment may render the pt unable to eat
for sometime.
 General guideline “well controlled
diabetic pt having routine periodontal
therapy may take their normal insulin
doses as they also eat their normal
meal”.
 If pt is restricted from eating before
treatment or if during long
procedures, normal insulin doses will
need to b reduced.

16. CAUTIONS
 Likewise if pt is restricted from
treatment after treatment , insulin or
sulfonyl urea dosages may be
reduced.
 Consult patient’s physician.
 If PDL surgery is indicated, it is best
to limit size of surgical fields so that
pt will be comfortable to resume
normal diet immediately.