Dangers - Hypoglycaemia.
Precautions - Aaequate dietary intake to be maintained at all times. Medical consultation. Consider admission to hospital.
Diabetic patients are treated either by diet alone (the elderly, obese diabetic patient) or by diet in combination with an oral hypoglycaemic agent or insulin. Minor dental procedures can be undertaken in most patients with diabetes without any alteration being made to their treatment, but hypoglycaemia may occur in patients taking the longer-acting oral hypoglycaemics if their aental treatment causes them to restrict unduly their usual daily food intake.
Incipient hypoglycaemia may be manifest by slurred speech, aggressive or argumentative behaviour, pallor and sweating. If this occurs, the dentist should cease operating and give the patient a drink containing sugar or glucose.
Insulin treatment also renders a patient liable to hypoglycaemia, while starvation and vomiting may lead to acidosis. The presence of infection may necessitate altered dosage of insulin and increase the incidence of vomiting. This will not only increase the risk of hypoglycaemia, but food deprivation and vomiting will lead to acidosis. For these reasons, diabetics who require insulin must be individually assessed and their medical practitioner must always be consulted prior to treatment. If not admitted to hospital, the diabetic patient should be discharged to the care of a responsible adult.
Dental treatment should be planned to permit adequate dietary intake post-operatively. If this is not possible, e.g. if multiple tooth removal or extensive oral surgery is required, this is a further indication for admission to hospital.
Indications for admission to hospital for dental treatment are: dental cronulla
- Unstable diabetes.
- Serious infection.
- Those in whom adequate dietary intake cannot be assured.
- Multiple tooth extractions.
- Extensive oral surgery.
- General anaesthesia.
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