Table 3.46.
Key considerations for dental management in diabetes mellitus (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 2 | Hypoglycaemia; angina; hypotension; cardiac arrest |
| Appropriate dental care | 2/4 | Type and severity of the diabetes; type of anaesthetic; extent of surgery; the diabetician should advise on the regimen |
| Pain and anxiety control | ||
| – Local anaesthesia | 0 | |
| – Conscious sedation | 0 | |
| – General anaesthesia | 3/4 | See Table 3.45 |
| Patient access and positioning | ||
| – Access to dental office | 0 | |
| – Timing of treatment | 1 | Early to mid-morning after breakfast and antidiabetic treatment |
| – Patient positioning | 1 | Postural hypotension |
| Treatment modification | ||
| – Oral surgery | 2 | |
| – Implantology | 2 | |
| – Conservative/Endodontics | 1 | |
| – Fixed prosthetics | 1 | |
| – Removable prosthetics | 1 | Denture-induced stomatitis |
| – Non-surgical periodontology | 2 | |
| – Surgical periodontology | 2 | |
| Hazardous and contraindicated drugs | 2 | Avoid aspirin, steroids and tetracyclines |
0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.